Micturition pp 41-55 | Cite as

Continence Mechanism

  • S. Kulseng-Hanssen
  • B. Klevmark


For a woman to be continent, the urethra must seal properly, the urethral pressure must be higher than the bladder pressure and the bladder must be under control.


Bladder Neck Pudendal Nerve Urethral Sphincter Urethral Pressure Bladder Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Huisman A. Morphologie van de vrouwelijke urethra. Thesis, Groningen, The Netherlands, 1979.Google Scholar
  2. 2.
    Rud T. Urethral pressure profile in continent women from childhood to old age. Acta Obstet Gynecol Scand 1980; 59:331–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Rud T, Ulmsten U, Andersson KE. Initiation of voiding in healthy women and those with stress incontinence. Acta Obstet Gynecol Scand 1978; 57:457–62.PubMedCrossRefGoogle Scholar
  4. 4.
    George NJR, Feneley RCL. The importance of postural influences on urethral musculature. Proceedings of the 8th Annual Meeting of the International Continence Society, Manchester, 1978: 117.Google Scholar
  5. 5.
    Sorensen S, Kirkeby HJ, Stodkilde Jorgensen H, Djurhus JC. Continuous recording of urethral activity in healthy female volunteers. Neurourol Urodynam 1986; 5:5–16.CrossRefGoogle Scholar
  6. 6.
    Kulseng-Hanssen S, Kristoffersen M. Urethral pressure variations in women with and without neurourological symptoms. Neurourol Urodynam 1987; 6:299–306.CrossRefGoogle Scholar
  7. 7.
    Kulseng-Hanssen S, Klevmark B. Ambulatory urethro-cystorectometry. A new technique. Neurourol Urodynam 1988; 7:119–30.CrossRefGoogle Scholar
  8. 8.
    Kulseng-Hanssen S. Thesis, Oslo, 1988.Google Scholar
  9. 9.
    Zinner NR, Sterling AM, Ritter RC. Role of inner urethral softness in urinary continence. Urol 1980; 16:115–17.PubMedCrossRefGoogle Scholar
  10. 10.
    Berkow SG. The corpus spongiosum of the urethra: its possible role in urinary control and stress incontinence in women. Am J Obstet Gynecol 1953; 65:346–51.PubMedGoogle Scholar
  11. 11.
    Enhørning G. Simultaneous recording of intravesical and intraurethral pressure. Acta Chir Scand [Suppl.] 1961;276:1–6.Google Scholar
  12. 12.
    Raz S, Caine M, Ziegler M. The vascular component in the production of intraurethral pressure. J Urol 1972; 108:93–6.PubMedGoogle Scholar
  13. 13.
    Rud T, Andersson KE, Asmussen M, Hunting A, Ulmsten U. Factors maintaining the intraurethral pressure in women. Invest Urol 1980; 17:343–7.PubMedGoogle Scholar
  14. 14.
    Gosling J A, Dixon JS, Humperson JR. Functional anatomy of the urinary tract. London: Gower, 1983.Google Scholar
  15. 15.
    Downie JW, Lautt WW. Is sympathetic control of the urethra mediated through vasomotor action? Neurourol Urodynam 1986; 5:219–25.CrossRefGoogle Scholar
  16. 16.
    Kulseng-Hanssen S, Stranden E. Urethral pressure variations in women with neurourological symptoms. III. Relationship to urethral wall venous plexus. Neurourol Urodynam 1987; 6:87–93.CrossRefGoogle Scholar
  17. 17.
    Smith P. Age changes in the female urethra. Br J Urol 1972; 44:667–76.PubMedCrossRefGoogle Scholar
  18. 18.
    Iosif CS, Batra S, Ek A, Astedt B. Estrogen receptors in the human female lower urinary tract. Am J Obstet Gynecol 1981; 141:817–20.PubMedGoogle Scholar
  19. 19.
    Donker PJ, Ivanovici F, Noach EL. Analysis of urethral pressure profile by means of electromyography and administration of drugs. Br J Urol 1972; 44:180–93.PubMedCrossRefGoogle Scholar
  20. 20.
    Nordling J. Alpha blockers and urethral pressure in neurological patients. Urol Int 1978; 33:304–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Mattiasson A, Andersson KE, Sjøgren C. Urethral sensitivity to alpha adrenoceptor stimulation and blockade in patients with parasympathetically decentralized lower urinary tract and in healthy volunteers. Neurourol Urodynam 1984; 3:230–234.CrossRefGoogle Scholar
