Terminal Nerve Distribution to the Urethra and Bladder Neck: Considerations in the Management of Stress Urinary Incontinence

Abstract

No AccessJournal of UrologyClinical Urology: Original Articles1 Sep 1997Terminal Nerve Distribution to the Urethra and Bladder Neck: Considerations in the Management of Stress Urinary Incontinence Thomas P. Ball, Joel M.H. Teichman, Francis E. Sharkey, Vince J. Rogenes, and Erle K. Adrian Thomas P. BallThomas P. Ball , Joel M.H. TeichmanJoel M.H. Teichman , Francis E. SharkeyFrancis E. Sharkey , Vince J. RogenesVince J. Rogenes , and Erle K. AdrianErle K. Adrian View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64329-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Recent reports have suggested an increased incidence of intrinsic sphincter dysfunction, most of which seems to appear following the failure of a previous, usually vaginal, surgical repair. Our studies attempt to define more precisely the neuroanatomical relationships that exist in the region of the bladder neck and proximal urethra, and between the urethra and anterior vaginal wall. Materials and Methods: We dissected the pelves of adult female cadavers and step sectioned them at 4 mm. intervals. Several staining methods were used on each section to identify and document the position of the nerves and vascular structures between the vaginal wall and urethra. Results: A rich plexus of blood vessels and nerves with ganglia is located between the vaginal wall, and the proximal urethra and bladder neck. The greatest concentrations of nerves are in the 4 o'clock and 8 o'clock positions but nerve fibers are identified throughout the loose areolar tissue planes through which vaginal surgery for stress urinary incontinence is often performed. Conclusions: When performing surgical procedures for the correction of stress urinary incontinence, the possibility that denervation and devascularization of the terminal urethra and bladder neck secondary to surgical dissection could contribute to the subsequent development of intrinsic sphincter dysfunction should be considered. References 1 : Correction of stress incontinence by simple vesicourethral suspension.. Surg., Gynec, & Obst.1949; 88: 509. Google Scholar 2 : Urethrovaginal fixation to Cooper's ligament for correction of stress urinary incontinence, cystocoel and prolapse.. Amer. J. Obst. Gynec.1961; 81: 281. Google Scholar 3 : Stress incontinence.. J. Urol.1961; 85: 291. Abstract, Google Scholar 4 : A simplified surgical procedure for the correction of stress incontinence in women.. West. J. Surg.1959; 67: 223. Google Scholar 5 : Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients.. Ann. Surg.1980; 192: 465. Google Scholar 6 : Modified bladder neck suspension for female stress incontinence.. Urology1981; 17: 82. Google Scholar 7 : Simplified correction of female stress incontinence.. J. Urol.1978; 120: 418. Abstract, Google Scholar 8 : No-incision pubovaginal suspension for stress incontinence.. J. Urol.1987; 138: 568. Abstract, Google Scholar 9 : Treatment of urinary incontinence by an implantable prosthetic urinary sphincter.. J. Urol.1974; 112: 75. Abstract, Google Scholar 10 : Pubovaginal sling procedure for stress incontinence.. J. Urol.1978; 119: 82. Abstract, Google Scholar 11 : Pubovaginal sling procedure.. In: Current Operative Urology. Edited by . Philadelphia: J. B. Lippincott Co.1990: 93. chapt. 7. Google Scholar 12 : Vaginal wall sling.. J. Urol.1989; 141: 43. Abstract, Google Scholar 13 : Injectable Collagen for Type III Female Stress Incontinence: the first 50 australian patients.. Med. J. Aust.1993; 158: 89. Google Scholar 14 : Periurethral Teflon injection for urinary incontinence.. J. Urol.1974; 111: 180. Link, Google Scholar 15 : Treatment of urinary incontinence by the periurethral implantation of gluteraldehyde crosslinked collagen.. J. Urol.1989; 141: 538. Google Scholar 16 : Anatomy of lower urinary tract.. In: Campbell's Urology. Edited by . Philadelphia: W. B. Saunders Co.1986: 46. chapt. 