TERMINAL NERVE DISTRIBUTION TO THE URETHRA AND BLADDER NECK - CONSIDERATIONS IN THE MANAGEMENT OF STRESS URINARY-INCONTINENCE

Purpose: Recent reports have suggested an increased incidence of intri nsic sphincter dysfunction, most of which seems to appear following th e failure of a previous, usually vaginal, surgical repair. Our studies attempt to define more precisely the neuroanatomical relationships th at exist in the region of the bladder neck and proximal urethra, and b etween the urethra and anterior vaginal wall. Materials and Methods: W e dissected the pelves of adult female cadavers and step sectioned the m at 4 mm. intervals. Several staining methods were used on each secti on to identify and document the position of the nerves and vascular st ructures between the vaginal wall and urethra. Results: A rich plexus of blood vessels and nerves with ganglia is located between the vagina l wall, and the proximal urethra and bladder neck. The greatest concen trations of nerves are in the 4 o'clock and 8 o'clock positions but ne rve fibers are identified throughout the loose areolar tissue planes t hrough which vaginal surgery for stress urinary incontinence is often performed. Conclusions: When performing surgical procedures for the co rrection of stress urinary incontinence, the possibility that denervat ion and devascularization of the terminal urethra and bladder neck sec ondary to surgical dissection could contribute to the subsequent devel opment of intrinsic sphincter dysfunction should be considered.