Skip to main content
SpringerLink
Log in

On the Physioanatomy of Micturition and Urinary Continence-New Concepts

  • Chapter
Bladder Disease, Part A

  • 308 Accesses

Abstract

The functions of the lower urinary tract are governed by a complex set of co- and interacting mechanisms. Many theories have sought to explain the mechanisms of urine storage and expulsion,21,22,26,28,34,71,79,81 but, probably due to as yet incomplete exploration of the anatomy and physiology of pelvic floor musculature, none has proved entirely satisfactory. For this reason, there is still much morbidity in the form of evacuation disorders and incontinence resulting from dysfunction of the urinary bladder opening and closing apparatus. This communication reviews new concepts of the mechanisms of continence and micturition that have been recently advanced on the basis of new anatomical and physiological findings.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Barrington FJF: Component reflexes in the micturition of the cat. Quart J Exp Physiol, 54:177, 1931.

    Google Scholar 

  2. Boyarsky S, Labay P: Ureteral dynamics. Baltimore: The Williams & Wilkins Co; p. 354, 1972.

    Google Scholar 

  3. Critchley MOD, Dixon JF, Gosling JA: Comparative study of the periurethral and perianal parts of the human levator ani muscle. Urol Int, 35:226, 1980.

    Article  PubMed  CAS  Google Scholar 

  4. De Groat WE, Ryall RW: Reflexes to sacral parasympathetic neurons concerned with micturition in the cat. J Physiol, 200:87, 1969.

    PubMed  Google Scholar 

  5. Denny-Brown D, Robertson EG: The state of the bladder and its sphincters in complete transverselesions of the spinal cord andcauda equina. Brain, 50:397, 1933.

    Article  Google Scholar 

  6. Donker PJ, Droes J, Van Ulden BM: Anatomy of the musculature and innervation of the bladder and the urethra. In: Williams DI, Chisholm GD, editors. Scientific Foundations of Urology. Vol II. London: Heinemann; p. 32, 1976.

    Google Scholar 

  7. Elbadawi A, Schenk EA: Parasympathetic and sympathetic postganglionic synapses in ureterovesical autonomic pathways. Zellforschung, 146:147, 1973.

    Article  Google Scholar 

  8. Feher E, Magasi P, Kontz P: Innervation of the ureterovesical junction musculature of man. Acta Morph Acad Sci Hung, 27:1, 1979.

    CAS  Google Scholar 

  9. Floyd WF, Walls EW: Electromyography of the sphincter an externus in man. J Physiol, 122:599, 1953.

    PubMed  CAS  Google Scholar 

  10. Gjone R: Peripheral autonomic influence on the motility of the urinary bladder in the cat. Ill Micturition Acta Physiol Scand, 66:81, 1966.

    Article  CAS  Google Scholar 

  11. Gleason DM, Bottaccini MR: The vital role of the distal urethral segment in the control of urinary flow rate. J Urol, 100:167, 1968.

    PubMed  CAS  Google Scholar 

  12. Goldberg SM, Gordon PH, Nivatvongs S: Anorectal Physiology. In: Goldberg SM, Gordon PH, Nivatvongs S, editors. Essentials of Anorectal Surgery. Philadelphia: JB Lippincott Co; p. 21, 1980.

    Google Scholar 

  13. Gosling JA, Dixon JS, Dunn M: Structure of the rabbits’ urinary bladder after experimental distension. Invest Urol, 14:386, 1977.

    PubMed  CAS  Google Scholar 

  14. Gosling JA, Dixon JS, Lendon RG: The autonomic innervation of the human male and female bladder neck and proximal urethral. J Urol, 118:302, 1977.

    PubMed  CAS  Google Scholar 

  15. Gosling JA, Dixon JS, Critchley, Hod, Thompson, SA: A comparative study of the human external and periurethral levator ani muscles. Br J Urol, 53:35, 1981.

    Article  PubMed  CAS  Google Scholar 

  16. Gosling JA: Structure and function of bladder and urethra. Urol Clin North AM, 6:31, 1979.

    PubMed  CAS  Google Scholar 

  17. Griffiths DJ, Notschaele C: The mechanics of urine transport in the upper urinary tract: I. The mechanics of the isolated bolus. Neurourol Urodynam, 2:155, 1983.

    Article  Google Scholar 

  18. Gudziak MR, McGuire EJ, Gormley EA: Urodynamic assessment of urethral sphincter function in post prostatectomy incontinence. J Urol, 156:1131, 1996.