  22. 22.
    Kulseng-Hanssen S. Urethral pressure variations in women with neurourological symptoms. 11. Relationship to urethral smooth muscle. Neurourol Urodynam 1987; 6:79–85.CrossRefGoogle Scholar
  23. 23.
    Lapides J, Grey HO, Rawling JC. Function of the striated muscles in the control of urination: effect of pudendal block. Surg Forum 1955; 6:611–15.Google Scholar
  24. 24.
    Krahn HP, Morales PA. The eifect of pudendal nerve anesthesia on urinary continence after prostatectomy. J Urol 1965; 94:282–5.PubMedGoogle Scholar
  25. 25.
    Brindley GS, Rushton DN, Craggs MD. The pressure exerted by the external sphincter of the urethra when its motor nerve fibers are stimulated electrically. Br J Urol 1974; 46:453–62.PubMedCrossRefGoogle Scholar
  26. 26.
    McGuire EJ, Wagner FC. The eff’ect of complete sacral rhizotomy on bladder and urethral function. Surg Gyn Obstet 1977; 144:343–6.Google Scholar
  27. 27.
    Ek A, Aim P, Andersson KE, Persson CGA. Adrenergic and cholinergic nerves of the human urethra and urinary bladder. A histochemical study. Acta Physiol Scand 1977; 99:345–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Gosling J A, Dixon JS, Lendon RJ. The autonomic innervation of the male and female bladder neck and proximal urethra. J Urol 1977; 118:302–5.PubMedGoogle Scholar
  29. 29.
    Nordling J. Influence of the sympathetic nervous system on lower urinary tract in man. Neurourol Urodynam 1983; 2:3–26.CrossRefGoogle Scholar
  30. 30.
    Mattiasson A, Andersson KE, Sjøgren C. Adrenergic and non-adrenergic contraction of isolated urethral muscle from rabbit and man. J Urol 1985; 133:298–303.PubMedGoogle Scholar
  31. 31.
    Mattiasson A. Receptor functions/neurotransmitters in the lower urinary tract. In: Thorup Andersen J, ed. Proceedings from Scandinavian Course in Neurourology. Mariehamn, 1987.Google Scholar
  32. 32.
    Torrens MJ. Urethral sphincteric responses to stimulation of the sacral nerves in the human female. Urol Int 1978; 33:22–6.CrossRefGoogle Scholar
  33. 33.
    Mattiasson A, Andersson KE, Sjøgren C. Adrenoceptors and cholinoceptors controlling the release of noradrenaline from the adrenergic nerves in the isolated urethra in rabbit and man. J Urol 1984; 131:1190–5.PubMedGoogle Scholar
  34. 34.
    DeLancey JOL. Correlative study of paraurethral anatomy. Obstet Gynecol 1986; 68:91–7.PubMedGoogle Scholar
  35. 35.
    Constantinou CE, Govan DE. Spatial distribution and timing of transmitted and reflexly generated urethral pressures in healthy women. J Urol 1982; 127:964–9.PubMedGoogle Scholar
  36. 36.
    DeLancey JOL. Pubovesical ligament: a separate structure from the urethral supports (“pubourethral ligaments”). Neurourol Urodynam 1989; 8:53–61.CrossRefGoogle Scholar
  37. 37.
    Delancey JOL. Anatomy and mechanics of structures around the vesical neck: how vesical neck position might affect its closure. Neurourol Urodynam 1988; 7:161–2.CrossRefGoogle Scholar
  38. 38.
    Gosling JA, Dixon JS, Critchley HOD, Thompson SA. A comparative study of the human external sphincter and periurethral levator ani muscles. Br J Urol 1981; 53:35–41.PubMedCrossRefGoogle Scholar
  39. 39.
    Murray A. Predicting the outcome of surgery for urethral incompetence in women by an intraoperative fluid bridge test. A feasibility study. MD Thesis, University of Liverpool, Liverpool, 1986.Google Scholar
  40. 40.
    Doyle PT, Briscoe CE. The effect of drugs and anaesthetic agents on the urinary bladder and sphincter. Br J Urol 1976; 48:329–34.PubMedCrossRefGoogle Scholar
