Repair of the distal closure mechanism
Next, the distal urethral closure mechanism, fig.1, is surgically
restored, VIDEO2. https://youtu.be/QM0rEtQ7i8w. Taking the midline
incision to within 0.5 cm of the external urethral meatus (EUM) allows
access to the external urethral ligament (EUL) which is sited
immediately lateral to the EUM. As per the VIDEO, a 00 vicryl suture is
inserted into the left EUL, then into the smooth muscle layer of the
vagina on the same side, then on the right side and finally, the right
EUL. The suture is lightly tied.
If the patient is continent on coughing with 300 ml in the bladder at
the end of the operation, it is highly likely she will remain cured. The
immediate post-operative treatment is as per a standard MUS operation.
* Compression of 0.5 millimetre beyond the normal urethral diameter,
fig2, requires a far higher detrusor pressure to evacuate the urine from
the detrusor, as the pressure change is exponentially determined, being
the inverse of the 4th power of the radius
(Poiseuille’s Law).