    Article  PubMed  CAS  Google Scholar 

  19. Hodges CV: Surgical anatomy of the urinary bladder and pelvic ureter. S Clin North Am, 44:1327, 1964.

    Google Scholar 

  20. Homsy GE: The dynamics of the ureterovesical and vesicoureteral junctions: 1. The role of the trigone and crista urethralis. Invest Urol, 4:399, 1967.

    PubMed  CAS  Google Scholar 

  21. Hutch JA, Rambo ON: A new theory of the anatomy of the internal urinary sphincter and the physiology of micturition. III. Anatomy of the urethra. J Urol, 97:696, 1967.

    PubMed  CAS  Google Scholar 

  22. Hutch JA: A new theory of the anatomy of the internal urinary sphincter and the physiology of micturition II. The base plate. J Urol, 96:182, 1966.

    Google Scholar 

  23. Jeffcoate TNA, Roberts H: Observations on stress incntinence of urine. Am J Obst Gynecol, 64:721, 1952.

    CAS  Google Scholar 

  24. Kawakami M: Electromyographic investigation of the human external sphincter muscle of anus. Japanese J Physiol, 4:1961, 1954.

    Google Scholar 

  25. Kaye KW, Milne N, Greed K, Van Der Werf B: The ‘urogenital diaphragm’, striated urethral sphincter and radical prostatectomy. Aust New Zeal J Surg, 67:40, 1997.

    Article  PubMed  CAS  Google Scholar 

  26. Kennedy WT: Muscle of micturition: its role in sphincter mechanism with reference to incontinence in female. Am J Obst Gynec, 52:206, 1946.

    CAS  Google Scholar 

  27. King LR, Levitt, SB: Vesicoureteric reflux, Megaureter and Ureteral Reimplantation. In: Walsh PC, Gittes RF, Perlmutter AD, editors. Campbell’s Urology. 5th ed. Philadelphia: WB Saunders Company; p 2031–2088, 1986.

    Google Scholar 

  28. Lapides J, Sweet RB, Lewis, LW: Role of striated muscle in urination. J Urol, 77:247, 1957.

    PubMed  CAS  Google Scholar 

  29. McGuire EJ, Savastano JA: Urodynamic findings and clinical status following vesical denervation procedures for control of incontinence J Urol, 132:87, 1984.

    PubMed  CAS  Google Scholar 

  30. McGuire EJ, Fitzpatrick CC, Wan J, Bloom D, Sanvordenker J, Ritchey M, et al: Clinical assessment of urethral sphincter function. J Urol, 150:1452, 1993.

    PubMed  CAS  Google Scholar 

  31. McGuire EJ: Physiology of the lower urinary tract. Am J Kid Dis, 2:402, 1983.

    PubMed  CAS  Google Scholar 

  32. McMinn RMH: Male urogenital region. In: McMinn RMH, editors. Last’s Anatomy: Regional and Applied. 8th ed Edinburgh: Churchill Livingstone; p. 407, 1990.

    Google Scholar 

  33. McMinn RMH: Thorax. In: McMinn RMH, editors. Last’s Anatomy. Regional and Applied. 8th ed. UK: Churchill Livingstone, p. 277–278, 1990.

    Google Scholar 

  34. Muellner SR, Fleischner FG: Normal and abnormal micturition: A study of bladder behaviour by means of the fluoroscope. J Urol, 61:233, 1949.

    PubMed  CAS  Google Scholar 

  35. Presti JC Jr, Schmidt RA, Narayan PA, Carroll FR, Tanagho EA: Pathophysiology of urinary incontinence after radical prostatectomy J Urol, 143:975, 1990.

    PubMed  Google Scholar 

  36. Ruskin AP, Davis, JC: Anal sphincter electromyography. Electroencephalography Clin Neurophysiol, 27:713, 1969.

    CAS  Google Scholar 

  37. Shafik A: Pelvic double-sphincter control complex: theory of pelvic organ continence with clinical application. Urology, 23:611, 1984.

    Article  PubMed  CAS  Google Scholar 

  38. Shafik A: A study of the continent mechanism of the external urethral sphincter with identification of the ‘voluntary urinary inhibition reflex’. J Urol, 162:1967, 1999.

    Article  PubMed  CAS  Google Scholar 

  39. Shafik A: Straining-levator reflex. The description of a new reflex and its clinical significance. Coloproctology, 13:314, 1991.

