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Rechberger E, Wróbel A, Kulik-Rechberger B, Miotla P, Ziętek A, Rechberger T. The clinical efficacy and safety of outside-in transobturator sling with additional paraurethral fixation - The prospective longitudinal study. Eur J Obstet Gynecol Reprod Biol 2023; 290:22-26. [PMID: 37713944 DOI: 10.1016/j.ejogrb.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
Stress urinary incontinence (SUI) is a common condition that affect 30-40% of women in their lifetime. Midurethral slings (MUS) either suprapubic or transobturator can be safely used in the surgical treatment of SUI. The aim of this study was to collect clinical long-term data regarding safety and performance of transobturator sling with an additional tape fixation in women with urinary incontinence. This prospective longitudinal study was conducted on a group of 2086 female patients diagnosed with stress urinary incontinence. Follow up visits where scheduled 6 weeks, 6 and 12 months after surgery followed by annual checking when possible. Patients underwent transobturator sling procedure from 01.01.2011 to 31.12.2021. All patients had a monofilament tape inserted at the mid-urethra using outside-in technique (TOT) with 2 absorbable sutures parallel to the urethra. Success of surgery was defined as lack of any leakage during cough stress test whereas the subjective cure rate was determined by Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF). 87% of patients who were operated at least 10 years before assessment reported ICIQ -SF < 6. Main postoperative complications were storage symptoms - de novo urgency and voiding difficulties. TOT is safe and highly effective surgical treatment for (SUI) in a long-term observation.
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Affiliation(s)
- Ewa Rechberger
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Andrzej Wróbel
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Beata Kulik-Rechberger
- Department of Paediatric Propedeutics, Medical University of Lublin, ul. A. Gebali 9, 20-091 Lublin, Poland
| | - Pawel Miotla
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland.
| | - Alicja Ziętek
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Rechberger
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
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Alshiek J, Wei Q, Javadian P, Quiroz LH, Baumfeld Y, Shobeiri SA. The Correlation Between the Sonographic Course of Transobturator Slings and Sling-Related Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:125-133. [PMID: 35388919 DOI: 10.1002/jum.15982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To determine whether transobturator slings follow a consistent path and whether there is an association between ultrasonographically visualized sling pattern or position with sling-related pain. METHODS This was a cross-sectional retrospective pilot study. We evaluated women who were presented to our clinic for pain or other urogynecologic symptoms following transobturator sling placement between 2009 and 2014. Patients had undergone a 3-dimensional endovaginal pelvic floor ultrasound, assessing minimal levator hiatus, antero-posterior diameter, left-right diameter, and the hiatal shape. The mesh patterns were categorized as seagull patterns (normal), lopsided, flat, and convoluted. RESULTS A total of 68 cases were reviewed. Fifty patients reported pain, and 18 did not. There were wide variations in the course of the slings. The sling center- minimal levator hiatus position ranged 14.8 mm below and 17.9 mm above the minimal levator hiatus. The lateral arm insertion points ranged between 17.1 mm below and 16.6 mm above the minimal levator hiatus. The right arm insertion points ranged between 9.6 mm below and 18.8 mm above the minimal levator hiatus. Thirty-five of 68 (70%) patients with pain and 13 of 18 (72.2%) without had abnormal sling patterns. The abnormal sling shape was not correlated with pain (P = 1). The levator shape trended toward a statistical significant correlation with sling shape abnormality (P = .084). CONCLUSIONS This population of women with transobturator sling complications demonstrated wide variations in anatomic paths. Neither the abnormal sling shape nor the distance of the center of the tape from the minimal levator hiatus level were correlated with pain.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Pouya Javadian
- Department of Obstetrics & Gynecology, the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Yael Baumfeld
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
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Šaherl L, Rakuša M. An anatomical description of the obturator region with clinical aspects. J ANAT SOC INDIA 2022. [DOI: 10.4103/jasi.jasi_134_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lorenzon L, Bini F, Landolfi F, Quinzi S, Balducci G, Marinozzi F, Biondi A, Persiani R, D’Ugo D, Tirelli F, Iannicelli E. 3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections. Int J Colorectal Dis 2021; 36:977-986. [PMID: 33230658 PMCID: PMC8026460 DOI: 10.1007/s00384-020-03802-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. METHODS A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx's tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. RESULTS Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. CONCLUSION Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.
