el-Sayed Rania Farouk, Morsy Medhat M, el-Mashed Sahar M, Abdel-Azim Mohamed S
Department of Radiology, Faculty of Medicine, Cairo University, Kaser El Aini St., Cairo 11511, Egypt.
AJR Am J Roentgenol. 2007 Nov;189(5):1145-57. doi: 10.2214/AJR.07.2215.
There has been no uniformity of opinion concerning the structures supporting the female urethra. Therefore, the aims of this prospective study were to define precisely the female urethral support structures at cadaveric anatomic dissection and histologic examination and to determine which of these structures can be detected on MRI of cadaveric specimens and of healthy volunteers.
Dissection of seven formalin-preserved cadavers (age at death, 25-50 years; no parity history available) was performed by a professor of anatomy to explore the anatomy of the urethral supporting ligaments and was followed by MRI of the cadaveric specimens with ligamentous markers in place and then by histologic analysis of the dissected ligaments. MRI of 17 healthy nulliparous women (age range, 20-35 years; mean age, 25.5 years) was then performed using T2-weighted, dual turbo spin-echo, balanced fast-field echo, and STIR sequences. A standardized grid system that allowed us to record structural observations on sequentially numbered axial MR images was used by a radiologist who then applied a 4-point grading scale to assess ligament visibility. Three authors--one radiologist, one anatomist, and one urologist--then compared the appearance of each ligament seen in a cadaveric specimen with its appearance on MR images of the same cadaver and on MR images of volunteers.
At cadaveric dissection we identified ventral and dorsal urethral ligaments. The ventral urethral ligaments included the pubourethral ligaments, which were found to consist of three separate components coursing anteroposterior from the bladder neck to the pubic bone; the periurethral ligament; and the paraurethral ligaments. Dorsal to the urethra, a slinglike ligament, which we believe should be named the "suburethral ligament," was identified. This ligament had a distinct plane of cleavage from the anterior vaginal wall. The MRI findings in the volunteers correlated with the MRI and gross anatomic findings in the cadavers. The proximal pubourethral, periurethral, paraurethral, and suburethral ligaments had visibility scores of 3 (moderately visible) or 4 (easily visible) on MRI in 47%, 65%, 47%, and 53% of volunteers, respectively.
Our results present evidence that may help resolve previous controversies regarding the MR appearance of the ventral urethral ligaments and that better define the course of the ligament dorsal to the urethra, the suburethral ligament. We hope that this detailed anatomic information about the structures involved in continence may lead eventually to improvements in the treatments for women with stress urinary incontinence.
关于支撑女性尿道的结构，目前尚无统一观点。因此，本前瞻性研究的目的是在尸体解剖和组织学检查中精确界定女性尿道支撑结构，并确定这些结构中哪些可在尸体标本及健康志愿者的磁共振成像（MRI）中被检测到。
由一位解剖学教授对7具用福尔马林保存的尸体（死亡年龄25 - 50岁；无生育史）进行解剖，以探究尿道支撑韧带的解剖结构，随后对带有韧带标记物的尸体标本进行MRI检查，接着对解剖后的韧带进行组织学分析。然后对17名健康未生育女性（年龄范围20 - 35岁；平均年龄25.5岁）进行MRI检查，采用T2加权、双涡轮自旋回波、平衡快速场回波和短TI反转恢复（STIR）序列。一名放射科医生使用标准化网格系统，该系统使我们能够在按顺序编号的轴向MR图像上记录结构观察结果，然后应用4分制评分量表评估韧带的可见性。三位作者——一名放射科医生、一名解剖学家和一名泌尿科医生——随后将尸体标本中每条韧带的外观与其在同一具尸体的MR图像以及志愿者的MR图像上的外观进行比较。
在尸体解剖中，我们识别出腹侧和背侧尿道韧带。腹侧尿道韧带包括耻骨尿道韧带，发现其由从膀胱颈到耻骨前后走行的三个独立部分组成；尿道周围韧带；以及尿道旁韧带。在尿道背侧，识别出一条吊带样韧带，我们认为应将其命名为“尿道下韧带”。该韧带与阴道前壁有明显的分离平面。志愿者的MRI结果与尸体的MRI及大体解剖结果相关。在志愿者中，近端耻骨尿道韧带、尿道周围韧带、尿道旁韧带和尿道下韧带在MRI上的可见性评分分别为3分（中度可见）或4分（容易可见）的比例分别为47%、65%、47%和53%。
我们的结果提供了证据，可能有助于解决先前关于腹侧尿道韧带MR表现的争议，并更好地界定尿道背侧韧带即尿道下韧带的走行。我们希望这些关于参与控尿的结构的详细解剖信息最终能改善压力性尿失禁女性的治疗方法。
