TVT-S in the U position--anatomical study.
OBJECTIVE
The objective is to describe the anatomical position of tension-free vaginal tape Secur (TVT-S) in the U position regarding possible injury and fixation site.


METHODS
We placed TVT-S inserters bilaterally in 13 embalmed and five fresh frozen female bodies. After dissection, we measured distances from the obturator bundle.


RESULTS
In embalmed bodies, the mean distance of TVT-S from the obturator bundle was 2.83 cm (standard deviation (SD) 0.87 cm) on the left, 2.92 cm (SD 1.24 cm) on the right. Perforation of the fascia of obturator internus muscle occurred in 38.5%. In fresh frozen bodies, results were fundamentally similar (p > 0.05).


CONCLUSIONS
There is a risk of injury to the obturator bundle and urinary bladder during TVT-S; however, there is a significant risk of inserting the TVT-S inserter outside the obturator internus muscle (into the lesser pelvis). The position of TVT-S does not change significantly after legs mal-positioning.
Hubka
Petr
P
First Faculty of Medicine and General Teaching Hospital, Department of Gynaecology and Obstetrics, Charles University in Prague, Apolinarska 18, Prague 2, 12000, Czech Republic. petr.hubka@centrum.cz
Nanka
Ondrej
O
Martan
Alois
A
Grim
Milos
M
Zvarova
Jana
J
Masata
Jaromir
J
D005260:Female; D005404:Fixatives; D005557:Formaldehyde; D013509:Gynecologic Surgical Procedures; D006801:Humans; D009776:Obturator Nerve / Q000033:anatomy & histology; D010388:Pelvis / Q000098:blood supply* / Q000294:innervation; D053825:Suburethral Slings; D001743:Urinary Bladder / Q000033:anatomy & histology; D014550:Urinary Incontinence, Stress / Q000601:surgery
D005404:Fixatives; D005557:Formaldehyde
Br J Obstet Gynaecol. 1999 Apr;106(4):345-50
10426241
Int Urogynecol J Pelvic Floor Dysfunct. 2007 Feb;18(2):183-7
16628374
Int Urogynecol J Pelvic Floor Dysfunct. 2001;12 Suppl 2:S5-8
11450979
Scand J Urol Nephrol. 1995 Mar;29(1):75-82
7618052
Ceska Gynekol. 2007 Jan;72(1):42-9
17357349
Int Urogynecol J. 2010 Sep;21(9):1179-80
20532870
Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jun;20(6):681-8
19214359
Int Urogynecol J Pelvic Floor Dysfunct. 2009 Jan;20(1):125
18575797
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Nov;19(11):1581-3
18418537
Int Urogynecol J. 2010 Sep;21(9):1175-7
20179906
J Gynecol Obstet Biol Reprod (Paris). 2008 May;37(3):229-36
18343602