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[Changes of the urethral closing pressure induced by cough and hold maneuver].

In order to clarify the mechanism of urinary continence under stress, the author measured synchronously the urethral closing pressure and bladder pressure at cough or hold maneuver, in 13 control males, 10 control females, 14 male patients with benign prostatic hypertrophy and 11 female patients with stress incontinence. EMGs of the external urethral and anal sphincters were obtained simultaneously with the pressure measurement. In all but the patients with stress incontinence, the closing pressure at the bladder neck, prostatic urethra and membranous urethra (mid-urethra in female) increased in response to cough and hold maneuver, with simultaneous increases of electromyographic activity in the striated muscle sphincters of the urethra and anus. The urethral closing pressure, therefore, was always higher than the bladder pressure. In patients with stress incontinence, despite the elevated electromyographic activity in the striated muscle sphincters, the closing pressure at the bladder neck and mid-urethra showed a very slight or no increase in response to cough or hold maneuver. It may be concluded that the urinary continence under stress is maintained by the reflex contraction of the urethral smooth muscle sphincter.