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International Urogynecology Journal

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16.09.2019 | Special Contribution

A structured review on the female urethral anatomy and innervation with an emphasis on the role of the urethral longitudinal smooth muscle

verfasst von: Michelle Alexandra Mistry, Niels Klarskov, John O. DeLancey, Gunnar Lose

Erschienen in: International Urogynecology Journal | Ausgabe 1/2020

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Abstract

A damaged sphincteric unit or support system, unstable urethral deformability or damaged sensory innervation are all potential causes of a dysfunctional urethral sphincter. With the current improvement in pharmacological targets and urodynamic understanding, studies have begun quantifying individual structures and their importance in closure pressure and consequently urethral continence. However, when it comes to the function of the longitudinal urethral smooth muscle layer, there is currently no consensus. The intent of this structured review is to critically examine literature regarding the female urethral anatomy and closure mechanism. We hypothesized that the longitudinal smooth muscle is a prerequisite for sufficient urethral closure and not merely involved during micturition. Overall opinions on a dysfunctional closure mechanism are controversial. Nonetheless, basic mechanics may be applied to understand simple urodynamics. With the assumption of longitudinal muscles forming a plug when contracted, this could have a substantial effect on the continence mechanism.

Jung J, Ahn HK, Huh Y. Clinical and functional anatomy of the urethral sphincter. Int Neurourol J. 2012;16(3):102–6. https://doi.org/10.5213/inj.2012.16.3.102.CrossRefPubMedPubMedCentral

Ashton-Miller JA, DeLancey JOL. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96. https://doi.org/10.1196/annals.1389.034.CrossRefPubMed

Kamo I, Kaiho Y, Canon TW, et al. Functional analysis of active urethral closure mechanisms under sneeze induced stress condition in a rat model of birth trauma. J Urol. 2006;176(6):2711–5. https://doi.org/10.1016/j.juro.2006.07.139.CrossRefPubMed

Huisman AB. Aspects on the anatomy of the female urethra with special relation to urinary continence. Contrib Gynecol Obstet. 1983;10:1–31 http://europepmc.org/abstract/MED/6685603.CrossRef

Tanagho EA, Meyers FH, Smith DR. Urethral resistance: its components and implications. I. Smooth muscle component. Investig Urol. 1969;7(2):136–49 http://europepmc.org/abstract/MED/4309609.

Gosling JA. The structure of the female lower urinary tract and pelvic floor. Urol Clin North Am. 1985;12(2):207–14 http://europepmc.org/abstract/MED/3992742.PubMed

Delancey JOL, Ashton-Miller JA. Pathophysiology of adult urinary incontinence. Gastroenterology. 2004;126(1 Suppl 1):S23–32. https://doi.org/10.1053/j.gastro.2003.10.080.CrossRefPubMed

DeLancey JOL, Trowbridge ER, Miller JM, et al. Stress urinary incontinence: relative importance of urethral support and urethral closure pressure. J Urol. 2008;179(6):2286–90. https://doi.org/10.1016/j.juro.2008.01.098.CrossRefPubMedPubMedCentral

Schäfer W. Some biomechanical aspects of continence function. Scand J Urol Nephrol Suppl. 2001;(207):44–60 discussion 106—25. http://europepmc.org/abstract/MED/11409614.CrossRef

10.

Zinner NR, Sterling AM, Ritter RC. Role of inner urethral softness in urinary continence. Urology. 1980;16(1):115–7. https://doi.org/10.1016/0090-4295(80)90352-0.CrossRefPubMed

11.

Klarskov N, Lose G. Urethral injection therapy: what is the mechanism of action? Neurourol Urodyn. 2008;27(8):789–92. https://doi.org/10.1002/nau.20602.CrossRefPubMed

12.

Saaby ML. The urethral closure function in continent and stress urinary incontinent women assessed by urethral pressure reflectometry. Dan Med J. 2014;61(2):1–15.

13.

Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Prim 2017;3:17097. doi:https://doi.org/10.1038/nrdp.2017.42.CrossRefPubMed

14.

Lose LG. Simultaneous recording of pressure and cross-sectional area in the female urethra: a study of urethral closure function in healthy and stress incontinent women. Neurourol Urodyn. 1992;11(2):55–89. https://doi.org/10.1002/nau.1930110202.CrossRef

15.

Oelrich TM. The striated urogenital sphincter muscle in the female. Anat Rec. 1983;205(2):223–32. https://doi.org/10.1002/ar.1092050213.CrossRefPubMed

16.

Elbadawi A, Schenk EA. A new theory of the innervation of bladder musculature. 4. Innervation of the vesicourethral junction and external urethral sphincter. J Urol. 1974;111(5):613–5. https://doi.org/10.1016/s0022-5347(17)60028-4.CrossRefPubMed

17.

DeLancey JO. Functional anatomy of the female lower urinary tract and pelvic floor. Ciba Found Symp. 151:57–69; discussion 69–76.

18.

