肠道新膀胱尿动力学检查的临床意义

目的 探讨全膀胱切除肠代膀胱术后患者新膀胱和尿道的尿动力学特点。方法 全膀胱切除回肠原位新膀胱术患者22例，术后6～55个月，平均28个月。尿动力学检查测定尿流率、剩余尿，充盈期、排尿期膀胱测压、直肠测压、括约肌肌电图和尿道压测定。结果 22例患者最大尿流率2．7～22．1ml／s，平均12．9ml／s；排尿时间17～240s，平均66s；剩余尿5～300ml，平均92ml；最大膀胱容量210～650ml，平均426ml；初次尿意膀胱容量137～540ml，平均296ml；急迫尿意膀胱容量200～620ml，平均388ml。充盈末期膀胱内压均〈50cmH2O，顺应性31～35ml／cmH2O，平均33ml／cmH2O。膀胱容量≤50％时充盈期新膀胱不自主收缩平均1．2次，容量〉50％～100％时2．6次。压力流率测定时患者排尿期新膀胱均未见主动收缩，排尿期最大腹压10～105cmH2O，平均64cmH2O。最大尿道闭合压33～114cmH2O，平均69cmH2O。功能性尿道长度17～56mm，平均37mm。结论 回肠新膀胱具有良好的储尿能力，新膀胱排尿主要依靠腹压和尿道的协同作用，保留尿道的控尿能力是保证术后控尿能力的关键。     

膀胱出口梗阻所致逼尿肌过度活动的神经电生理研究

目的 从膀胱传入神经以及盆底相关神经肌肉角度探讨神经因素及肌源性因素在膀胱出口梗阻所致的逼尿肌过度活动发生中的作用.方法 采用耻骨上膀胱颈梗阻的方法建立逼尿肌过度活动大鼠模型,测定不稳定收缩时盆神经传入电位信号,并同步测定阴部神经运动支电位、尿道外括约肌肌电及腹肌肌电的反射反应.并观察T8段脊髓截断、双侧盆神经截断、腹交感干截断以及双侧阴部神经截断后大鼠膀胱充盈测压不稳定收缩的变化.结果 成功制作了膀胱出口梗阻逼尿肌过度活动大鼠模型,成功率62.5%.充盈性膀胱测压神经肌电生理同步记录结果显示,允盈期逼尿肌过度活动可分为两种类型,一种为收缩幅度高于10 cmH2O(1 cmH2O=0.098 kPa)的逼尿肌过度活动(B-DO),伴有同步盆神经传入的信号明显增强,且能引发阴部神经、尿道外括约和腹肌肌电图出现显著变化;一种为收缩幅度低于10 cmH2O的逼尿肌过度活动(S-DO),没有上述盆神经传入及相关神经肌电变化.T8脊髓截断后,膀胱充盈-排尿收缩周期消失,膀胱基础压显著升高,B-DO消失,S-DO仍然存在,且收缩幅度较截断前略有上升,但差异无统计学意义.依次截断控制膀胱的盆神经、交感神经和阴部神经后,膀胱失去充盈-排尿收缩周期,基础压显著升高,不稳定收缩中B-DO消失,S-DO仍然存在.结论 膀胱出口梗阻所致的逼尿肌过度活动存在不依赖于中枢和周围神经的膀胱源性因素.     

女性下尿路症状患者的尿动力学分析

目的　探讨女性下尿路症状原因及临床意义。　方法　 72例下尿路症状女性患者 ,年龄 8～ 86岁 ,平均 4 8岁。其中排尿困难 4 6例 ,尿失禁 14例 ,尿频 10例 ,夜间遗尿 2例。患者均行尿动力学检测。　结果　 4 6例排尿困难者膀胱容量 6 0～ 80 0ml,其中 2 0例膀胱逼尿肌收缩力为 0 ,2 6例9～ 16 0cmH2 O(1cmH2 O =0 .0 98kPa)。Linp URR图示为Ⅲ级以上梗阻者 19例。尿道静态分布阻力2 5～ 130cmH2 O。膀胱逼尿肌与尿道外括约肌协调性良好者 5例 ,协同失调者 33例。 10例尿频患者膀胱容量 97～ 4 5 0ml,2例排尿期膀胱逼尿肌收缩力为 0 ,8例 31～ 110cmH2 O。Linp URR图示显示Ⅲ级以上梗阻者 2例。 1例急迫性尿失禁者膀胱过度敏感。 6例压力性尿失禁者腹压漏尿点压力 4 4～76cmH2 O。 3例充盈性尿失禁者排尿期膀胱逼尿肌压力为 0 ,尿道静态分布阻力 32～ 4 2cmH2 O。真性尿失禁 4例尿道外括约肌压力 0～ 16cmH2 O ,平均 (8.5± 5 .7)cmH2 O。 2例遗尿患者存在不稳定性膀胱表现 ,排尿期膀胱收缩乏力。　结论　尿动力学检查对女性下尿路症状疾病诊断、治疗、预后判断具有重要指导意义。     

K-2阿片受体激动剂诱发大鼠膀胱括约肌和尿道外括约肌失协调

目的：通过脊髓鞘内给与选择性K1（U50,488）和K-2（GR89,696）阿片受体激动剂来验证脊髓K阿片受体亚型在大鼠尿道外括约肌控制中的作用。方法：乌拉坦麻醉雌性大鼠,膀胱顶部插管充盈膀胱诱发排尿进行膀胱测压,肌电图评估尿道外括约肌（EUS）功能,脊髓鞘内或静脉注射给药。结果：大鼠排尿时EUS在基础的（连续的）收缩活动之上出现高频舒张收缩以利于排空尿道完成排尿。GR-89,696（0．05to5μg鞘内注射it）使EUS每次排尿时的舒张收缩的次数呈剂量依赖性减少。它使排尿效率降低,大剂量时导致EUS排尿时的舒张收缩消失,呈持续收缩状态,出现膀胱逼尿肌和EUS协同失调和充盈性尿失禁。非选择性阿片受体拮抗剂纳洛酮（1mg／kg静脉注射iv）可阻滞GR89,696的效应。U-50,488（0．05 to 5μg鞘内注射it）对膀胱内压和EUS肌电图参数无影响。结论：大鼠有效的排尿需要依靠脊髓信号发生器刺激EUS运动神经元产生信号．使EUS产生舒张收缩,从而导致尿道快速的舒张与收缩以利于排空。脊髓鞘内注射K2阿片受体激动剂可以抑制信号发生器,减少每次排尿期舒张收缩的次数,但并不影响与尿道关闭有关的基础收缩。由此产生膀胱逼尿肌和EUS协同失调,导致排尿效率降低。和大鼠脊髓损伤导致的膀胱逼尿肌和EUS协同失调排尿障碍相似。因此,应该进一步研究K-2阿片受体在脊髓损伤导致的排尿障碍中的作用。     

非神经源性逼尿肌膀胱颈协同失调

报告５例原发性膀胱颈功能障碍患者表现为排尿时膀胱颈开放不良，病变为逼尿肌膀胱颈协同失调，可命名为非神经源性逼尿肌膀胱颈协同失调。提示其诊断标准：（１）有下尿路功能性梗阻；（２）排尿时膀胱颈开放不良，膀胱内压－膀胱颈内压梯度异常；（３）无影响膀胱尿道功能的神经系疾患。同时对此症的发病机理和治疗选择进行了讨论。     

排尿期尿道测压的临床应用

目的：确定下尿路梗阻及其梗阻部位。方法：对４１例有下尿路梗阻症状患者进行了排尿期尿道测压（ＭＵＰＰ）,其中包括前列腺增生症（ＢＰＨ）２９例,男性尿道狭窄３例,逼尿肌－外括约肌协同失调３例,女性压力性尿失禁４例,女性尿道末端缩窄综合征１例,前例腺炎１例。结果：２９例ＢＰＨ患者中,２６例有梗阻,其中梗阻位于膀胱颈部２０例;３例逼尿肌－外括约肌协同失调患者表现为外括约肌部压力下降;４例女性压力性尿失禁患     