  41. 41.
    Kulseng-Hanssen S, Stien R, Fonstelien E. Urethral pressure variations in women with neurourological symptoms. L Relationship to urethral and pelvic floor striated muscle. Neurourol Urodynam 1987; 6:71–8.CrossRefGoogle Scholar
  42. 42.
    Collins CD. Electrical stimulation in the treatment of incontinence. ChM Thesis, University of Sheffield, 1972.Google Scholar
  43. 43.
    Heidler H, Wölk H, Jonas U. Urethral closure mechanism under stress conditions. Eur Urol 1979; 5:110–12.PubMedGoogle Scholar
  44. 44.
    Constantinou CE, Gowan DE. Urodynamic analysis of urethral, vesical and perivesical pressure distribution in the healthy female. Urol Int 1980; 35:53–72.CrossRefGoogle Scholar
  45. 45.
    Hilton P, Stanton S. Urethral pressure measurements by microtransducer. The results in symptom-free women and in those with genuine stress incontinence. Br J Obstet Gynaecol 1983; 90:919–33.PubMedCrossRefGoogle Scholar
  46. 46.
    Snooks SJ, Swash M. Abnormalities of the innervation of the urethral striated sphincter musculature in incontinence. Br J Urol 1984; 56:401–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Klevmark B. Motility of the urinary bladder in cats during filling at physiological rates. L Intravesical pressure patterns studied by a new method of cystometry. Acta Physiol Scand 1974; 90:565–77.PubMedCrossRefGoogle Scholar
  48. 48.
    Klevmark B. Motility of the urinary bladder in cats during filling at physiological rates IL Effects of extrinsic bladder denervation on intraluminal tension and intravesical pressure patterns. Acta Physiol Scand 1977; 101:176–84.PubMedCrossRefGoogle Scholar
  49. 49.
    Uvelius B, Gabella G. Relation between cell length and force production in urinary bladder smooth muscle. Acta Physiol Scand 1980; 110:357–65.PubMedCrossRefGoogle Scholar
  50. 50.
    Winter DL. Receptor characteristics and conduction velocities in bladder efferents. J Psychiat Res 1971; 8:225–35.PubMedCrossRefGoogle Scholar
  51. 51.
    Torrens M. Human physiology. In: Torrens M, Morrison JFB, eds. The physiology of the lower urinary tract. London: Springer, 1987; 333–50.CrossRefGoogle Scholar
  52. 52.
    Barrington FJF. The nervous mechanism of micturition. Q J Exp Physiol 1914; 8:33.Google Scholar
  53. 53.
    de Groat WC. Nervous control of the urinary bladder in the cat. Brain Res 1975; 87:201–11.PubMedCrossRefGoogle Scholar
  54. 54.
    Blackman JG, Crowcroft PJ, Devine EE, Holman ME, Yonemura K. Transmission from preganglionic fibres in the hypogastric nerve to peripheral ganglia of male guinea-pigs. J Physiol 1969; 201:723–43.PubMedGoogle Scholar
  55. 55.
    de Groat WC, Ryall RW. Recurrent inhibition in sacral parasympathetic pathways to the bladder. J Physiol 1968; 196:579–91.PubMedGoogle Scholar
  56. 56.
    de Groat WC, Booth AN. Inhibition and facilitation in parasympathetic ganglia. Fed Proc 1980; 39:2990–6.PubMedGoogle Scholar
  57. 57.
    de Groat WC, Saum WR. Parasympathetic ganglia: activation of an adrenergic inhibitory mechanism by cholinomimetic agents. Science 1972; 175:659–61.PubMedCrossRefGoogle Scholar
  58. 58.
    Barrington FJF. The component reflexes of micturition in the cat. Parts I and II Brain 1931; 54:177–88.Google Scholar


  1. 1.
    Chapple CR, Helm CW, Blease S, Milroy EJG, Rikards D, Osborne JL. Asymptomatic bladder neck incompetence in nulliparous females. Br J Urol 1989; 64:357–60.PubMedCrossRefGoogle Scholar

Copyright information

© Royal College of Obstetricians and Gynaecologists 1990

Authors and Affiliations

  • S. Kulseng-Hanssen
  • B. Klevmark

There are no affiliations available

Personalised recommendations