Perucchini D, DeLancey JOL, Ashton-Miller JA, Peschers U, Kataria T. Age effects on urethral striated muscle. I. Changes in number and diameter of striated muscle fibers in the ventral urethra. Am J Obstet Gynecol. 2002;186(3):351–5. https://doi.org/10.1067/mob.2002.121089.CrossRefPubMed

19.

Berkow SG. The corpus spongiosum of the urethra: its possible role in urinary control and stress incontinence in women. Am J Obstet Gynecol. 1953;65(2):346–51 http://europepmc.org/abstract/MED/13040386.CrossRef

20.

Yoshimura N, Chancellor MB. Neurophysiology of lower urinary tract function and dysfunction. Rev Urol. 2003;5(Suppl 8):S3–S10 https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/16985987/?tool=EBI.PubMedPubMedCentral

21.

Canda AE, Cinar MG, Turna B, Sahin MO. Pharmacologic targets on the female urethra. Urol Int. 2008;80(4):341–54. https://doi.org/10.1159/000132690.CrossRefPubMed

22.

Mamas MA, Reynard JM, Brading AF. Nitric oxide and the lower urinary tract: current concepts, future prospects. Urology. 2003;61(6):1079–85. https://doi.org/10.1016/s0090-4295(03)00131-6.CrossRefPubMed

23.

Gosling JA, Dixon JS, Lendon RG. The autonomic innervation of the human male and female bladder neck and proximal urethra. J Urol. 1977;118(2):302–5. https://doi.org/10.1016/s0022-5347(17)57981-1.CrossRefPubMed

24.

Tanagho EA, Smith DR. The anatomy and function of the bladder neck. Br J Urol. 1966;38(1):54–71. https://doi.org/10.1111/j.1464-410x.1966.tb09679.x.CrossRefPubMed

25.

Ek A, Alm P, Andersson KE, Persson CG. Adrenergic and cholinergic nerves of the human urethra and urinary bladder. A histochemical study. Acta Physiol Scand. 1977;99(3):345–52. https://doi.org/10.1111/j.1748-1716.1977.tb10387.x.CrossRefPubMed

26.

Miller KL. Stress urinary incontinence in women: review and update on neurological control. J Womens Health (Larchmt). 2005;14(7):595–608. https://doi.org/10.1089/jwh.2005.14.595.CrossRef

27.

Nakamura T, Yoshimura M, Shinnick-Gallagher P, Gallagher JP, Akasu T. Alpha 2 and alpha 1-adrenoceptors mediate opposing actions on parasympathetic neurons. Brain Res. 1984;323(2):349–53. https://doi.org/10.1016/0006-8993(84)90312-3.CrossRefPubMed

28.

Förstermann U, Closs EI, Pollock JS, et al. Nitric oxide synthase isozymes. Characterization, purification, molecular cloning, and functions. Hypertension. 1994;23(6 Pt 2):1121–31. https://doi.org/10.1161/01.hyp.23.6.1121.CrossRefPubMed

29.

Sjögren C, Andersson KE, Mattiasson A. Effects of vasoactive intestinal polypeptide on isolated urethral and urinary bladder smooth muscle from rabbit and man. J Urol. 1985;133(1):136–40. https://doi.org/10.1016/s0022-5347(17)48822-7.CrossRefPubMed

30.

Yoshimura N, de Groat WC. Neural control of the lower urinary tract. Int J Urol. 1997;4(2):111–25. https://doi.org/10.1111/j.1442-2042.1997.tb00156.x.CrossRefPubMed

31.

Klarskov N, Darekar A, Scholfield D, Whelan L, Lose G. Effect of fesoterodine on urethral closure function in women with stress urinary incontinence assessed by urethral pressure reflectometry. Int Urogynecol J. 2014;25(6):755–60. https://doi.org/10.1007/s00192-013-2269-6.CrossRefPubMed

32.

Reitz A, Haferkamp A, Kyburz T, Knapp PA, Wefer B, Schurch B. The effect of tamsulosin on the resting tone and the contractile behaviour of the female urethra: a functional urodynamic study in healthy women. Eur Urol. 2004;46(2):235–40; discussion 240. https://doi.org/10.1016/j.eururo.2004.04.009.CrossRefPubMed

33.

Klarskov N, Cerneus D, Sawyer W, Newgreen D, van Till O, Lose G. The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry. Neurourol Urodyn. 2018;37(1):244–9. https://doi.org/10.1002/nau.23282.CrossRefPubMed

34.

Rud T, Andersson KE, Asmussen M, Hunting A, Ulmsten U. Factors maintaining the intraurethral pressure in women. Investig Urol. 1980;17(4):343–7 http://europepmc.org/abstract/MED/7188694.

Titel: A structured review on the female urethral anatomy and innervation with an emphasis on the role of the urethral longitudinal smooth muscle
verfasst von: Michelle Alexandra Mistry
Niels Klarskov
John O. DeLancey
Gunnar Lose
Publikationsdatum: 16.09.2019
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 1/2020
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04104-7

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A structured review on the female urethral anatomy and innervation with an emphasis on the role of the urethral longitudinal smooth muscle

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