The effect of bilateral pudendal blockade on the adjunctive urethral closure forces in healthy females.

The effect of bilateral pudendal blockade on the urethral pressure and power generation during coughing and pelvic floor squeezing was evaluated in 10 healthy women. The measurements were carried out at the bladder neck, in the high pressure zone, and distally in the urethra before and after blockade. Strong adjunctive closure forces were demonstrated all along the urethra. They were significantly reduced by pudendal blockade except at the bladder neck during coughing. The results indicate that the pudendal innervated striated muscles contribute significantly to the adjunctively acting closure forces all along the female urethra, including the bladder neck. Some passive pressure transmission to the bladder neck seems to take place during stress episodes following pudendal blockade, but whether it occurs in healthy females remain uncertain. The findings following pudendal blockade, corroborate with those in stress incontinent women, and thereby support the concept that striated muscle weakness is of pathophysiological significance in stress urinary incontinence.