The anatomy of midurethral slings and dynamics of neurovascular injury.
The aim of this study was to investigate the course of midurethral slings using tension-free vaginal tape. The TVT procedure was performed on six fresh pelves, measurements were obtained, and the structures were cross-referenced in 16 embalmed pelves. The midurethral sling enters the suburethral tissue 2.2-3 cm caudad to the internal urethral meatus, pierces the paraurethral musculature and vascular plexus, and exits 2+/-0.5 cm from the midline lateral to the point of insertion of the arcus tendineus fasciae pelvis. On the pubic tubercle the sling is 4+/-0.5 cm, 4+/-1 cm and 6+/-1 cm from the accessory obturator, the inferior epigastric and the external iliac vessels, respectively. The critical angle of error resulting in the external iliac vessel injury is 7-15 degrees. A current knowledge of pelvic anatomy may help the surgeon avoid the neural and vascular structures that are in the path of the sling.
Abbas Shobeiri
S
S
Department of Obstetrics and Gynecology--Section of Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd--WP2410, P.O. Box 26901, Oklahoma City, OK 73190, USA. Abbas-Shobeiri@ouhsc.edu
Gasser
Raymond F
RF
Chesson
Ralph R
RR
Echols
Karolynn T
KT
D001808:Blood Vessels / Q000293:injuries*; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D017773:Pelvic Floor; D019736:Prostheses and Implants; D013526:Surgical Mesh; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000293:injuries*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery*