title: Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence.
abstract: OBJECTIVE
  To analyze the relation between urethral hypermobility and urethral incompetence, and to summarize the interdependence between maximum urethral closure pressure (MUCP), urethral hypermobility, and urethral incompetence.
  
  
  METHODS
  A group of 255 patients was selected from a large bank of cases. Inclusion criteria were age 20 years or above, no neurological disease, stable bladder, and no previous incontinence surgery or hysterectomy. The degree of hypermobility (cysto-urethrocele) and the degree of urethral incompetence (abdominal leak point pressure (ALPP)) were determined. Statistical analyses between urethral hypermobility and incompetence were performed with Spearman's correlation and the Jonckherre-Terpstra test.
  
  
  RESULTS
  The Spearman's rank correlation test showed a statistically significant relation between urethral hypermobility and the degree of urethral incompetence (P = 0.0049).
  
  
  CONCLUSIONS
  The statistically significant relation between urethral incompetence and hypermobility suggests that urethral incompetence will increase as the degree of urethral hypermobility does. Optimal conditions for urinary continence include a high maximum urethral closure pressure, absence of hypermobility, and a low degree of urethral incompetence. This last factor is assured by a strong support underneath the urethra permitting compression of the latter during straining. Failure of the urethral closure mechanism is highly probable with a diminished maximum closure pressure accompanied by urethral hypermobility often associated with a high degree of urethral incompetence. Clinically significant urinary incontinence may appear in many intermediate circumstances between these two extreme states, but stress urinary incontinence is essentially an activity-related phenomenon.
authors.affiliation: Division of Urology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Québec, Canada. eschick@videotron.ca
authors.forename: Erik
authors.initials: E
authors.lastname: Schick
authors.forename: Martine
authors.initials: M
authors.lastname: Jolivet-Tremblay
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Tessier
authors.forename: Charles
authors.initials: C
authors.lastname: Dupont
authors.forename: Pierre E
authors.initials: PE
authors.lastname: Bertrand
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009122:Muscle Hypertonia / Q000150:complications* / Q000503:physiopathology; D011312:Pressure; D014521:Urethra / Q000503:physiopathology*; D014522:Urethral Diseases / Q000150:complications* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000150:complications* / Q000503:physiopathology; D014563:Urodynamics