In mammals the flow of urine from the urinary bladder is controlled by a group of muscles collectively called the urethral sphincter, named for their proximity to the urethra. Both sexes have at least two areas of muscle: the internal sphincter, or bladder neck; and the external, or distal, sphincter.
In males the internal and external urethral sphincters are more powerful, able to retain urine for twice as long as females, and are furthermore backed up by the tertiary rings of urethral sphincters along the length of the penis.
Both sexes can use the levator ani, the voluntary muscle of the pelvic floor, to control urination. In females this muscle is more important because of the weakness of the urethral sphincters. Kegel exercises are a form of exercise intended to strengthen the pelvic floor muscles.
There are anecdotal reports that many men, although able to control the onset of urination, are unable to stop urinating once they have started. It is uncertain whether this is a common phenomenon in real life.
Sometimes weakness of the internal urethralsphincter was in the lower part, and rupture and widening of the urethral lumen was seen in the lower part, giving a “flask shape” appearance.
II- The internal sphincter is composed mainly of collagenous and elastic tissues extending concentrically outwards from an inner mucosa which lies on the “lamina propria” followed by the collagenous bundles extending beyond the muscle layer.
In conclusion, three dimension vaginal ultrasonic assessment of the internal urethralsphincter is an additional informative, non-invasive tool in the evaluation of cases of SUI as it is both sensitive and specific in the diagnosis of SUI.
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