Thoughts on sphincteric function and comments on management of bladder outlet obstruction in the female.

Abstract

SUMMARY The mode of action of the bladder sphincter is not known but it seems to be more than a simple mechanical valve and may depend at least in part on some orderly pattern of muscular contraction, possibly of peristaltic nature, under autonomic control. A minor procedure for dealing with meatal stricture is described. Bougies a boule have been found of great assistance in the investigation of the female urethra, and passage of these bougies has been found to be the best method for demonstrating and locating a stricture. Very little mechanical strength is required to narrow the urethra and the fact that no stricture is detected by the passage of a cylindrical instrument is not valid evidence of the absence of a stricture. In the cine cystourethrogram a narrowing, with dilatation above, suggests the presence of a stricture, but strictures are not always displayed by this technique. In the short term, internal urethrotomy appears to be a most useful procedure for dealing with strictures, but it will be many years before its long term value will be fully assessed. The operation is simple and appears to be remarkably safe. YV-plasty should not be performed on the adult female except after the most careful and extensive investigation.