女性不同类型尿失禁临床及尿动力学特点

目的 探讨女性不同类型尿失禁临床及尿动力学特点，提高临床诊治水平。方法 对76例女性患者常规行尿动力学检查，包括尿流率、压力流率研究、尿道压力测定、漏尿点压测定。结果 76例患者中，压力性尿失禁30例，运动紧迫性尿失禁15例，反射性尿失禁19例，混合型压力性／紧迫性尿失禁2例，不稳定尿道3例，假性尿失禁7例。运动紧迫性尿失禁中，DLPP≥40cmH2O者14例，均有不同程度双肾积水。结论 腹压漏尿点压测定可以协助确定压力性尿失禁的手术方式。神经性膀胱尿道功能障碍和膀胱出口梗阻均可能出现膀胱顺应性下降，逼尿肌漏尿点压可以帮助决定膀胱顺应性下降时手术治疗时机。当逼尿肌漏尿点压≥40cmH2O，或者膀胱充盈200ml时逼尿肌压力≥40cmH2O时，必须进行治疗，否则会导致上尿路损害。     

排尿期尿道压力测定在膀胱出口梗阻疾病诊断中的应用

目的　研究排尿期尿道压力测定 (MUPP)在膀胱出口梗阻 (BOO)疾病诊断中的应用。方法　下尿路梗阻患者 4 5例 ,其中良性前列腺增生 (BPH) 38例 ,前尿道狭窄 3例 ,女性尿道狭窄 4例。对照组为健康志愿者 4例。按常规方法行压力 流率测定 ,静态尿道压力测定 (UPP)及MUPP。以压力下降梯度计算梗阻程度。数据分析采用t检验。研究不同疾病梗阻患者尿道压力下降点及下降梯度 ,MUPP对梗阻部位的诊断价值 ,MUPP与压力 流率研究对可疑梗阻诊断的比较 ,MUPP与压力 流率研究判断梗阻程度的比较。　结果　对照组 2例男性 ,外括约肌以上尿道内压与膀胱内压力相等 ,尿道压在外括约肌处快速下降 ;2例女性 ,膀胱压与全部尿道压几乎相等 ,尿道末端 1cm处尿道压下降。 38例BPH患者最大排尿压增高 ,平均为 (99.33± 4 1.0 9)cmH2 O(1cmH2 O =0 .0 98kPa) ,尿道压力在膀胱颈或前列腺尖部下降。 3例前尿道狭窄患者后尿道近端压力与膀胱压相等 ,球部及远端尿道压力下降。 4例女性远端尿道狭窄患者尿道压力在狭窄远端区域下降。BPH、前尿道狭窄、女性远端尿道狭窄平均MUPP压力下降梯度分别为 (71.6 3± 37.4 1)cmH2 O、(43.5 1± 15 .71)cmH2 O、(41.4 8± 17.34)cmH2 O ,与正常对照组的 (2 4 .2 5± 2 .99)cmH2 O相比 ,差别有     

245例前列腺增生患者尿流动力学的结果分析

本文采用自制半卧位尿动力测定床及Ｄａｎｅｃ尿动力仪器，常规行尿流率，压力－流率（同步测定尿道外括约肌肌电图），尿道测压。结果明确诊断ＢＯＯ１６１例，可疑５０例，合并逼尿肌功能受损６５例；膀胱顺应性降低７０例，外括约肌功能失调１１４例；逼尿肌不稳定５９例。最大尿流率受测压导管影响；功能尿道长度与经直肠Ｂ超测定的前列腺尿道长度相关联。结论：１、ＢＰＨ的排尿症状的机械因素与动力学因素共同作用的结果；尿动力学检查是诊断由ＢＰＨ所致ＢＯＯ的一个非常重要的手段，但分析结果时应考虑干扰因素的影响。２、功能性尿道长度与前列腺部尿道长度相关联。     

新生儿膀胱压力和肌电图联合检查

目的　了解无排尿异常新生儿的尿动力学过程。　方法　肾盂扩张的新生儿 14例。男 10例 ,女 4例。年龄 2d～ 2 .5个月 ,平均 (1.2± 0 .8)个月。用DanTech膀胱测压和肌电图记录仪在X线电视监视下进行膀胱测压检查。患儿均未发现排尿异常症状和膀胱输尿管返流。　结果　膀胱剩余尿 (1.2± 0 .8)ml,最大膀胱容量 (33± 2 4 )ml,排尿效率为 0 .87± 0 .17。不稳定性膀胱发生率 2 1% (3/ 14 )。可见两种排尿类型 ,协调性排尿和非协调性排尿或间断性排尿。在协调性排尿过程中最大逼尿肌排尿压为 (74± 2 4 )cmH2 O(1cmH2 O =0 .0 98kPa) ,尿道外括约肌活动减弱或不变。6 4 % (9/ 14 )新生儿表现为非协调性排尿或间断性排尿 ,逼尿肌压力可升至 10 0cmH2 O以上。　结论　无排尿异常症状的新生儿膀胱多可完全排空 ,少数可有较多的剩余尿 ,可能与新生儿间断性排尿有关。新生儿最大逼尿肌排尿压与成人相似 ,如 >10 0cmH2 O ,常提示括约肌活动增强或膀胱出口梗阻。     