    Google Scholar 

  40. Shafik A: Study of the effect of external urethral sphincter contraction on the mechanical activity of the ureterovesical junction and urinary bladder. Recognition of the sphinctero-ureterovesical reflex. Urology, 50:949, 1997.

    Article  PubMed  CAS  Google Scholar 

  41. Shafik A: Electrovesicography in interstitial cystitis. Urol Int, 54:66, 1995.

    Article  PubMed  CAS  Google Scholar 

  42. Shafik A: Sigmoidorectal junction reflex. Role in defecation mechanism. Clin Anat, 9:391, 1996.

    Article  PubMed  CAS  Google Scholar 

  43. Shafik A, El-Sibai O: New physioanatomical aspects of the urinary sphincter apparatus and the micturition mechanism. II. Levator ani muscle: role in the mechanism of micturition. Eg Med J, 3:31, 1986.

    Google Scholar 

  44. Shafik A, Gamal MA, El-Bagoury EM, Abdel Hamid Z, Metwalli S, Olfat S: A new concept of the anatomy of the anal sphincter mechanism and physiology of defecation XLIV. The involuntary action of the external anal sphincter. Histologic study. Acta Anat, 138:359, 1990.

    Article  PubMed  CAS  Google Scholar 

  45. Shafik A, El-Sibai O: New physioanatomical aspects of the urinary sphincter apparatus and the micturition mechanism. I. Anatomy of the external urethral sphincter. Eg Med J, 3:147, 1986.

    Google Scholar 

  46. Shafik A, Gamal MA, Olfat S, Abdel Hamid Z, El-Said B: A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XLVI. The involuntary action of the external anal sphincter. Manometric and electromyographic studies. Eur Surg Res, 24:188, 1992.

    Article  PubMed  CAS  Google Scholar 

  47. Shafik A: Electrovesicogram in the neurogenic bladder. J Invest Surg, 9:481, 1996.

    Article  PubMed  CAS  Google Scholar 

  48. Shafik A: Micturition and urinary continence. New concepts. Int Urogynecol J, 3:168, 1992.

    Article  Google Scholar 

  49. Shafik A: Role of the trigone in micturition. J Endourol, 12:273, 1998.

    Article  PubMed  CAS  Google Scholar 

  50. Shafik A: Stress urinary incontinence: an alternative concept of pathogenesis. Int Urogynecol J, 5:3, 1995.

    Article  Google Scholar 

  51. Shafik A: Study of the effect of vesical filling and voiding on uretero-vesical junctions and internal urethral meatus. The ‘filling’ and ‘meato-vesico-ureteral’ reflexes. Int J Urol, 5:449, 1998.

    Article  PubMed  CAS  Google Scholar 

  52. Shafik A: Study of the electromechanical activity of the urinary bladder. Experimental study. World J Urol, 12:316, 1994.

    Article  PubMed  CAS  Google Scholar 

  53. Shafik A: A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Mass contraction of the pelvic floor muscles. Int Urogynecol J, 9:28, 1998.

    Article  CAS  Google Scholar 

  54. Shafik A: A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VIII. Levator hiatus and tunnel: anatomy and function. Dis Colon Rectum, 22:539, 1979.

    Article  PubMed  CAS  Google Scholar 

  55. Shafik A: A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. I. The external anal sphincter: a triple loop system. Invest Urol, 12:412, 1975.

    PubMed  CAS  Google Scholar 

  56. Shafik A: A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XII. Anorectal mobilization: a new surgical access to rectal lesions. Am J Surg, 142:629, 1981.

    Article  PubMed  CAS  Google Scholar 

  57. Shafik A: A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XXV. Anorectal mobilization in the treatment of rectal lesions: further study. Coloproctology, 7:107, 1985.

    Google Scholar 

  58. Shafik A: Levator-puborectalis reflex. The description of a new reflex and its clinical significance. Pract Gastroenterol, 15:28, 1991.

    Google Scholar 

  59. Shafik A: Levator-urethral reflex. A new reflex with clinical significance. Urology, 36:93, 1990.

    Article  PubMed  CAS  Google Scholar 

  60. Shafik A: Straining-urethral reflex. The description of a reflex and its clinical significance. Acta Anat, 140:104, 1991.

    Article  PubMed  CAS  Google Scholar 

  61. Shafik A: Study on the origin of the external anal, urethral, vaginal and prostatic sphincters. Int Urogynecol J, 8:126, 1997.

