Abstract
OBJECTIVE: This study examines the anatomic factors that could explain the mechanical basis
for transmission of abdominal pressure to the urethra. STUDY DESIGN: Dissection of 19 embalmed and 42 fresh cadavers and examination of 13 sets of serial
pelvic sections were performed to study the structures involved in urethral support.
The effect of simulated increases in abdominal pressure on the pelvic floor and urethra
was observed in fresh specimens. RESULTS: The urethra lies on a supportive layer that is composed of the endopelvic fascia
and the anterior vaginal wall. This layer gains structural stability through its lateral
attachment to the arcus tendineus fascia pelvis and levator ani muscle. Pressure from
above compresses the urethra against this hammock-like supportive layer, compressing
its lumen closed. The stability of the suburethral layer depends on the intact connection
of the vaginal wall and endopelvic fascia to the arcus tendineus fasciae pelvis and
levator ani muscles. CONCLUSION: Increases in urethral closure pressure during a cough probably arise because the
urethra is compressed against a hammock-like supportive layer, rather than the urethra
being truly “intraabdominal.” (AM J Obstet Gynecol 1994;170:1713-23.)
Keywords
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Article Info
Footnotes
☆From the Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School
☆☆Reprint requests: John O.L. DeLancey, MD, D2230 Medical Professional Building, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0718.
★0002-9378/94 $3.00 + 0 6/6/55733
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Copyright
© 1994 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