Video urodynamics using transrectal ultrasonography for lower urinary tract symptoms in women

AIMS: To understand the properties of lower urinary tract disorders in women, we evaluated 60 female patients with lower urinary tract disorders or symptoms of recurrent cystitis by free uroflowmetry and video urodynamics using transrectal ultrasonography (VU-TRUS). METHODS: Results of urodynamic studies or symptoms of stress incontinence were used to divide 60 women into 7 normal controls and 53 with voiding dysfunctions. RESULTS: In normal controls, VU-TRUS showed that the mean posterior urethrovesical angle and anteroposterior diameter of the proximal urethra at maximum flow was 151.4 degrees and 4.9 mm, respectively. In patients with voiding dysfunction, VU-TRUS during voiding revealed various urethral abnormalities, including 16 detrusor sphincter dyssynergia, 4 detrusor bladder neck dyssynergia, and 13 insufficient opening of the entire urethra. VU-TRUS also showed pelvic floor abnormalities, including 24 urethral hypermobilities (group 1) and 11 cystoceles (group 2). Eighteen patients had neither urethral hypermobility nor cystocele (group 3). Major pressure-flow abnormalities in the 53 patients with voiding dysfunctions were weak detrusor (72%) and/or bladder outlet obstruction (25%). There were no significant differences in the distribution of the pressure-flow abnormalities among the three groups. However, the mean values of abdominal pressure at maximum flow of group 1 (20.9 cm H(2)O) and group 2 (17.9 cm H(2)O) were significantly higher than that of group 3 (6.3 cm H(2)O; each P < 0.05). The mean values of residual urine volume of group 2 (60.8 mL) and group 3 (77.6 mL) were significantly higher than that of group 1 (23.5 mL; each P < 0.05). CONCLUSIONS: The symptoms of women with lower urinary tract disorders were frequently accompanied by urethral and/or pelvic floor abnormalities during voiding that were clearly detected by VU-TRUS. VU-TRUS is useful for objective evaluation of female lower urinary tract symptoms.     

尿动力学联合膀胱尿道造影在女性压力性尿失禁诊断中的价值

目的探讨尿动力学检查联合排泄性膀胱尿道造影在女性压力性尿失禁诊断中的应用价值。方法回顾性分析56例临床诊断为女性压力性尿失禁（SUI）的患者,年龄（59．2±8．2）岁,每例均行尿动力学和排泄性膀胱尿道造影检查,评估膀胱顺应性、逼尿肌稳定性、尿道压、膀胱及尿道的形态。鳍杲尿动力学检查提示最大尿流率（33．6±7．7）mL／s,残余尿（17．8±14．7）mL,膀胱顺应性正常,膀胱容量（356．3±99．3）mL,33例测得腹压漏尿点压（49．8±17．6）cmH2O,最大尿道闭合压（47．4±10．5）cmH2O,功能性尿道长度（2．6±0．6）cm。相关性分析显示病程与腹压漏尿点压高度负相关（r=-0．816,P〈0．01）。排泄性膀胱尿道造影见膀胱颈及近端尿道下移34例,膀胱尿道后角变钝或消失44例,静息期膀胱颈和近端尿道呈漏斗形7例,咳嗽时47例见造影剂从尿道溢出。结论在无影像尿动力学设备的单位,尿动力学检查和排泄性膀胱尿道造影联合应用对SUI的诊断和术前评估具有重要的价值,比单用一种方法更具有临床意义。     

Correlation between lower urinary tract symptoms and urethral function in benign prostatic hyperplasia

