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. 2022 Jan 22;33(3):523–530. doi: 10.1007/s00192-021-05024-1

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© The Author(s) 2021

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Fig. 1 — Illustration of hypermobile stress urinary incontinence during a Valsalva maneuver. In the illustrated case, the Pabd is just less than the abdominal leak point pressure (aLPP), and thus there is hanging/forced funneling without urine leakage. The maximal urethral pressure during stress (sMUP) resists the distending force (Fd) but the enforced distension of the proximal urethra may provoke urgency and frequency symptoms [4]. (1) Right anterior pubourethral ligament, which attaches to the pubocervical fascia (PCF), (2) right posterior pubourethral ligament which attaches to the PCF, (3) right intermediate pubourethral ligament, which attaches to the PCF (between this ligament and the os pubis, there is only fat and a ramus of vena clitoridis) and (4) PCF. Abbreviations: Fd: outflow distending force, Fs: pulling/ shearing force, v. clitor: ramus of vena clitoridis, v.p.: vaginal point (which corresponds to the attachment point of the posterior pubourethral ligaments (PUL) to the PCF on each side of the urethra), IVP: intravesical pressure, Pabd: intraabdominal pressure, Pdet: detrusor pressure. The illustration can alternatively be interpreted to demonstrate a urethra with minimal mobility (“fixed urethra”), exhibiting hanging/“forced funneling,” even at rest