The Basic And Clinical Study Of Female Urinary Continent Mechanism In Female Orthotopic Urinary Diversion

Objective: To study the morphological mechanism of urinary continence and the clinical applied effects in female orthotopic urinary diversion. To investigate the pelvic autonomic nerve and pudendal nerve to female urethra in female corpse, including their composing, distributing, dominating range, the point of its come into the urethra and their neighbors. We also study the composing, morphologic and component of urinary continent muscles and their relationship between the vagina and the pelvic floor muscles. Based on the basical study, the clinical effects of orthotopic urinary diversion in women were also investigated.Methods: 1, The gross anatomy had been done on 20 female cadavers. In each cadaver, the dissection proceeded from both perineal approach and intrapelvic approach. The perineal dissection involved isolating the pudendal nerve exiting the pudendal canal (Alcock' Canal) and tracing the terminal branches through the ischiorectal fossa and its terminal branches to the urethra. After the perineal dissection, parasagittal section of each en bloc pelvis allowed wide exposure for the intrapelvic dissection. Beginning from the vertebral column, the individual sacral nerve roots (S1-S4) were isolated. The pelvic nerve, taking origin from the inferior hypogastric plexus, was then followed along the lateral rectum, and was traced in detail as its branches approached the urinary sphincter complex. Deep to the course of the pelvic nerve, the pudendal nerve was identified running in the pudendal canal and was finally traced in its intrapelvic course and into the schiorectal fossa. 2, With the nerve to the urinary sphincter complex (the continence nerve) exposed, mock retropubic operations were performed to identify any surgical maneuvers that might damage the nerves and muscles. 3, Checking the whole female lower urinary grossly and in pathology, we collected the representative specimens of presumptive nerve tissue for histologic examination. Longitudinal and transverse sections made from representative nerve samples were stained with hematoxylin-eosin, PTAH, Modified...