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Les fonctions sphinctériennes pp 71–89Cite as

Exploration urodynamique de la fonction sphinctérienne

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Abstrait

La fonction sphinctérienne de ľurètre est ľun des éléments fondamentaux de la continence urinaire, tout particulièrement chez la femme. Ľexistence ďun gradient urétrovésical constamment positif permet ďassurer une continence tant au repos que lors des efforts. La pression urétrale est assurée par des éléments actifs muscularies, intrinsèques et extrinsèques, et des éléments passifs constitués par des structures viscoélastiques permettant ľobturation de ľurètre pendant la phase de remplissage et son relâchement pendant la miction. Si au repos le tonus de base est assuré par la musculature lisse dépendant ďune régulation alpha-adrénergique, lors des efforts la pression intra-urétrale est assurée, ďune part par la conformation anatomique elle-même (écrasement du col) et, ďautre part par les forces de cisaillement musculaires et ligamentaires contraignant ľurètre grâce aux possibilités ďobturation permises par sa viscoélasticité. Ľaugmentation des pressions vésicales lors de ľeffort est précédée ďune augmentation des résistances urétrales généré par une contraction anticipative des muscles péri-urétraux et périnéaux, permettant le maintien du gradient vésico-urétral. Cette activité préprogrammée dans le système nerveux central est ľun des éléments majeurs de la continence urinaire. Un déficit du tonus de base et/ou de la contraction anticipative conduit à une incontinence le plus souvent liée à ľeffort. À ľinverse, une augmentation des résistances sphinctériennes, normalement nulles lors de la miction grâchement synergique du sphincter urétral lors de la contraction détrusorienne, conduit à une dysurie, voire à une rétention par hypertonie urétrale et dyssynergie vésicosphinctérienne. Il est dès lors très tentant ďévaluer ces résistances urétrales et le comportement dynamique de ce sphincter lors des troubles mictionnels, qu’il s’agisse ďincontinence ou de rétention urinaires.

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Authors
  1. G. Amarenco
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  2. F. Haab
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  3. J.-F. Hermieu
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  4. S. Sheikh Ismael
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Amarenco, G., Haab, F., Hermieu, JF., Ismael, S.S. (2006). Exploration urodynamique de la fonction sphinctérienne. In: Les fonctions sphinctériennes. Collection de L’Académie Européenne de Médecine de Réadaptation. Springer, Paris. https://doi.org/10.1007/978-2-287-37362-6_6

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