Continence Mechanism of the Isolated Female Urethra: An Anatomical Study of the Intrapelvic Somatic Nerves

Abstract

No AccessJournal of UrologyClinical Urology: Original Articles1 Sep 1997Continence Mechanism of the Isolated Female Urethra: An Anatomical Study of the Intrapelvic Somatic Nerves S. Borirakchanyavat, S.R. Aboseif, P.R. Carroll, E.A. Tanagho, and T.F. Lue S. BorirakchanyavatS. Borirakchanyavat , S.R. AboseifS.R. Aboseif , P.R. CarrollP.R. Carroll , E.A. TanaghoE.A. Tanagho , and T.F. LueT.F. Lue View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64327-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A neuroanatomical study was initiated to gain better insight into the continence mechanism of the isolated urethra in women. Materials and Methods: We performed a detailed gross and histological neuroanatomical study to identify the intrapelvic somatic pathway from the sacral spinal cord to the female urethral sphincter. Gross anatomical dissection was performed in 5 formalin fixed female adult pelvises by tracing the autonomic nerves from the pelvic plexus and the spinal somatic nerves from S2-S4 to the urethral sphincter. Immunohistochemical staining of urethral step sections with a neuropeptide specific antibody was performed to demonstrate the course of the periurethral somatic nerves in relation to the vaginal wall. Results: Our study demonstrated an intrapelvic somatic pathway derived from the S2, S3 and S4 sacral roots, distinct from the peripheral pudendal nerve, supplying the levator ani and the urethra. The somatic nerves travel beneath the endopelvic fascia in close relation to the inferior vascular pedicle of the bladder and are susceptible to injury during radical pelvic surgery. Mixed autonomic fibers from the pelvic plexus travel along the course of the ureter and are also intimately associated with the vascular pedicle of the bladder. Immunohistochemical staining of urethral step sections demonstrated that the periurethral nerves travel in close relation to the lateral and anterior vaginal wall. Conclusions: We believe that the identification of intrapelvic somatic pathways to the urethra provides a basis for developing surgical techniques to preserve urethral somatic innervation during radical pelvic surgery in women. References 1 : Urethral resistance: its components and implications. II. Striated muscle component.. Invest. Urol.1969; 7: 179. Google Scholar 2 : Urethral resistance: its components and implications. I. Smooth muscle component.. Invest. Urol.1969; 7: 136. Google Scholar 3 : Urinary striated sphincter: what is its nerve supply?. Urology1982; 20: 415. Google Scholar 4 : Clinical significance of sacral and pudendal nerve anatomy.. J. Urol.1988; 139: 74. Abstract, Google Scholar 5 : Urethral function after cystectomy: a canine in vivo experiment.. Urol. Res.1993; 21: 45. 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Abstract, Google Scholar From the Department of Urology, University of California, San Francisco, California.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHinata N, Murakami G, Abe S, Honda M, Isoyama T, Sejima T and Takenaka A (2011) Detailed Histological Investigation of the Female Urethra: Application to Radical CystectomyJournal of Urology, VOL. 187, NO. 2, (451-456), Online publication date: 1-Feb-2012.Stein J, Penson D, Lee C, Cai J, Miranda G and Skinner D (2009) Long-Term Oncological Outcomes in Women Undergoing Radical Cystectomy and Orthotopic Diversion for Bladder CancerJournal of Urology, VOL. 181, NO. 5, (2052-2059), Online publication date: 1-May-2009.Stein J, Penson D, Wu S and Skinner D (2007) Pathological Guidelines for Orthotopic Urinary Diversion in Women With Bladder Cancer: A Review of the LiteratureJournal of Urology, VOL. 178, NO. 3, (756-760), Online publication date: 1-Sep-2007.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.GIANNANTONI A, DI STASI S, CUCCHI A, MEARINI E, BINI V and PORENA M (2018) Pelvic Floor Muscle Behavior During Valsalva Leak Point Pressure Measurement in Males and Females Affected by Stress Urinary IncontinenceJournal of Urology, VOL. 170, NO. 2, (485-489), Online publication date: 1-Aug-2003.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.FUJISAWA M, GOTOH A, MIYAZAKI S, NAKAMURA I, HARA I, OKADA H, ARAKAWA S and KAMIDONO S (2018) SIGMOID NEOBLADDER IN WOMEN AFTER RADICAL CYSTECTOMYJournal of Urology, VOL. 163, NO. 5, (1505-1509), Online publication date: 1-May-2000.MILLS R and STUDER U (2018) FEMALE ORTHOTOPIC BLADDER SUBSTITUTION: A GOOD OPERATION IN THE RIGHT CIRCUMSTANCESJournal of Urology, VOL. 163, NO. 5, (1501-1504), Online publication date: 1-May-2000.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: 822-826 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information S. Borirakchanyavat More articles by this author S.R. Aboseif More articles by this author P.R. Carroll More articles by this author E.A. Tanagho More articles by this author T.F. Lue More articles by this author Expand All Advertisement PDF downloadLoading ...