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Affiliation(s)
- Laura Lorenzon
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy ,grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Fabiano Bini
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Federica Landolfi
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Serena Quinzi
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Genoveffa Balducci
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Franco Marinozzi
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Alberto Biondi
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Roberto Persiani
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Domenico D’Ugo
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Flavio Tirelli
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Elsa Iannicelli
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
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Contasure-needleless single incision slings versus transobturator slings (TOT/TVT-O) for female patients with stress urinary incontinence: a systematic review and meta-analysis. BMC Urol 2020; 20:51. [PMID: 32375733 PMCID: PMC7204064 DOI: 10.1186/s12894-020-00622-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 04/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background To assess the current evidence on the effectiveness and safety of Contasure-Needleless (C-NDL) versus transobturator slings (TOT/TVT-O) in the management of female stress urinary incontinence (SUI). Methods A comprehensive literature review of articles that investigated the efficacy and safety of C-NDL and TOT/TVT-O was performed based on studies published before June 2019 and retrieved from PubMed, Embase, CNKI and the Cochrane Library. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software. Results Seven studies with 1188 SUI female patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence were included. Our meta-analysis showed that the clinical efficacy of C-NDL is statistically non-inferior to that of TOT / TVT-O in terms of subjective cure rate [OR = 0.77, 95% confidence interval (CI) (0.53 to 1.10), p = 0.15] and objective cure rate [OR = 0.78, 95% CI (0.53 to 1.13), p = 0.19]. In addition, operating times were statistically shorter with C-NDL compared to TOT / TVT-O [mean difference (MD) = − 7.38, 95% CI (− 10.73 to − 4.04), p < 0.0001]. In terms of the postoperative visual analogue scale (VAS) and the incidence of postoperative pain, C-NDL has a greater advantage [MD = − 1.71, 95% CI (− 2.91 to − 0.50), p = 0.005]; [OR = 0.21, 95% CI (0.05 to 0.96), p = 0.04]. Complication rates were statistically similar between the groups, except for groin pain which was higher in TOT / TVT-O. Conclusion Our data suggest that C-NDL slings have similar short-term efficacy as TOT/TVT-O in curing SUI patients. Compared with TOT/TVT-O, C-NDL is associated with a shorter operative time, and the incidence of postoperative pain is decreased. Nevertheless, these findings should be further confirmed through large-volume, well-designed prospective randomized controlled trials (RCTs) with long-term follow-up.
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What is the optimal length for single-incision tape? Int Urogynecol J 2019; 30:2171-2175. [DOI: 10.1007/s00192-019-03926-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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Pawlaczyk A, Wąż P, Matuszewski M. Introital ultrasound in the diagnosis of lower urinary tract symptoms following anti-incontinence surgery using a synthetic midurethral tape. Int Urogynecol J 2018; 30:1503-1508. [PMID: 30564870 PMCID: PMC6706474 DOI: 10.1007/s00192-018-3837-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical treatment of stress urinary incontinence in women using a synthetic midurethral tape has become a standard procedure. One of the complications observed postoperatively are lower urinary tract symptoms (LUTS). The aim was to analyze the role of introital ultrasound in the identification of patients at risk for developing LUTS after surgical treatment using synthetic tape. METHODS A group of 50 patients suffering from LUTS following anti-incontinence surgery using synthetic tape was included in this study. The patients with pelvic organ prolapse and coexisting overactive bladder-wet before surgery were excluded. The control group consisted of 50 patients after the same treatment without any complications and with a good outcome. Tape visualization was performed using introital two-dimensional ultrasound. The assessment of the Tape Index (T/U) enabled us to divide the study group into the two subgroups with the tape index value of 0.375 as a borderline. The correlation between the tape position and the occurrence of LUTS was evaluated using a Chi-squared test. RESULTS In the group of patients suffering from LUTS, the tape was found to be closer to the bladder neck (the lower edge of the tape was more than 37.5% of the urethral length) and it was statistically significant (Chi-squared = 19.87, p < 0.001). CONCLUSIONS The tape position in the proximal urethra may have an impact on the postoperative occurrence of LUTS. The simple method of introital ultrasound could allow the identification of patients at risk for the development of LUTS after anti-incontinence surgery using synthetic tape.
