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The alternation between urine retention and discharge several times
daily from a nappy to the cessation ofall vital functions only
becomes the subject baby's first wet of greater attention if the
harmony of the structure and function of the bladder is disturbed.
Functional disturbances of the lower urinary tract are not only of
great socio-economic importance, but are also a considerable
personal burden for the patient. Hence urinary incontinence is
rightly classified as a severelydisabling illness (Hauri 1985).
Opinions still differ regarding the morphological basis ofurinary
continence.The Terminologia Anatomica (1998) defines a musculus
sphincter urethrae internus (in- ternal urethral sphincter) and a
musculus sphincter urethrae externus (external ure- thral
sphincter),which in the older nomenclature were known as musculus
sphincter vesicae and musculussphincterurethrae,respectively.The
internal urethral sphincter isascribed apurelyinvoluntaryandthe
externalurethralsphincterapurelyvoluntary innervation. The
significance of the musculature of the pelvic floor for maintaining
urinarycontinence has notyetbeen ascertained. Duringnumerous
urologicaloperations (forinstancetransurethralresectionofthe
prostate and bladder neck incisions), the only involuntarily
innervated sphincter at the collum vesicae,the
internalurethralsphincter,is partiallyorcompletelydestroyed (Fig.
27C,D).All the patients remain continent as long as the
externalurethral sphinc- ter remains intact.Howcan
apurelyvoluntarilyinnervated sphincterlikethe external urethral
sphincter ensureconstant continence in such cases? Improving the
continence rate after radical surgery is a key topic of urological
research. The incontinence rate after radical prostatectomy is
still between 8.1% (third-degree incontinence) and41.4% (first- to
second-degree incontinence; Rudyet al. 1984; Igel et a1.1987;
Schroderand Ouden 1992).
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