    Article  CAS  Google Scholar 

  62. Shafik A: The role of the levator ani muscle in evacuation, sexual performance and pelvic floor disorders. Review article. Int Urogynecol J, 11:6, 2000.

    Article  Google Scholar 

  63. Shafik A: Ureterovesical junction inhibitory reflex and vesicoureteral junction excitatory reflex: Description of two reflexes and their role in the ureteric antireflux mechanism. Urol Res, 24:339, 1996.

    Article  PubMed  CAS  Google Scholar 

  64. Shafik A: Urethral dilating and closing reflexes. Description and clinical significance of new urethral reflexes. World J Urol, 9:105, 1991.

    Article  Google Scholar 

  65. Shafik A: Vesico-levator reflex. The description of a new reflex and its clinical significance. Preliminary study. Urology, 41:96, 1993.

    Article  PubMed  CAS  Google Scholar 

  66. Shafik A: Vesico-puborectalis reflex. The description of a new reflex and its clinical significance. Preliminary report. Urologia, 63:259, 1996.

    Google Scholar 

  67. Shafik A: A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. II Anatomy of the levator ani muscle with special reference to puborectalis. Invest Urol, 18:175, 1975.

    Google Scholar 

  68. Snell RS: The perineum. In: Snell RS, editors. Clinical Anatomy for Medical Students. 5th ed. Boston: Little Brown & Co; p. 460, 1995.

    Google Scholar 

  69. Strasser H, Klima G, Poisel S, Horninger W, Bartsch G: Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate, 28:24, 1996.

    Article  PubMed  CAS  Google Scholar 

  70. Tanagho EA, Hutch JA: Primary reflux J Urol, 93:158, 1965.

    CAS  Google Scholar 

  71. Tanagho EA, Smith DR: The anatomy and function of the bladder neck. Br J Urol, 38:54, 1966.

    Article  PubMed  CAS  Google Scholar 

  72. Tanagho EA, Hutch JA, Meyers FH, Rambo ON Jr: Primary vesicoureteral reflux: experimental study of its etiology J Urol, 93:165, 1965.

    PubMed  CAS  Google Scholar 

  73. Tanagho EA, Meyers FA, Smith, DR: Urethral resistance: its components and implications. I. Smooth muscle component. Invest Urol, 7:195, 1969.

    PubMed  CAS  Google Scholar 

  74. Tanagho FA, Meyers FH, Smith DR: The trigone: anatomical and physiological considerations. I. In relation to the ureterovesical junction J Urol, 100:623, 1968.

    PubMed  CAS  Google Scholar 

  75. Tang PC, Ruch TC: Non-neurogenic basis of bladder tonus. Am J Physiol, 181:249, 1955.

    PubMed  CAS  Google Scholar 

  76. Taverner D, Smiddy FG: An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm. Dis Col Rect, 2:153, 1959.

    Article  CAS  Google Scholar 

  77. Warwick R, Williams PL. In: Warwick R, Williams PL, editors. Gray’s Anatomy. 35th ed. Edinburgh: Longman Group Ltd; p. 347, 1975.

    Google Scholar 

  78. Warwick R, Williams PL. In: Gray’s Anatomy. 35th ed. Edinburgh: Longman Group Ltd; p. 190, 1975.

    Google Scholar 

  79. Wesson MB: Anatomical, embryological and physiological studies of the trigone and neck of the bladder. J Urol, 4:279, 1920.

    Google Scholar 

  80. Whitaker RH: Methods of assessing obstruction in dilated ureters. Br J Urol, 45:15, 1973.

    PubMed  CAS  Google Scholar 

  81. Woodburne RT: Structure and function of the urinary bladder. J Urol, 84:79, 1960.

    Google Scholar 

  82. Young B: Lower urinary tract obstruction in childhood. Philadelphia: Lea & Febiger, 1972.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery and Experimental Research, Cairo University Faculty of Medicine, Cairo, Egypt

    Ahmed Shafik

Authors
  1. Ahmed Shafik
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA

    Anthony Atala

  2. Ridgefield, Connecticut, USA

    Debra Slade

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer Science+Business Media New York

About this chapter

Cite this chapter

Shafik, A. (2003). On the Physioanatomy of Micturition and Urinary Continence-New Concepts. In: Atala, A., Slade, D. (eds) Bladder Disease, Part A. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-8889-8_28

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-8889-8_28

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-4707-1

  • Online ISBN: 978-1-4419-8889-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation