Surgical Therapy for Abnormalities of the Urinary Sphincter in the Female1

SUMMARY In the female the urinary sphincter is synonymous with the proximal three‐fourths of urethra and is a tubular structure with a wall composed of smooth muscle and elastic tissue. The efficiency of the tube as a sphincter varies directly with the length of intact urethra. Most cases of non‐neurogenic urinary incontinence are due to a decrease in length of intact urinary sphincter. The shortened sphincter may be caused by a drooping of the urethra in the erect position, a defect in the wall of the urethra or by a defective urethra which droops. Treatment incorporates restoration of normal length to the involved urethra by anterior urethropexy, excision of the urethral defect or by a combination of the two procedures. Posterior buttressing of the urethra and urethrocystopexies which do not lengthen the urethra are inadequate, unphysiological procedures for restoring urinary continence.