Regarding “Letter to the editor: Misconceptions derived from the use of microtip catheters in tissue,” Fred Miyazaki (1996): Neurourol. Urodynam. 15:672 and “author's reply: Misconceptions derived from the use of microtip catheters in tissue,” P.E. Papa Petros (1996): Neurourol. Urodynam. 15:673
✍ Scribed by John O. L. DeLancey
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 5 KB
- Volume
- 16
- Category
- Article
- ISSN
- 0733-2467
No coin nor oath required. For personal study only.
✦ Synopsis
Dr. Petros has appropriately observed that "the posterior urethral wall moves forward against the anterior urethral wall during stress." He goes on to state that this would be contrary to my observations published in 1994.
Actually, I am quite in agreement with his observation. One of the key elements in the continence control system, as discussed in the cited 1994 article, is the attachment of the endopelvic fascia to the levator ani muscles so that contraction of the levator ani can elevate the urethra. Active contraction of the levator during cough is known electromyographically. Because the layered endopelvic fascia on which the urethra rests is attached to the levator muscles this would force the posterior urethral wall upwards to oppose intraabdominal pressure.