title: Following the needles: an anatomical study to evaluate the postoperative safety and symptoms of patients receiving a transobturator male sling implant.
abstract: OBJECTIVE
  Implanting a transobturator male sling is a valid option to manage urinary incontinence after prostatectomy. We evaluated the trajectory of Argus T™ needles blindly introduced into the retropubic space to determine the safety and etiology of postoperative symptoms that can arise from this implant.
  
  
  METHODS
  Needles were implanted and perineal dissection was performed in 20 fixed, adult human male cadavers. The distance was measured from the upper and lower extremities of the needles in the internal pelvic wall up to the obturator neurovascular bundle. Anatomical variations identified in this area proximal to the needles were characterized. The inguinocrural region was also dissected from the needles positioned there. Statistical analysis of the results was done.
  
  
  RESULTS
  All needles transfixed the obturator internus muscle. Of the needles 90% were completely immersed in its fibers and not visible in the inner wall of the pelvis. The distance to the obturator neurovascular bundle and anatomical variations were noted. In the inguinocrural region the pectineus and adductor longus muscles were perforated in all cadavers.
  
  
  CONCLUSIONS
  The needle sling implant preserves the obturator neurovascular bundle and obviates the potential for postoperative pelvic hematoma. The anatomical trajectory of the needles used for this implant account for the groin and perineal pain side effects. Based on similarities between the Argus T and other types of outside-in transobturator male slings the results of the current study could be extrapolated to the latter slings.
authors.affiliation: Department of Anatomy, Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil. Electronic address: joaoapc@ig.com.br.
authors.forename: João Antonio
authors.initials: JA
authors.lastname: Pereira-Correia
authors.affiliation: Department of Anatomy, Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil.
authors.forename: Carolina Gama
authors.initials: CG
authors.lastname: Rodrigues dos Santos
authors.affiliation: Department of Anatomy, Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil.
authors.forename: Bernardo Gonçalves
authors.initials: BG
authors.lastname: Bastian-Pinto
authors.affiliation: Department of Anatomy, Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil.
authors.forename: Fernanda Cascardo
authors.initials: FC
authors.lastname: Bilouro
authors.affiliation: Department of Anatomy, Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil.
authors.forename: Caroline Fagundes
authors.initials: CF
authors.lastname: Facó Hauaji
authors.affiliation: Department of Anatomy, Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil.
authors.forename: André Luis
authors.initials: AL
authors.lastname: Santos Saud
authors.affiliation: Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil.
authors.forename: Fábio
authors.initials: F
authors.lastname: Sant'anna de Moraes
authors.affiliation: Department of Urology, Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil.
authors.forename: Valter José Fernandes
authors.initials: VJ
authors.lastname: Muller
mesh_terms: D000368:Aged; D002102:Cadaver; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D053825:Suburethral Slings / Q000009:adverse effects*
keywords: cadaver; male; suburethral slings; urethra; urinary incontinence