Original scientific paper

IMAGING THE INTERNAL URETHRAL SPHINCTER AND THE VAGINA IN NORMAL WOMEN AND WOMEN SUFFERING FROM STRESS URINARY INCONTINENCE AND VAGINAL PROLAPSE

Abdel Karim M. El Hemaly ; Al Azhar University, Faculty of Medicine, 3 Emad El Din Kamel St, Nasr city, Post No:11371, Cairo, Egypt
Ibrahim M. Kandil ; Al Azhar University, Faculty of Medicine, Nasr city, Cairo, Egypt
Asim Kurjak ; Al Azhar University, Faculty of Medicine, Nasr city, Cairo, Egypt
Ahmad G. Serour ; Al Azhar University, Faculty of Medicine, Nasr city, Cairo, Egypt
Laila A.S. Mousa ; Al Azhar University, Faculty of Medicine, Nasr city, Cairo, Egypt
Amr M. Zaied ; Al Azhar University, Faculty of Medicine, Nasr city, Cairo, Egypt
Khalid Z. El Sheikha ; Al Azhar University, Faculty of Medicine, Nasr city, Cairo, Egypt

Abstract

Introduction. The internal urethral sphincter (IUS) is a cylinder formation that extends from the urinary bladder neck to the urogenital diaphragm. It is composed of a strong collagen sheet with muscle fibers that intermingle with the collagen in the middle of the cylinder’s thickness. The strong collagen sheet gives the IUS the high wall tension necessary to create the high urethral pressure. The muscle fibers, innervated by alpha sympathetic nerves (T10-L2) are responsible for closure and opening the urethra. Urinary continence depends on the presence of an intact and strong IUS and of an acquired behavior, gained by learning and training in early childhood, how to maintain a high alpha sympathetic tone at the IUS keeping it closed until there is a need. Normal vagina is a cylinder of collageno-elastic-muscular tissues. Its strong collagen sheet is responsible for keeping it in its normal upward position. Labors cause redundancy and weakness of the vaginal walls with subsequent prolapse and lacerations of the IUS which is intimately overlying the anterior vaginal wall resulting in stress urinary incontinence (SUI). Objectives. To image by 3D-US and MRI the IUS and the vagina; and to examine their histopathology. Methods. Histopathology as well as 3D-US and MR imaging are done. Results. Images show the IUS as a compact tissue cylinder that extends from the bladder neck to the urogenital diaphragm in continent women; IUS is torn in women with SUI. Conclusion. The anterior vaginal wall and the IUS are torn in patients with SUI and with vaginal prolapse. They are intact in continent women.

Keywords

internal urethral sphincter (IUS); three dimension ultrasound (3D-US); magnetic resonance image (MRI); vaginal prolapse; stress urinary incontinence (SUI)

Hrčak ID:

65964

URI

https://hrcak.srce.hr/65964

Publication date:

1.12.2009.

Article data in other languages: croatian

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