AIM: To examine the potential correlation between urethral function and lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). METHODS: Thirty-one patients with clinical BPH, who were confirmed to have benign prostatic enlargement (BPE) of 20 ml or more, were enrolled into the study. A mark-sheet questionnaire was used for obtaining the LUTS history. Multichannel pressure-flow urodynamic studies were performed and external urethral sphincter pressure (PEUS), intravesical pressure (PVES), and bladder neck pressure (PBN) were recorded both at maximum cystometric capacity and during voiding with 5-microtip transducers, for the purpose of detecting BPE-specific urodynamic findings at different levels within the urethra. RESULTS: There was a positive correlation between hesitancy and detrusor bladder neck dyssynergia (DBND) (P = 0.0011) and between incomplete emptying and low PBN at maximum cystometric capacity (P = 0.0425). The hesitancy proved to have no correlation with bladder neck opening time (TBNO). CONCLUSION: Urodynamic evaluation of urethral function was beneficial for attributing LUTS to clinical BPH. Among various parameters, DBND was the most specific to clinical BPH, suggesting it to be a situation where a steep rise in PBN or prostatic urethral pressure remains greater than the increasing PVES, resulting in sustained difficulty in opening the bladder neck and subsequently the subjective sensation of hesitancy.     

Female urethral syndrome: Clinical and urodynamic perspectives

Eighteen women with the urethral syndrome were studied urodynamically with synchronous video-pressure flow studies and electromyography of the external urethral sphincter (EUS). When compared with an age and sex matched control group, the most striking finding was a significantly higher than normal maximum urethral closure pressure. Abnormal and low urinary flow rates, instability of the intraurethral pressure at rest, incomplete funnelling of the bladder neck, and distal urethral narrowing during voiding constitute other typical urodynamic findings in the female urethral syndrome. Detrusor-striated sphincter dyssynergia or primary striated sphincter spasm was not observed. Even though striated E US spasticity cannot be excluded as a cause of this syndrome in some patients, an autonomically mediated spasm of the smooth muscle sphincter seems plausible to explain both our urodynamic findings and a favorable response of 4 patients treated with alpha-blocking agents.     

Combined electromyography and gas urethral pressure profilometry before and after transurethral resection of the prostate.

Combined electromyographic and gas urethral pressure profilometry was done on 10 consecutive patients before and 3 months after transurethral resection of the prostate. A significant reduction was found postoperatively in the functional urethral length, whereas the maximum urethral closure pressure remained unchanged. Increase in urethral resistance in prostatic obstruction of the posterior urethra was related to the increase in the functional length of the posterior urethra rather than to mechanical occlusion of the urethral lumen. Periurethral striated muscle activity was recorded from the membranous urethra to the urethrovesical junction with the maximal activity located in the membranous urethra. Marked striated muscle activity also was found consistently at the bladder neck.     

Real-time transrectal sonographic voiding cystourethrography

Transrectal linear array transducer makes possible a sagittal view of the bladder base-plate, prostatic urethra, and membranous urethra yielding an image similar to that obtained with voiding cystourethrogram. This permits lack of time limitation, such as imposed by the use of fluoroscopy, and the possibility of visualizing not only the lumen of the bladder neck and urethra but also the surrounding soft tissue. Using ultrasonographic urodynamics in neuromuscular dysfunctions of the bladder and urinary voiding obstructions we obtained excellent results in patients with detrusor-sphincter dyssynergia and in those with posterior ledge at the bladder neck. Both conditions are clearly visualized, particularly the existence of the posterior ledge which is responsible for the failure of the sphincterotomy in patients with periurethral striated sphincter spasm.     

脊髓发育不良和隐性骶椎裂患者的尿流动力学改变

本文分析34例有泌尿系统症状的脊髓发育不良和隐性骶椎裂患者尿流动力学表现。结果:根据尿流动力学检查分为反射性和无反射性神经膀胱两大类。临床症状和尿流动力学结果与脊髓损伤的平面无相关性。膀胱颈口开放患者尿道闭合压力显著低于膀胱颈口闭合患者(P<0.01)。膀胱排尿期压力升高与上尿路损害有明显关系,当膀胱排尿期压力超过3.92kPa(40cmH_2O)时就可造成上尿路的损害。     

Preliminary observations of a synergistic bladder-sphincter relationship following spinal cord injury in a quadruped animal

