By Sandip P. Vasavada, Rodney Appell, Peter K. Sand, Shlomo Raz
Seriously illustrated for transparent navigation and realizing of anatomical websites, surgical strategies, and reconstructive approaches, this reference experiences the surgical and nonsurgical overview and administration of varied issues affecting girl urinary and pelvic health-collecting priceless ideas, instructions, and top practices from over a hundred expert gurus for professional tips within the remedy of urinary incontinence, pelvic organ prolapse, and different dysfunctions.
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Additional resources for Female Urology, Urogynecology, and Voiding Dysfunction
However, more anatomical dissections are needed for this area. Classically, the autonomic nervous system has been regarded as a two-neuron system composed of two neuron models; preganglionic and postganglionic neurons. Elbadawi has nicely reviewed the anatomic aspects of the contemporary modifications of classical autonomic nervous system (7 –11). He stated that the muscular innervation of the lower urinary tract is derived exclusively from postganglionic neurons of what is called the urogenital short neuron system.
The sympathetic nervous system acts primarily to facilitate the filling and/or storage phase of micturition and does so by three mechanisms: (a) increasing accommodation by stimulation of b-adrenergic receptors in the bladder body; (b) increasing outlet resistance by stimulation of the predominantly a-adrenergic receptors in the bladder base and proximal urethra and by causing an increase in activity of striated muscle of the pelvic floor (“guarding reflex”); and (c) inhibiting bladder contractility by means of a blocking effect on parasympathetic ganglionic transmission (35,36).
In addition, the tensile forces of the urethropelvic ligaments along with the adjacent levator musculature facilitate compression of the proximal and midurethra. Finally, the striated musculature of the midurethral complex adds resting tone to the urethra, further effecting closure. Surrounding the sphincteric unit is skeletal musculature that provides an important additional mechanism for urethral closure. The striated musculature provides resting urethral tone as well as an involuntary reflex contraction in response to stress that increases coaptation.