Mostwin J L
James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Urol Clin North Am. 1991 May;18(2):175-95.
The female urinary bladder and urethra are situated on the intrapelvic surface of the anterior vaginal wall, firmly anchored to the distal vagina by the urogenital diaphragm and to the superior vagina at the vesicocervicouterine junction. The anterior surface of the proximal urethra is firmly anchored to the posterior aspect of the symphysis pubis by the pubourethral ligaments and to the remaining distal vagina by the lower two thirds of the urogenital diaphragm. The lateral bladder wall derives its support from the anterior vaginal wall attachments to the pelvic sidewall. The anterior vaginal wall is strongly supported by pubococcygeus muscle fibers inserting on the vaginal wall and the genital hiatus and by the cardinal and uterosacral ligaments. Vaginal detachment from the lateral pelvic sidewall can result in herniation, with accompanying secondary posterior bladder descent. Levator ani weakness or injury may be a contributing etiologic factor in the genesis of vaginal wall detachment and the development of stress incontinence.
女性膀胱和尿道位于阴道前壁的盆腔内表面，通过泌尿生殖膈牢固地附着于阴道远端，并在膀胱宫颈子宫交界处附着于阴道上段。近端尿道的前表面通过耻骨尿道韧带牢固地附着于耻骨联合的后方，并通过泌尿生殖膈的下三分之二附着于其余的远端阴道。膀胱外侧壁由阴道前壁与盆腔侧壁的附着处提供支撑。阴道前壁由插入阴道壁和生殖裂孔的耻骨尾骨肌纤维以及主韧带和子宫骶韧带提供强有力的支撑。阴道从盆腔侧壁外侧分离可导致疝形成，并伴有继发性膀胱后脱垂。肛提肌无力或损伤可能是阴道壁分离和压力性尿失禁发生的一个促成病因。
