Ventral tethering of the vagina and its role in the kinetics of urethra and bladder-neck straining.

Based on the principle that the urethra forms an integral part of the ventral wall of the vagina, the aim of this study was to determine the elements of fixation of this wall and their role in the maintenance of urethral statics during strain exertion. Eight dissections of the female pelvis were performed by a simultaneous high and low approach. The anatomic data were compared with a study of the kinetics of the urethra by dynamic MRI. The lower part of the ventral vaginal wall is tethered to the pubis and the ischiopubic rami by a complex mixed system containing elements of both suspension and support. These elements simultaneously allow a complex and asymmetric movement around the inferior border of the pubic symphysis and maintain urinary continence during straining.