structure and function of the bladder neck

ISBN-13: 9783540679981 / Angielski / Miękka / 2001 / 114 str.

W. Dorschner; J. U. Stolzenburg; J. Neuhaus

Opis

The alternation between urine retention and discharge several times daily from a nappy to the cessation ofall vital functions only becomes the subject baby's first wet of greater attention if the harmony of the structure and function of the bladder is disturbed. Functional disturbances of the lower urinary tract are not only of great socio-economic importance, but are also a considerable personal burden for the patient. Hence urinary incontinence is rightly classified as a severelydisabling illness (Hauri 1985). Opinions still differ regarding the morphological basis ofurinary continence.The Terminologia Anatomica (1998) defines a musculus sphincter urethrae internus (in ternal urethral sphincter) and a musculus sphincter urethrae externus (external ure thral sphincter), which in the older nomenclature were known as musculus sphincter vesicae and musculussphincterurethrae, respectively.The internal urethral sphincter isascribed apurelyinvoluntaryandthe externalurethralsphincterapurelyvoluntary innervation. The significance of the musculature of the pelvic floor for maintaining urinarycontinence has notyetbeen ascertained. Duringnumerous urologicaloperations (forinstancetransurethralresectionofthe prostate and bladder neck incisions), the only involuntarily innervated sphincter at the collum vesicae, the internalurethralsphincter, is partiallyorcompletelydestroyed (Fig. 27C, D).All the patients remain continent as long as the externalurethral sphinc ter remains intact.Howcan apurelyvoluntarilyinnervated sphincterlikethe external urethral sphincter ensureconstant continence in such cases? Improving the continence rate after radical surgery is a key topic of urological research. The incontinence rate after radical prostatectomy is still between 8.1% (third-degree incontinence) and41.4% (first- to second-degree incontinence; Rudyet al. 1984; Igel et a1.1987; Schroderand Ouden 1992).

Spis treści

Introduction.-Materials and Methods.-Musculus Detrusor Vesicae.-The Musculature of the Trigonum Vesicae.-Diaphragma Urogenitale.-Musculus Sphincter Urethrae.-Musculus Dilatator Urethrae.-Musculus Ejaculatorius.-Changes of the Muscles of the Lower Uninary Tract with Age.-Three Dimensional Model of the Anatomy of the Lower Urinary Tract.-Fundamentals of the Neuroanatomy of the Lower Urinary Tract.-Discussion (Functional Interpretation of the Anatomical Findings).-Further Studies and New Approaches.-Terminologia Anatomica of the Lower Urinary Tract.-Summary.-References.-Subject Index

Blurb

The studies described here are based on histological serial sections of the entire bladder neck region of 50 male and 15 female deceased of all age groups. For the first time, a musculus vesicoprostaticus et vesicovaginalis, a musculus dilator urethrae and a musculus ejaculatorius are defined. The bipartite musculus sphincter urethrae (glaber et transversostriatus) is the morphological basis for the maintenance of the rest and stress continence. New findings necessitate new interpretations of the basic functions of the lower urinary tract. The results presented here prove that the corresponding morphological substrate differs in many respects from descriptions in the literature.