What are the supportive structures of the female urethra?

Abstract

Aims: Female stress urinary incontinence is thought to result from impairment of the connective tissue ''ligaments'' of the urethra. Surgical repair of female incontinence mainly involves ¢xation of the urethra to the pubic bone or other surrounding structures. In the present anatomical-radiological study, the anatomy of the connective tissue structures around the female urethra was investigated to determine the anatomical structures that support the urethra and the rhabdosphincter. Materials and Methods: The topography of the anterior compartment of the female pelvis was studied in serial sections and one anatomical preparation of 30 female fetuses and of six adult females. The pelves of 29 female fetuses were processed according to plastination histology technique. The pelves of the six adult specimens were processed according to sheet plastination technique. In addition, the anatomical ¢ndings were compared with MR images of 41 adult female volunteers. Results: The ventro-lateral aspect of the urethra remains free of ¢xating ligaments throughout its pelvic course. Ventro-laterally the urethra is enclosed by the ventral parts of the levator ani, its fasciae and a ventral urethral connective tissue bridge connecting both sides. Dorsally, the urethra is intimately connected to the wall of the vagina. Conclusions: The female urethra has no direct ligamentous ¢xation to the pubic bone. Urethral continence after pregnancy and childbirth may be explained by a widening of the hiatus of the levator ani or the anterior vaginal wall, resulting in overstretching of the ventral urethral connective tissue bridge or the disruption of the ¢xation between urethra and vagina. Neurourol. Urodynam. 25: 128^134, 2006. ß 2005 Wiley-Liss, Inc.

Pharmacologic Targets on the Female Urethra

“…Obviously, continence dysfunction is a result of anatomical and functional alterations in the bladder and urethra [145] . Although the anatomical changes regarding the urethra are established during pregnancy [146] , alterations at the receptor and cellular levels need to be clarified.…”

The relationship between urethral mobility and parity

“…Remarkably, other authors have claimed that there are no identifiable ligamentous structures fixing the urethra to the pelvic sidewall. 17 Urethral fixation (by whichever mechanism) is likely to be important for urinary continence because any 'fixation' or 'tethering' implies force (or pressure) transmission. In a subset of the population tested here we have previously been able to show that urethral mobility, as determined by UMP, is strongly associated with urodynamic stress incontinence, but not with other urodynamic diagnoses.…”

Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

“…The role of the urogenital diaphragm for the mechanism of maintaining continence is still unknown. Many studies investigating the histomorphological and histochemical properties of striated muscles of the urethral sphincter muscle and the levator ani, regarding the control of continence, have been published [21][22][23][24][25]. Dimpfl et al [23] have shown in histomorphological studies of the pelvic floor that both aging and vaginal birth may lead to myogenic changes.…”