The functional anatomy of the urethra: role of the pubourethral ligaments.
OBJECTIVE
This clinical study examines and defines the functional anatomy of the urethra as it relates to the Valsalva and Kegel maneuvers and to urethral stability.


METHODS
Dissection of embalmed cadavers and examination of 60 patients were performed to study adjunct structures in urethral stability. Provocative maneuvers (Valsalva and Kegel) were used in all 60 patients. Urethral prolapse was graded with use of the international Continence-Society classification.


RESULTS
Cadaveric dissection confirmed the structural anatomy of the pubourethral muscles and ligaments. Physical examination in 30 patients revealed a lack of urethral stability in all patients with stress urinary incontinence. In 30 patients acting as normal controls, no urinary incontinence was present, and all maintained urethral stability with provocation. The urethrovesical junction was mobile in all patients in performing a Valsalva maneuver.


CONCLUSIONS
Intact pubourethral ligamentous and muscular attachments aid in stabilizing the urethra to its normal anatomic position. This helps maintain continence.
Cruikshank
S H
SH
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, OH, USA.
Kovac
S R
SR
D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology* / Q000502:physiology*; D014521:Urethra / Q000033:anatomy & histology* / Q000502:physiology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology; D014621:Vagina / Q000033:anatomy & histology / Q000502:physiology; D014636:Valsalva Maneuver