A New Theory of the Anatomy of the Internal Urinary Sphincter and the Physiology of Micturition

Hutch, John A.

doi:10.1097/00006254-196804000-00027

Cited by 33 publications

(36 citation statements)

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“…Since the smooth muscle fibers from the blad der base extend through what has been ascribed as being associated with an internal sphincter mechanism, it might seem that cholinergic activity would close the bladder outlet resulting in higher resistance. However, the existence of a true internal sphincter in bladder has been questioned by Woodburne (18) and others (11,13), who have been unable to demonstrate a circular oriented smooth muscle at the bladder outlet. Woodburne (18) has described spiral oriented muscle bundles that descend into the urethra from the bladder.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Urinary Bladder Base and Detrusor to Cholinergic and Histaminergic Receptor Activation in the Rabbit

Buren¹,

Anderson²

1979

Pharmacology

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The effects of cholinergic and histaminergic agonists and antagonists on the receptor responsiveness of the bladder neck as well as the fundus were compared. Carbachol and histamine were more potent and generated a greater force of contraction in the detrusor muscle than in the neck region. Histamine characteristically produced a rapid twitch-like contraction followed by an increase in motility in the neck smooth muscle while it produced an increased sustained contraction similarly induced by carbachol in the detrusor preparation. Pyrilamine was equally effective in competitively blocking histamine response in both the detrusor and neck preparations. We conclude that the bladder neck, like the detrusor regions, has cholinergic and H₁ histaminergic receptors.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Urinary Bladder Base and Detrusor to Cholinergic and Histaminergic Receptor Activation in the Rabbit

Buren¹,

Anderson²

1979

Pharmacology

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“…At a certain critical pressure, the afferent discharge is of sufficient intensity to overcome the inhibitory mechanisms and a discharge of the autonomic neurones is elicited via a supraspinal mechanism. This reflex, which represents Barrington's (1941) first reflex, causes a contraction of the bladder, which in turn leads to an opening of the proximal urethra by mechanical means (Langworthy et al 1940;Hutch, 1965;Nyberg-Hansen, 1966). Simultaneously, there is a relaxation of the external urethra by a spinal viscerosomatic inhibitory reflex (Barrington's 5th reflex; see also Garry, Roberts & Todd, 1959).…”

Section: Discussionmentioning

confidence: 99%

Reflexes to sacral parasympathetic neurones concerned with micturition in the cat

Groat¹,

Ryall²

1969

The Journal of Physiology

256

129

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SUMMARY1. Reflexes to sacral parasympathetic neurones were studied by electrophysiological techniques in decerebrate, in chloralose-anaesthetized, and in chronic spinal cats.2. Excitatory reflexes from pelvic nerve and sacral somatic afferent nerve fibres were present before and after chronic transection of the spinal cord, but the latencies differed markedly. It was concluded that the longlatency reflexes observed when the spinal cord was intact involved longloop reflexes to the brain-stem. The weak, short-latency reflexes in the chronic spinal cat were never observed when the spinal cord was intact and could be due to reorganized spinal connexions. The short-latency reflexes are probably unimportant in normal micturition.3. Stimulation of afferent fibres in the pelvic or sacral somatic nerves produced short-latency inhibitory post-synaptic potentials (IPSPs) and inhibition of discharges in parasympathetic neurones. This inhibition was due to a spinal reflex. 4. A local reflex was demonstrated in the pelvic plexus. This was probably a cholinergic axon reflex, but the remote possibility that it was a local cholinergic reflex involving sensory neurones in the bladder wall has not been excluded.

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“…Lapides et al (5) suggested that under normal circumstances, the bladder neck opens in response to an adequate amount of urine and to contraction of the bladder smooth muscle, which causes the urethra to become shorter and wider. Hutch et al (6) have noted that the arrangement of muscle fiber in the intrinsic urethral sphincter is closely related to closing or opening of the urethra, as morphological adaptation of this structure allows voiding. Some authors have reported that urethra-supporting structures regulate the resistance of the bladder and urethra to urine flow (7).…”

Section: Discussionmentioning

confidence: 99%

The Significance of Beaking Sign on Cystography in Stress Urinary Incontinence

Kim

Lee

et al. 2001

J Korean Radiol Soc

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Stress urinary incontinence (SUI) is defined as the involuntary loss of urine that occurs due to increased intra-abdominal pressure and without detrusor contraction. Many investigators have attempted to classify SUI, and the classification of Blaivas et al (1), based on the descent of the bladder neck revealed by cystography, has been widely accepted because it provides useful information for determining the treatment modality. According to this classification system, retropubic urethropexy is indicated for patients with type-0 to type-IIb SUI, and suburethral sling for those with type-III SUI (1).Although the Blaivas classification adequately reflects the degree of integrity of the intrinsic sphincter by grading the descent of the bladder neck between resting and stress states, morphological alteration in the resting state, involving subtle opening of the bladder neck with- Purpose: To evaluate the clinical and urodynamic significance of the beaking sign at cystography in patients with stress urinary incontinence (SUI). Materials and Methods:We retrospectively reviewed the cystograms of 253 patients with SUI, defining the beaking sign as the triangular contrast collection below the bladder base in the resting state without overt leakage. Various clinical parameters including patient age, symptom duration, parity, the one-hour pad test, and urodynamic study data including Valsalva leak point pressure (VLPP) and maximal urethral closing pressure (MUCP) were compared between the beaking-positive and the beaking-negative group. The distribution of Blaivas type in SUI between these two groups was also analysed. Results:The beaking sign was observed in 153 patients (60%). Those who were older and showed greater parity more often belonged to the beaking-positive group than the beaking-negative (p<0.05). Both VLPP and MUCP were significantly lower in the beaking-positive group than in beaking-negative group (p=0.03; p=0.01, respectively). Type-0 or -I SUI was more common in the beaking-negative group, while the frequency of other types was similar between the two groups. Conclusion:The beaking sign has clinical and urodynamic significance, reflecting functional deficiencies of the intrinsic sphincter, and may possibly be regarded as an additional parameter in the planning of treatment.

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A New Theory of the Anatomy of the Internal Urinary Sphincter and the Physiology of Micturition

Cited by 33 publications

References 0 publications

Comparison of the Urinary Bladder Base and Detrusor to Cholinergic and Histaminergic Receptor Activation in the Rabbit

Comparison of the Urinary Bladder Base and Detrusor to Cholinergic and Histaminergic Receptor Activation in the Rabbit

Reflexes to sacral parasympathetic neurones concerned with micturition in the cat

The Significance of Beaking Sign on Cystography in Stress Urinary Incontinence

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