BACKGROUND/OBJECTIVES: High urethral resistance or detrusor-sphincter dyssynergia (DSD) is characterized by obstructed voiding during bladder contractions. DSD is caused by an exaggerated pelvic floor reflex resulting from sensory input from elevated pressure in the bladder that produces reflex constriction of the urethral sphincter. The objective of this study was to determine whether sensory input from the bladder produced synergistic or dyssynergic pelvic floor reflexes following SCI in an animal model. METHODS: A pelvic floor reflex that shares the same motor pathway with DSD is the bulbocavernosus (BC) reflex. The BC reflex was elicited with electrical stimulation in 4 male cats with T1 spinal injury, and recorded as an anal sphincter contraction. Recordings were obtained during control and elevated bladder pressures. Increased bladder pressure was induced with either manual pressure (Crede procedure) or spontaneous contractions resulting from bladder filling. RESULTS: During the control period, the BC reflex indicated by the peak anal pressure response was 23 +/- 6 cmH2O. During elevated bladder pressure of 34 +/- 18 cmH2O, the BC response decreased to 10 +/- 3 cmH2O (not significant), showing a synergistic relationship. Anal sphincter tone between BC reflex tests showed a dyssynergic response. All 4 animals showed increased tone during elevated bladder pressures that averaged 9 +/- 5 cmH2O. Because abdominal pressure was not recorded, the significance is not clear. However, there was further support of a dyssynergic relationship based on increases in the anal and urethral electromyography recordings and some pelvic floor spasms during the elevated bladder pressure. CONCLUSIONS: Because 2 different pelvic floor activities were observed during increased bladder pressures, this animal model may be described best as a mixed model. This model shows both synergistic and dyssynergic relationships between the bladder and the BC contractions. Although observed changes were not significant, the unique observations of synergistic bladder-sphincter activity shown by the inhibited BC reflex is in marked contrast to the strictly dyssynergic bladder-sphincter relationship seen in SCI patients.     

Effects of selective autonomic and pudendal denervation on the urethral function and development of retention in female dogs

PURPOSE: This trial is an experimental approach to the possible causes of continence and voiding problems after urethra sparing radical cystectomy and orthotopic bladder substitution in women. MATERIALS AND METHODS: Between January 1996 and January 1999 we included 24 mongrel female dogs in this 4-phase study of 6 dogs each. The effects of autonomic denervation of the urethra (phase 1) and urethral transection just distal to the bladder neck (phase 2) on the urethral pressure profile were recorded. In phase 3 the effects of autonomic denervation, urethral transection and pharmacological manipulation of the denervated transected urethra on the urethral pressure profile were studied in succession. In phase 4 the effects of pudendal nerve transection and pharmacological blockade were recorded. In the 12 phases 2 and 3 dogs the transected urethra was re-anastomosed to the bladder neck. Acute experiments were repeated after 2 and 6 months, urethrocystoscopy was done and post-void residual urine was estimated. Two of the latter dogs were sacrificed 6 months after the acute experiment and the urethras were histopathologically examined. RESULTS: Autonomic denervation resulted in a 46% to 48% decrease in mean maximal pressure in the proximal urethra in phases 1 and 3 (p <0.001) with no significant effect on the distal urethra. Urethral transection in phase 2 did not affect the urethral pressure profile. Phentolamine injection after urethral denervation and transection in phase 3 produced a further reduction of 11.3% and 46.3% in mean resting pressure in the proximal and distal urethra, respectively, while succinyl choline produced a 38.1% further decrease in the distal urethra. Unilateral and bilateral pudendal denervation reduced pressure in the distal urethra significantly but not in the proximal urethra. When phentolamine was given thereafter, a further decrease of 38% and 2.4% resulted in resting pressure values in the proximal and distal urethra, respectively. The change in distal urethral pressure was marginally significant after succinyl choline injection (p = 0.05). Results were reproducible after 2 and 6 months. The proximal urethra remained patent with no post-void residual urine after autonomic denervation. There was no significant urethral fibrosis after realignment of the transected urethra in the 2 sacrificed phases 2 and 3 dogs. CONCLUSIONS: From this study we concluded that autonomic denervation reduced pressure in the proximal urethra by less than 50%. Continuity of the urethra with the bladder is not necessary for proper urethral function. After autonomic denervation the proximal urethra remained patent with no subsequent fibrosis. In addition, no post-void residual urine was noted. Bilateral pudendal denervation did not completely block activity of the distal urethra. The nonneuromuscular components had a small role in the creation of urethral closure function.