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Mechanism of Micturition, Voiding Dysfunction
Anatomy Urethra
Male
Female
Striated Muscular Sphincter
(Invests Distal 2/3 of Urethra)
• Complete Ring of Muscle Proximally
• Fibres passes onto Posterior,
Lateral Vaginal Walls
• At Vestibule, Fibres encompasses
both Urethral, Vaginal Opening
(Urethrovaginal Sphincter)
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In Females
Peritoneum on Superior Surface of Bladder is
• Reflected over the Uterus (Vesicouterine Pouch)
• Continuous Posteriorly over the Uterus (Rectouterine Pouch)
Contraction of Pelvic Diaphragm
Elevates Bladder Neck
Draws it Anteriorly
In Women with Stress Urinary Incontinence
Bladder Neck Drops below Pubic Symphysis
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Micturition Cycle
Bladder Overactivity
Involuntary Contractions ↓ Compliance
Neurologic Disease, Injury Neurologic Disease, Injury
↑ Afferent Input (Inflammation, • Sacral, Infrasacral Level
Irritation of Bladder, Urethral Wall) • Result from any process that
BOO Destroy Viscoelastic, Elastic
Stress Urinary Incontinence Properties of Bladder Wall
Aging
Idiopathic
Outlet Underactivity
May occur with
Neurologic Disease, Injury
Surgical, Mechanical Trauma
Aging
Sphincter Incontinence will Ensue
Genuine Stress Incontinence (GSI) Intrinsic Sphincter Deficiency (ISD)
Associated with Nonfun ctional at Rest
• Hypermobility of Bladder Outlet (Poorly Functional)
• Urethral Hypermobility • Bladder Neck (BN)
Due to Poor Pelvic Support • Proximal Urethra
Outlet that was Stress-Related Urinary Incontinence
• Competent at Rest (SUI)
• Lost its Competence when Symptoms that arise 1° from
↑ Intra-Abdominal Pressure Damaged to
• Muscles
• Nerves
• Connective Tissues
• Combination within Pelvic Floor
Urethral Support is Important in
Female
Urethral Hypermobility
Weakness of Pelvic Floor supporting structures
During ↑ in Intra-Abdominal Pressure
(Descent of Bladder Ne ck, Proximal Urethra)
If Outlet opens concomitantly, SUI ensues