1. MENOPAUSE and VOIDING TROUBLES Prof . Abdel karim M. El Hemaly MRCOG- FRCS

4. Menopause Marked drop of ovarian steroid hormones. Cumulative effects of trauma from previous childbirth. Increased total body weight Diabetes Mellitus and other metabolic disorders Hypertension General conditions e.g.

7. Menopause Weakness of the internal Urethral sphincter Voiding troubles Cumulative effects from previous childbirth trauma Marked drop of ovarian Steroid hormones infection

8. Recently, In 1996 we put forward a new concept, based on evidence explaining the act of micturition and urinary continence.

9. Micturition can be divided into 2 stages: Stage-I : in Infancy before training of micturition. Stage-II : in childhood after training of the act of micturition (how to control).

13. NORMAL INTERNAL URETHRAL SPHINCTER 3-D. ULTRASONOGRAPHY U.B. U.B. Closed urethra due to a strong, intact int. u. sphincter

14. Closed lumen Intact wall, compact sheet of collagenous tissue with muscle fibers lie on and intermingle with the collagen fibers In the middle part of the cylinder 3D U.S. Cross section

16. Urethra Vagina Urethral lumen Collag. tissue cylinder Muscle layer MRI picture of a normal continent woman

17. U.B. Post. Wall of internal urethral sphincter. Uterus Vagina MRI picture of a normal continent woman

29. ThankYou