1. Google Scholar 17 : Neuroanatomy of the male rhabdosphincter.. Urology1997; 49: 426. Google Scholar 18 : Cystolysis: a procedure for the selective denervation of the bladder.. J. Urol.1980; 123: 360. Abstract, Google Scholar 19 : Partial denervation of the bladder. A new operation for the treatment of urge incontinence and similar conditions in women.. Acta Obst. Gynec. Scand.1959; 38: 487. Google Scholar 20 : Urethrolysis in the management of females with recurrent frequency and dysuria.. Brit. J. Urol.1981; 53: 634. Google Scholar 21 : Impotence following radical prostatectomy: insight into etiology and prevention.. J. Urol.1982; 128: 492. Abstract, Google Scholar 22 : The Raz bladder neck suspension: results in 206 patients.. J. Urol.1992; 148: 845. Abstract, Google Scholar 23 : Surgical management of stress urinary incontinence.. AUA Update Series1985; volume 4. Lesson 17. Google Scholar 24 Montague D.K.: Personal communication. Google Scholar 25 Guerriero W.G.: Personal communication. Google Scholar 26 Scott F.B.: Personal communication. Google Scholar 27 : Vaginal wall sling for anatomical incontinence and intrinsic sphincter dysfunction: efficacy and outcome analysis.. J. Urol.1996; 156: 166. Abstract, Google Scholar 28 : Success rate of modified pereyra bladder neck suspension determined by outcomes analysis.. J. Urol.1994; 152: 1453. Abstract, Google Scholar 29 : Modified Pereyra bladder neck suspension: 10-year mean followup using outcomes analysis in 125 patients.. J. Urol.1995; 154: 1841. Abstract, Google Scholar From the Departments of Surgery/Urology, Pathology, and Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, Texas.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byDaneshgari F, Kong W and Swartz M (2008) Complications of Mid Urethral Slings: Important Outcomes for Future Clinical TrialsJournal of Urology, VOL. 180, NO. 5, (1890-1897), Online publication date: 1-Nov-2008.HIJAZ A, DANESHGARI F, HUANG X, BENA J, LIU G, SAFFORE L and DAMASER M (2018) ROLE OF SLING INTEGRITY IN THE RESTORATION OF LEAK POINT PRESSURE IN THE RAT VAGINAL SLING MODELJournal of Urology, VOL. 174, NO. 2, (771-775), Online publication date: 1-Aug-2005.YUCEL S, de SOUZA A and BASKIN L (2018) NEUROANATOMY OF THE HUMAN FEMALE LOWER UROGENITAL TRACTJournal of Urology, VOL. 172, NO. 1, (191-195), Online publication date: 1-Jul-2004.AKMAN Y, LIU W, LI Y and BASKIN L (2018) PENILE ANATOMY UNDER THE PUBIC ARCH: RECONSTRUCTIVE IMPLICATIONSJournal of Urology, VOL. 166, NO. 1, (225-230), Online publication date: 1-Jul-2001.FULFORD S, FLYNN R, BARRINGTON J, APPANNA T and STEPHENSON T (2018) AN ASSESSMENT OF THE SURGICAL OUTCOME AND URODYNAMIC EFFECTS OF THE PUBOVAGINAL SLING FOR STRESS INCONTINENCE AND THE ASSOCIATED URGE SYNDROMEJournal of Urology, VOL. 162, NO. 1, (135-137), Online publication date: 1-Jul-1999.SHAFIK A and DOSS S (2018) SURGICAL ANATOMY OF THE SOMATIC TERMINAL INNERVATION TO THE ANAL AND URETHRAL SPHINCTERS: ROLE IN ANAL AND URETHRAL SURGERYJournal of Urology, VOL. 161, NO. 1, (85-89), Online publication date: 1-Jan-1999. (2018) EDITORIAL COMMENTJournal of Urology, VOL. 160, NO. 1, (54-54), Online publication date: 1-Jul-1998. Volume 158Issue 3September 1997Page: 827-829 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Thomas P. Ball More articles by this author Joel M.H. Teichman More articles by this author Francis E. Sharkey More articles by this author Vince J. Rogenes More articles by this author Erle K. Adrian More articles by this author Expand All Advertisement PDF downloadLoading ...