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Affiliation(s)
- Anna Pawlaczyk
- Department of Urology, Medical University of Gdansk, Gdansk, Poland. .,Klinika Urologii UCK, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland.
| | - Piotr Wąż
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
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Chen J, Chen C, Li Y, Chen L, Xu J, Liu P. Impact of radical hysterectomy on the transobturator sling pathway: a retrospective three-dimensional magnetic resonance imaging study. Int Urogynecol J 2017; 29:1359-1366. [PMID: 29242958 DOI: 10.1007/s00192-017-3533-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Morphological and functional anomalies of the urethra may cause stress urinary incontinence after radical hysterectomy (RH). We introduce a novel three-dimensional (3D) magnetic resonance imaging (MRI) technique to assess the impact of RH on the transobturator sling pathway. METHODS 3D-MRI reconstruction models were retrospectively developed for the measurement of various parameters before and after RH, including puncture angle, orientation and distance from the midurethral puncture site to the obturator membrane (DUO), in 31 patients with cervical cancer. Additionally, the correlations between DUO and body height and interspinal diameter were evaluated. RESULTS No significant differences were noted between the preoperative and postoperative inclination angle (-7.1 ± 33.5° vs. -0.68 ± 23.9°, ranges -62.4 to 46.8° vs. -54.1 to 42.2°, respectively) or between the preoperative and postoperative left and right mean rotation angles (left 69.0 ± 8.0° vs. 67.8 ± 9.2°; right 65.1 ± 8.38° vs. 64.3 ± 10.5°). Similarly, there were no statistically or clinically significant differences between the preoperative and postoperative DUO, although slight differences were noted between the two sides before and after RH (P = 0.018 and P = 0.023, respectively). None of the parameters differed significantly between the groups with and without postoperative urodynamic stress incontinence. Further, there was no clinically significant correlation between DUO and height or interspinal diameter. CONCLUSIONS The sling procedure via the transobturator approach is technically safe from a 3D anatomical standpoint. However, wide variability in the anatomical parameters must be taken into account when planning the procedure.
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Affiliation(s)
- Jinyang Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, NO.1838, Guangzhou Northern Avenue, Guangzhou, 510515, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, NO.1838, Guangzhou Northern Avenue, Guangzhou, 510515, China
| | - Yige Li
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, NO.1838, Guangzhou Northern Avenue, Guangzhou, 510515, China
| | - Lan Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, NO.1838, Guangzhou Northern Avenue, Guangzhou, 510515, China
| | - Juan Xu
- Department of Radiology, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, NO.1838, Guangzhou Northern Avenue, Guangzhou, 510515, China.
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Halski T, Ptaszkowski K, Słupska L, Dymarek R, Paprocka-Borowicz M. Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study. Clin Interv Aging 2017; 12:75-83. [PMID: 28115836 PMCID: PMC5221554 DOI: 10.2147/cia.s121467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position. Materials and methods This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance. Results In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104). Conclusion The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM.
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Affiliation(s)
- Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders
| | - Lucyna Słupska
- Department of Physiotherapy, Opole Medical School, Opole
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Ultrasound Evaluation of Midurethral Sling Position and Correlation to Physical Examination and Patient Symptoms. Female Pelvic Med Reconstr Surg 2016; 21:263-8. [PMID: 25730429 DOI: 10.1097/spv.0000000000000161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary objective was to evaluate the position and angle variation between 3 different midurethral slings (MUSs) using 3-dimensional ultrasound (US) technology. The secondary objective was to compare differences in findings on physical examination and symptoms of incontinence and sexual dysfunction between subjects. METHODS This was a cross-sectional study of 61 subjects who had undergone MUS placement without concomitant anterior or apical compartment prolapse surgery (21 retropubic [RP], 19 out-to-in transobturator [TOT], 21 in-to-out transobturator [TVT-O]). Subjects completed validated questionnaires (Sandvik Incontinence Severity Index, Urogenital Distress Inventory 6) and underwent a pelvic examination and standardized 2-dimensional and 3-dimensional ultrasonography evaluation. RESULTS On translabial US, the median RP sling angle was 108.2 degrees (72.6-135.9), significantly more acute than the angle of TOT and TVT-O slings (119.3 degrees [72.3-140.4, P = 0.02] and 118.5 degrees [99.0-154.7, P = 0.004]). There was no difference in the sling angles between the TOT and TVT-O slings (P = 0.86). No difference was noted in the position of the sling along the urethra (P = 0.82). The TOT sling was more often palpable (57.8%, P = 0.02) compared with the RP or TVT-O groups.Fifteen patients (4 RP, 5 TOT, 6 TVT-O) reported discomfort during intercourse that they attributed to the MUS. Three of 19 TOT subjects reported that their partner experienced pain with intercourse because of the sling. However, sexual function and urinary symptoms were not statistically different between the 3 groups. CONCLUSIONS On 3-dimensional US, RP sling angle was found to be significantly more acute than the angles of the TOT and TVT-O slings, and there was no difference between the 2 transobturator slings. The TOT sling was more often palpable on examination, but this finding did not correlate with increased pain on palpation.
