Anatomical Reasoning for Atraumatic Trocar Placement during Implantation of a Transobturator  Suburethral Sling

The aimof this research was to study the variant anatomy of the obturator complex in terms of surgical treatment of stress urinary incontinence, as well as to determine the most atraumatic technique for conducting a surgical trocar for a transobturator suburethral sling.Material and methods.A suburethral sling was implanted on 40 sagittally dissected samples of the female pelvis with preserved soft tissues using two techniques: the conventional one based on the use of external landmarks and the technique of the trocar rotation around the lower branch of the pubic bone developed at the University Clinic of St. Petersburg. After implantation of a transobturator suburethral sling, the probability of injury to the branches of the obturator nerve was assessed by precision preparation for each of the presented techniques using 40 samples. It was also suggested to develop a protocol for atraumatic placement ofa sling for stress urinary incontinence.Results. Based on the results obtained and study of the topographic relationships of the trocar and branches of the obturator nerve, it is concluded that the obturator complex has significant anatomical variability. This relates to both the muscular component –the internal and external obturator muscles, and neurovascular structures. The obturator nerve has two types of branching: joint and separate. The latter is a risk factor for intraoperative nerve injury. The technique of suburethral sling implantation by rotating the surgical trocar around the inferior branch of the pubic bone is atraumatic and safe.Conclusions.Variant anatomy of the obturator complex influences the probability of trauma in a transobturator suburethral sling implantation. In particular, the separate branching of the obturator nerve is a risk factor for its intraoperative injury. Further clinical studies are required to assess the outcomes of surgical t reatment of stress urinary incontinence taking into account the variant anatomy of the true pelvis.

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Anatomical premises for the variability of the results of transobturator mid-urethral sling

Herald Urology ◽

10.21886/2308-6424-2021-9-2-64-73 ◽

2021 ◽

Vol 9 (2) ◽

pp. 64-73

Author(s):

G. V. Kovalev ◽

D. D. Shkarupa ◽

N. D. Kubin ◽

G. I. Nichiporuk ◽

I. V. Gaivoronsky

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Soft Tissues ◽

Original Method ◽

Suburethral Sling ◽

Pubic Bone ◽

Sling Surgery ◽

Anatomical Part

Introduction. The implantation of a synthetic sub-urethral sling is the main method of surgical correction of stress urinary incontinence (SUI). However, the investigation results of long-term effectiveness indicate the ambiguity of the surgery outcomes. In addition, the problem of pain in the perineum remains relevant for everyday practice. One of the important aspects in this matter may be a variant technique for installing a suburethral sling, including based on the anatomical variability of the small pelvis.Purpose of the study. To identify key anatomical factors that can negatively affect the effectiveness and safety of the environment of suburethral sling surgery for urinary incontinence in women.Materials and methods. The study consisted of 2 parts - anatomical and clinical. In the anatomical part of the study, a suburethral sling was implanted on 20 preparations of a female pelvis with a lower limb and preserved soft tissues. The clinical part of the study involved 50 patients with stress urinary incontinence. These patients underwent installation of a transobturator suburethral sling in two ways using the “inside-out” technique: using the standard “external landmarks” technique and using the proposed anatomical technique developed in the first part of the study. After visualization of the suburethral sling using the original method, the outcomes of the operations were assessed depending on the location of the sling in the patient's tissues.Results. In the anatomical part of the study, the most atraumatic method of suburethral sling implantation was determined by rotating the tool around the lower branch of the pubic bone. In the clinical part of the study, this method demonstrated a higher efficiency of the operation at a follow-up of 1 year, presumably due to the U-shaped angle of the «hammock» for the urethra, which is characteristic of the retropubic sling.Conclusion. Outcomes of operations for SUI depend, among other things, on the method of the suburethral sling implantation.

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Experimental use of a cellulosic biopolymer as a new material for suburethral sling in the treatment of stress urinary incontinence

International braz j urol ◽

10.1590/s1677-5538.ibju.2014.0155 ◽

2015 ◽

Vol 41 (6) ◽

pp. 1148-1153

Author(s):

Roberto G. Lucena ◽

Salvador V. C. Lima ◽

José L. de A. Aguiar ◽

Rogerson T. Andrade ◽

Flávia C. M. Pinto ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Suburethral Sling ◽

New Material ◽

Experimental Use

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Transobturator tension-free “inside-to-out” suburethral sling procedure for the treatment of stress urinary incontinence

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1202047l ◽

2012 ◽

Vol 140 (1-2) ◽

pp. 47-50

Author(s):

Darko Laketic ◽

Andrej Veljkovic ◽

Vesna Laketic

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Health Centre ◽

Suburethral Sling ◽

Abdominal Pressure ◽

Sudden Increase ◽

Voiding Function ◽

Sling Procedure ◽

Tension Free ◽

Significant Difference

Introduction. Stress urinary incontinence is an involuntary leakage of urine on a sudden increase of intra-abdominal pressure by physical activity, exercise, coughing, sneezing or laughing. Objective. To assess symptoms, functional and anatomical status of voiding function, complications and short term success of a novel procedure, tension-free vaginal tape obturator technique (TVT-O) in the treatment of stress urinary incontinence. Methods. A prospective study was performed on 40 female patients who underwent the TVT-O suburethral sling at the Urology Department of the Health Centre in Prokuplje and Urology Hospital in Nis between May 2009 and February 2010. The mean patients? age was 58 years (range 34-84 years). Preoperative evaluation included a detailed history and gynaecologic examination including urodynamic testing and voiding studies.UDI-6 and UIQ-7 score testing was performed before, and six months after surgery. All patients who demonstrated stress urinary incontinence with a Q-tip test-angle during maximal straining were included into the study. Postoperatively, outcomes evaluation included voiding function, anatomical parameters, complications, as well as subjective success rates. Results. In 30 patients surgery was performed under spinal and in ten under general anaesthesia. The average intraoperative blood loss during the TVT-O was minimal (<50 ml). There were no vascular, bladder, bowel, and neurological injuries. Thirty-eight patients (95%) were discharged voiding satisfactorily. There was a statistically significant difference in symptoms between UDI-6 and UIQ-7 before and after surgery. Conclusion. Initial experience with TVT-O suburethral sling is promising. The TVT-O differs from retropubic procedures by resulting in lower postoperative morbidity, intraoperative and postoperative complications.

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