Petros Peter
University of Western Australia School of Engineering and Mathematical Sciences, Perth, Australia.
Cent European J Urol. 2022;75(2):169-170. doi: 10.5173/ceju.2022.0107. Epub 2022 Jun 29.
The ongoing debate in "International Urogynecology Journal" about urethral closure mechanisms is important, because without a clear understanding of the anatomy of closure and stress urinary incontinence, the surgeon can never understand how corrective surgery works, or how to systematically address complications of such operations. The two dominant mechanisms which explain urethral closure rely either on Enhorning's 'pressure transmission theory', or musculo-elastic closure which relies on structurally sound suspensory ligaments. Pressure transmission hypotheses fail a simple test, "Why does the same raised intrabdominal pressure which 'closes the urethra' not stop micturition when the woman strains downwards?" Rather, it increases urine flow, a consequence of the relaxation of the forward closure muscle, pubococcygeus, which allows the posterior vectors levator plate/longitudinal muscle of the anus, to open out the urethra prior to micturition, while the raised pressure from straining drives the urine out faster.
《国际尿控协会杂志》上正在进行的关于尿道闭合机制的辩论很重要，因为如果对闭合解剖结构和压力性尿失禁没有清晰的认识，外科医生就永远无法理解矫正手术的原理，也不知道如何系统地处理此类手术的并发症。解释尿道闭合的两种主要机制，要么基于恩霍宁的“压力传递理论”，要么基于肌肉弹性闭合，而肌肉弹性闭合依赖于结构健全的悬吊韧带。压力传递假说无法通过一个简单的测试，即“当女性向下用力时，同样升高的腹内压‘闭合尿道’，为什么不会阻止排尿？”相反，它会增加尿流，这是前方闭合肌耻骨尾骨肌放松的结果，耻骨尾骨肌的放松使得后方的提肛板/肛门纵肌在排尿前打开尿道，而用力产生的升高压力则促使尿液更快排出。
