Cruikshank S H, Kovac S R
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, OH, USA.
Am J Obstet Gynecol. 1997 Jun;176(6):1200-3; discussion 1203-5. doi: 10.1016/s0002-9378(97)70335-1.
This clinical study examines and defines the functional anatomy of the urethra as it relates to the Valsalva and Kegel maneuvers and to urethral stability.
Dissection of embalmed cadavers and examination of 60 patients were performed to study adjunct structures in urethral stability. Provocative maneuvers (Valsalva and Kegel) were used in all 60 patients. Urethral prolapse was graded with use of the international Continence-Society classification.
Cadaveric dissection confirmed the structural anatomy of the pubourethral muscles and ligaments. Physical examination in 30 patients revealed a lack of urethral stability in all patients with stress urinary incontinence. In 30 patients acting as normal controls, no urinary incontinence was present, and all maintained urethral stability with provocation. The urethrovesical junction was mobile in all patients in performing a Valsalva maneuver.
Intact pubourethral ligamentous and muscular attachments aid in stabilizing the urethra to its normal anatomic position. This helps maintain continence.
本临床研究旨在检查并确定尿道的功能解剖结构，及其与瓦尔萨尔瓦动作、凯格尔运动和尿道稳定性的关系。
对防腐尸体进行解剖，并对60例患者进行检查，以研究尿道稳定性的辅助结构。所有60例患者均采用激发动作（瓦尔萨尔瓦动作和凯格尔运动）。使用国际尿失禁学会的分类方法对尿道脱垂进行分级。
尸体解剖证实了耻骨尿道肌和韧带的结构解剖。对30例患者的体格检查发现，所有压力性尿失禁患者均存在尿道稳定性不足。在30例作为正常对照的患者中，无尿失禁情况，且所有患者在激发动作时均保持尿道稳定性。在进行瓦尔萨尔瓦动作时，所有患者的尿道膀胱连接部均可活动。
完整的耻骨尿道韧带和肌肉附着有助于将尿道稳定在其正常解剖位置。这有助于维持控尿。
