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Disturbed Urinary Flow: Urethral Dynamics

Samuel J. Arnold, MD
JAMA. 1967;201(4):274-275. doi:10.1001/jama.1967.03130040070031.
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To the Editor:—  Physicians could resolve their differences about the "urethral syndrome" (199:221, 1967; 184:894, 1963), I believe, if they focused less on "inflammatory changes" and more on disturbed urethral dynamics.The urethra and the para-urethral system (male and female prostate) communicate. Normal function, therefore, would require an equilibrium between these systems and the dynamics of urethral flow. Urethral narrowings, as at the verumontanum, increase velocity in the region where most prostatic ducts open, and, like the venturi of a faucet aspirator, decrease static pressure1 which probably assists glandular secretion. In women, a sudden steep fall in static pressure occurs immediately proximal to the external orifice.1Obstruction, as long as the pump (bladder) can compensate, produces abnormal forces: velocities which generate traumatic shearing effects; negative pressures which may elevate layers of epithelium; turbulence and regurgitation2 which may compound obstruction; and increased lateral pressures which may


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