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**9** 

*Egypt* 

**The Concept and Pathophysiology** 

Abdel Karim M. El Hemaly\*, Laila A. Mousa and Ibrahim M. Kandil

We put forward a novel concept on the Pathophysiology of micturition, urinary continence and urinary incontinence 1-7. Urinary continence depends on two main factors, one inherent

The inherent factor is the presence of an intact and strong internal urethral sphincter (IUS). The IUS is a collagen-muscular tissue cylinder that extends from the bladder neck down to the perineal membrane. It gets its nerve supply from the alpha sympathetic nerves from the hypogastric plexus T10-L2. The collagen sheet, being the strongest tissue in the body, is to give the IUS its high wall tension necessary to create in the urethra the high urethral pressure. The muscle fibers lie on, intermingle with the collagen fibers in the middle of the cylinder thickness, and are responsible for closure and opening of the urethra in response to

The functions of the IUS are 1- to keep the urethra closed and empty all the time due to the high alpha sympathetic tone gained by learning and training early in childhood. 2- On relaxation to open the urethra to allow voiding. In women, the IUS is intimately lying on the

The acquired factor is an acquired behavior gained by learning and training in early childhood how to maintain a high alpha sympathetic tone at the IUS to keep it closed and

Micturition develops in two stages. First stage is uncontrolled reflex, which then gets central

As the urinary bladder fills afferent sensations travel along the pelvic parasympathetic nerves (S. 2, 3 & 4) to the spinal cord. When it is full efferent pelvic parasympathetic nerve

empty all the time until there is a desire or a need to void.

**1. Introduction** 

and one acquired.

alpha sympathetic tone.

anterior vaginal wall.

**2. Micturition** 

 \*

control in the second stage. First stage of micturition: 2,

Corresponding Author

**of Urinary Incontinence** 

*FRCS-MRCOG, Ob/Gyn Al Azhar University, Cairo,* 

