A NEW THEORY OF MICTURITION AND URINARY CONTINENCE BASED ON HISTOMORPHOLOGICAL STUDIES .1. THE MUSCULUS DETRUSOR VESICAE - OCCLUSIVE FUNCTION OR SUPPORT OF MICTURITION

Micturition and urinary continence theories have been under discussion since the last century. Up to now all these theories have been unsati sfactory. There is an obvious discrepance between the anatomical prese ntation and the clinical perceptions and physiological phenomena. This was the reason for a renewed and global examination of the whole dist al urinary tract. The results are published in five successive papers. Our own examinations are based on 30,000 serial sections of the bladd er neck taken from 65 male and female cadavers of all age groups. The muscle system of the urinary bladder consists of a network of smooth m uscle cells forming three layers. Caudally the longitudinal muscle lay ers form two special recently described structures: the collare vesica e and nodus vesicae. None of the muscle systems of the urinary bladder leaves the spatial dimension of the organ. Simply two anatomical stru ctures fix the urinary bladder in the pelvis. Dorsally it is the muscu lus vesicoprostaticus and the musculus vesicovaginalis, respectively; ventrally the existence of the musculi pubovesicales is introduced. Th ere is no involvement of the lamellas of the bladder muscles in the fo rmation of the urinary sphincter. Therefore the morphological substrat e for a hitherto generally acknowledged contribution of the detrusor v esicae to the active continence function does not exist.