title: What are the supportive structures of the female urethra?
abstract: OBJECTIVE
  Female stress urinary incontinence is thought to result from impairment of the connective tissue "ligaments" of the urethra. Surgical repair of female incontinence mainly involves fixation of the urethra to the pubic bone or other surrounding structures. In the present anatomical-radiological study, the anatomy of the connective tissue structures around the female urethra was investigated to determine the anatomical structures that support the urethra and the rhabdosphincter.
  
  
  METHODS
  The topography of the anterior compartment of the female pelvis was studied in serial sections and one anatomical preparation of 30 female fetuses and of six adult females. The pelves of 29 female fetuses were processed according to plastination histology technique. The pelves of the six adult specimens were processed according to sheet plastination technique. In addition, the anatomical findings were compared with MR images of 41 adult female volunteers.
  
  
  RESULTS
  The ventro-lateral aspect of the urethra remains free of fixating ligaments throughout its pelvic course. Ventro-laterally the urethra is enclosed by the ventral parts of the levator ani, its fasciae and a ventral urethral connective tissue bridge connecting both sides. Dorsally, the urethra is intimately connected to the wall of the vagina.
  
  
  CONCLUSIONS
  The female urethra has no direct ligamentous fixation to the pubic bone. Urethral continence after pregnancy and childbirth may be explained by a widening of the hiatus of the levator ani or the anterior vaginal wall, resulting in overstretching of the ventral urethral connective tissue bridge or the disruption of the fixation between urethra and vagina.
authors.affiliation: Institute of Anatomy and Histology, University of Innsbruck, Innsbruck, Austria.
authors.forename: Helga
authors.initials: H
authors.lastname: Fritsch
authors.forename: Germar Michael
authors.initials: GM
authors.lastname: Pinggera
authors.forename: Andreas
authors.initials: A
authors.lastname: Lienemann
authors.forename: Michael
authors.initials: M
authors.lastname: Mitterberger
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Hannes
authors.initials: H
authors.lastname: Strasser
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology / Q000502:physiology; D000328:Adult; D000368:Aged; D003238:Connective Tissue / Q000737:chemistry* / Q000196:embryology; D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011247:Pregnancy; D014521:Urethra / Q000033:anatomy & histology* / Q000196:embryology