Abstract
The use of transvaginal ultrasound (7.5 MHz, linear array) during urethral instability enabled us to describe three movements that were seen during the urethral pressure drops: a shortening of the urethra (relaxation of the striated sphincter), an increase in the distance between the probe and the symphysis pubica (relaxation of the levator ani muscles) and a forward displacement of the “prepubien”. During ultrasound examinations (endovaginal and vulvar), the prepubien and its movements are easily visible in the space located between the external urethral meatus and the clitoris. The drop in urethral pressure is sometimes associated with an urgent need to urinate. In 75% of the patients, finger compression of the prepubien on the symphysis inhibited urethral instability and urgency. After all classic treatments for pollakiuria, nocturia and urge incontinence had failed, we tried to cut the prepubien in patients who were under general anesthesia. This operation was carried out in 19 women, of whom 13 were cured (68%), 5 showed improvement and 1 was a failure. Only two short-term side effects were observed: a sexual disability that lasted for 2 months and a labial haematoma.
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