A New Theory of the Anatomy of the Internal Urinary Sphincter and the Physiology of Micturition. II. The Base Plate

Hutch, John A.

doi:10.1016/s0022-5347(17)63231-2

Cited by 69 publications

(23 citation statements)

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“…These results contrast sharply with the results of numerous authors [7,8,11,15,[19][20][21][22][23], who describe a continuation of the inner longitudinal layer to the urethra. Further more, there is no involvement of the lamellas of the blad der muscles in the formation of the sphincter muscle of the urinary bladder as Heiss [1,6], Liidinghausen [ 13] and Graning [14] defined.…”

Section: Discussioncontrasting

confidence: 99%

A New Theory of Micturition and Urinary Continence Based on Histomorphological Studies

Dorschner¹,

Stolzenburg²,

Leutert

1994

Urol Int

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Micturition and urinary continence theories have been under discussion since the last century. Up to now all these theories have been unsatisfactory. There is an obvious discrepance between the anatomical presentation and the clinical perceptions and physiological phenomena. This was the reason for a renewed and global examination of the whole distal urinary tract. The results are published in five successive papers. Our own examinations are based on 30,000 serial sections of the bladder neck taken from 65 male and female cadavers of all age groups. The muscle system of the urinary bladder consists of a network of smooth muscle cells forming three layers. Caudally the longitudinal muscle layers form two special recently described structures: the collare vesicae and nodus vesicae. None of the muscle systems of the urinary bladder leaves the spatial dimension of the organ. Simply two anatomical structures fix the urinary bladder in the pelvis. Dorsally it is the musculus vesicoprostaticus and the musculus vesicovaginalis, respectively; ventrally the existence of the musculi pubovesicales is introduced. There is no involvement of the lamellas of the bladder muscles in the formation of the urinary sphincter. Therefore the morphological substrate for a hitherto generally acknowledged contribution of the detrusor vesicae to the active continence function does not exist.

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Section: Discussioncontrasting

confidence: 99%

A New Theory of Micturition and Urinary Continence Based on Histomorphological Studies

Dorschner¹,

Stolzenburg²,

Leutert

1994

Urol Int

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“…It is regulat ed and controlled by various reflex actions like the vesical reflex and levator urethral reflex [1|. However, many aspects of the mechanism are still awaiting explanation despite the many theories that have been devised [2][3][4][5].During the study of the myoelectric activity of the external urethral sphincter, it was found that the muscle contracted on straining and this reflex action was reprodu cible. The present communication describes the straining urethral reflex and its clinical significance.…”

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confidence: 99%

Straining Urethral Reflex: Description of a Reflex and Its Clinical Significance

Shafik

1991

Cells Tissues Organs

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The present communication describes a reflex which I call ‘straining urethral reflex’ and discusses its clinical significance. The study was performed on 17 healthy volunteers with a mean age of 39.6 years. The intrarectal pressure (representative of the intra-abdominal pressure) was measured by means of a balloon-tipped catheter introduced into the rectum and connected to a pressure transducer. A concentric needle electrode was introduced into the external urethral sphincter. The subject was asked to strain, and the urethral sphincter electromyographic activity and the intrarectal pressure were recorded. Two types of straining were investigated: sudden and slow. The procedure was repeated in 10 subjects after urethral sphincter infiltration with xylocaine or saline. On sudden straining, the external urethral sphincter contracted. The anesthetized sphincter did not respond, while the saline-infiltrated sphincter responded to sudden straining. Slow sustained straining did not evoke the reflex response. The latency of the reflex was calculated. The external urethral sphincter contraction on sudden straining guards against the involuntary opening of the vesical neck and urinary leak under stress conditions of a sudden increase in the intra-abdominal pressure. The reflex may prove significant in the diagnosis of micturition control disorders. It can thus be included as an investigative tool in urologic practice.

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“…From the anatomical point of view, the internal sphincter was defined as base plate, ventrally consists of lamellas of the bladder musculature and dorsally of trigonal musculature [Hutch, 1966;Tanagho and Smith, 1966]. By using a special investigation technique , it was demonstrated that this smooth muscle embraces the internal urethral orifice and consists solely of trigonal musculature not of lamellas of bladder musculature.…”

Section: Introductionmentioning

confidence: 99%

Sphincteric Musculature of Female Canine Urethra in Comparison to Woman Including 3D Reconstruction

Stolzenburg

Dorschner

Postenjak

et al. 2001

Cells Tissues Organs

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The circular arranged sphincteric musculature of bladder neck of female dogs and women were studied histomorphologically. 3D reconstructions of the anatomy of the bladder neck improve the understanding of construction principles of the musculature of the lower urinary tract and help to compare both species. Our own investigations based on 12 adult female canine and 15 female human autopsy preparations. The special feature of our study was the extensive en bloc preparation of all the organs of the lower urinary tract and surrounding organs. The organ blocks were reprocessed in complete serial sections from the bladder outlet down to the bulb of vestibuli. Despite different detailed construction, in both species the striated sphincter musculature of the urethra is an independent morphological unit. There is no continuation of pelvic floor muscles to the urethra. In humans, the urethral sphincter consists of a smooth muscular part (m. sphincter urethrae glaber) and a striated part (m. sphincter urethrae transversostriatus). In the female dog, striated muscle fibres encircle the urethra in the middle third exclusively. In the distal third of the urethra, it encircles the urethra and the vagina. In the female dog, the lamellae of detrusor continue directly to the urethra. Throughout the cranial and middle third of the urethra, smooth muscle cell bundles form a homogenous compact sphincteric muscle originating from the middle circular layer of detrusor. In that way, no true bladder neck sphincter according to the m. sphincter vesicae in women exists in dogs. According to the smooth muscular part of the m. sphincter urethrae in women, for this musculature the term m. sphincter urethrae glaber is suggested. Despite a superficial resemblance, this study revealed a considerable difference of circular sphincteric muscle components between female dog and woman suggesting that functional studies in respect to urinary continence obtained in dogs cannot be attributed without qualification to humans.

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A New Theory of the Anatomy of the Internal Urinary Sphincter and the Physiology of Micturition. II. The Base Plate

Cited by 69 publications

References 0 publications

A New Theory of Micturition and Urinary Continence Based on Histomorphological Studies

A New Theory of Micturition and Urinary Continence Based on Histomorphological Studies

Straining Urethral Reflex: Description of a Reflex and Its Clinical Significance

Sphincteric Musculature of Female Canine Urethra in Comparison to Woman Including 3D Reconstruction

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