DeLancey J O
Department of Obstetrics and Gynecology, University of Michigan Medical School.
Am J Obstet Gynecol. 1994 Jun;170(6):1713-20; discussion 1720-3. doi: 10.1016/s0002-9378(94)70346-9.
This study examines the anatomic factors that could explain the mechanical basis for transmission of abdominal pressure to the urethra.
Dissection of 19 embalmed and 42 fresh cadavers and examination of 13 sets of serial pelvic sections were performed to study the structures involved in urethral support. The effect of simulated increases in abdominal pressure on the pelvic floor and urethra was observed in fresh specimens.
The urethra lies on a supportive layer that is composed of the endopelvic fascia and the anterior vaginal wall. This layer gains structural stability through its lateral attachment to the arcus tendineus fascia pelvis and levator ani muscle. Pressure from above compresses the urethra against this hammock-like supportive layer, compressing its lumen closed. The stability of the suburethral layer depends on the intact connection of the vaginal wall and endopelvic fascia to the arcus tendineus fasciae pelvis and levator ani muscles.
Increases in urethral closure pressure during a cough probably arise because the urethra is compressed against a hammock-like supportive layer, rather than the urethra being truly "intraabdominal."
本研究探讨可解释腹压传导至尿道的力学基础的解剖学因素。
对19具防腐尸体和42具新鲜尸体进行解剖，并对13套盆腔连续切片进行检查，以研究参与尿道支撑的结构。在新鲜标本中观察模拟腹压增加对盆底和尿道的影响。
尿道位于由盆内筋膜和阴道前壁组成的支撑层上。该层通过其与耻骨筋膜弓和肛提肌的外侧附着而获得结构稳定性。来自上方的压力将尿道压向这个吊床样的支撑层，压缩其管腔使其闭合。尿道下支撑层的稳定性取决于阴道壁和盆内筋膜与耻骨筋膜弓和肛提肌的完整连接。
咳嗽时尿道闭合压升高可能是因为尿道被压向吊床样支撑层，而非尿道真正处于“腹腔内”。
