Visual inspection and digital tests are easy and reliable methods by which insight can be gained into the multi-muscular activity and coordination of the pelvic floor and lower abdominal muscles in continent and incontinent women.
THE excellent recent studies of Tanagho and Smith (1966), Hutch (1967), Woodburne (1968) andGil Vernet (1964) have clarified many problems about continence and micturition. However neither the micro-anatomical details of the course of the fibres of the external urethral sphincter nor its exact part in urinary continence and micturition are yet solved in a definite manner.Our working hypothesis is that urinary continence and voiding are controlled in the urethra by 3 complementary factors: the visco-elastic characteristics of the wall, the activity of the striated paraurethral muscles, and the activity of the smooth muscles descending from the detrusor layers.Starting from this hypothesis we made a preliminary study of the electromyographical activity of the paraurethral and perineal muscles, in relation to the pressures in the bladder, urethra and rectum. Normal as well as pathological conditions were examined.
A significant number (10/22) of children born with occult spinal dysraphism and TC did not develop UMN symptoms during follow-up; neurosurgical correction after the appearance of an UMN sign restored normal neurologic and urinary function in all children; and untethering in children presenting at birth with UMN symptoms resulted in poorer outcome.
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