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

Autor: Abdel Karim M. El Hemaly, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A.S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha
Jazyk: angličtina
Rok vydání: 2009
Předmět:
Zdroj: Gynaecologia et perinatologia : journal for gynaecology, perinatology, reproductive medicine and ultrasonic diagnostics
Volume 18
Issue 4
ISSN: 1330-0091
Popis: 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.
Uvod. Unutrašnji uretralni sfinkter (IUS) je cilindričnog oblika, proteže se od vrata mokraćnog mjegura do urogenitalne dijafragme. Sastoji se od čvrstog kolagenog sloja s mišićnim vlaknima koja su izmiješana s kolagenom u sredini debljine cilindra. Jaki kolageni sloj daje IUS-u snažnu napetost stijenke potrebnu da stvori visoki intrauretralni tlak. Mišićna vlakna, inervirana alfa simpatičnim živcima (Th10-L2) su odgovorna za zatvaranje i otvaranje uretre. Kontinencija mokraće ovisi o postojanju intaktnog i jakog IUS-a te o stečenom ponašanju, učeći i vježbajući u ranom djetinjstvu kako održati visoki alfa simpatički tonus IUS-a, držeći ga zatvorenim dok je potrebno. Normalna vagina je cilindrična cijev kolageno-elastično-mišićnog tkiva. Njen jaki kolageni sloj je odgovoran za njen uspravni položaj. Porod uzrokuje suvišak i slabost vaginalne stijenke s posljedičnim prolapsom i laceracijom IUS-a, koji intimno prileži prednjoj vaginalnoj stijenci, što rezultira stresnom mokraćnom inkontinencijom (SUI). Cilj istraživanja. Prikazati trodimenzionalnim ultrazvukom (3D-UZ) i magnetskom rezonancijom (MR) te histopatološkim pregledom intrauretralni sfinkter i vaginu. Metode. Histopatološka tehnika te 3D-UZ i MR prikazi. Rezultati. Prikazi pokazuju IUS kao kompaktni tkivni cilindar koji se proteže od vrata mokraćnog mjehura do urogenitalne dijafragme u kontinentnih žena; IUS je oštećen u žena sa SUI. Zaključak. Prednja vaginalna stijenka i IUS bivaju oštećeni (prsnuti) u pacijentica sa SUI i s vaginalnim prolapsom. Oni su intaktni u kontinentnih žena.
Databáze: OpenAIRE
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