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Nyangoh Timoh K, Bader G, Fauconnier A, Barrau V, Delmas V, Touboul C. Determination of a Central Avascular Triangle within the Obturator Foramen: A Radioanatomic Study. PLoS One 2015; 10:e0143642. [PMID: 26624993 PMCID: PMC4666647 DOI: 10.1371/journal.pone.0143642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/06/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To map the vascular anatomy of the obturator foramen using fixed anatomic landmarks. METHOD Twenty obturator regions were dissected in 10 fresh female cadavers after vascular blue dye injection in five cadavers (50%). Furthermore, 104 obturator regions were reconstructed by angiotomodensitometry from 52 women under investigation for suspected arterial disease. The anatomy of the obturator region was mapped by measuring the distance of vascular structures from the middle of the two branches of the ischiopubic bone, which were used as fixed landmarks. RESULTS The bifurcation of the obturator artery was at a mean (SD) distance of 30.0 mm (4.5) from the middle of the ischiopubic branch (MISP). The anterior branch of the obturator vessels was 15.2 mm (10.1) from the MISP. The posterior branch of the obturator vessels was 5.5 mm (4.0) and 23.6 mm (8.7) from the middle of the outer edge of the obturator foramen (MOE) and the MISP, respectively. Using 5° and 95° percentiles of these measurements we defined a central avascular triangle. CONCLUSIONS Our data show that, beyond inter-individual variations, a central triangular avascular area can be identified in the obturator foramen between the posterior and anterior obturator artery using fixed landmarks.
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Affiliation(s)
- Krystel Nyangoh Timoh
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Créteil, University Paris Est, UPEC-Paris XII, Paris, France
| | - Georges Bader
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hôpital de Poissy, University Saint-Quentin-en-Yvelines, Poissy, France
| | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hôpital de Poissy, University Saint-Quentin-en-Yvelines, Poissy, France
| | - Vincent Barrau
- Department of radiology, Centre cardiologique du Nord, Saint Denis, France
| | - Vincent Delmas
- URDIA EA 4465, Anatomy, Université Paris Descartes, Paris, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Créteil, University Paris Est, UPEC-Paris XII, Paris, France
- UMR INSERM U965: Angiogenèse et Recherche translationnelle, Hôpital Lariboisière, Paris, France
- * E-mail:
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Both the middle and distal sections of the urethra may be regarded as optimal targets for 'outside-in' transobturator tape placement. World J Urol 2014; 32:1605-11. [PMID: 24531879 PMCID: PMC4236631 DOI: 10.1007/s00345-014-1261-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate whether the position of the tape under the urethra may influence ‘outside-in’ transobturator sling (TOT) outcome. Methods The study comprised 141 women who underwent TOT for clinically and urodynamically proved stress urinary incontinence. The postoperative ultrasound examination with an endovaginal biplane probe was performed before discharging the patients from hospital. The measurements obtained described the position of the tape relative to the urethra and pubic symphysis, as well as anatomical relationships in the anterior compartment. Results Ninety-six (68.1 %) patients were cured, 27 (19.1 %) significantly improved, and in 18 cases (12.7 %), the surgery failed. The tape position under the midurethra (40–70th percentile of the urethral length) or distal urethra (>70th percentile) coincided with better results (cure rate 67.1 and 82.4 %, respectively) than the location in the proximity of the bladder neck (<40th percentile) (21.4 % cured, p = 0.0015 and p < 0.001, respectively). However, the risk of failure was the lowest when the tape was located under the distal urethra. Other ultrasonographic findings were not related to treatment results. Conclusions The highest failure rate for ‘outside-in’ TOT is associated with the location of the tape under the proximal third of the urethra. Both the middle and distal sections of the urethra may be regarded as targets for transobturator tape placement.
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MARTAN A, KRHUT J, MAŠATA J, ŠVABÍK K, HALAŠKA M, HORČIČKA L, ZACHOVAL R. Prospective Randomized Study of MiniArc and Ajust Single Incision Sling Procedures. Low Urin Tract Symptoms 2013; 6:172-4. [DOI: 10.1111/luts.12041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/28/2013] [Accepted: 09/11/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Alois MARTAN
- Department of Obstetrics and Gynecology; Charles University and General Faculty Hospital in Prague; Prague Czech Republic
| | - Jan KRHUT
- Department of Urology; Ostrava University; Ostrava Czech Republic
| | - Jaromír MAŠATA
- Department of Obstetrics and Gynecology; Charles University and General Faculty Hospital in Prague; Prague Czech Republic
| | - Kamil ŠVABÍK
- Department of Obstetrics and Gynecology; Charles University and General Faculty Hospital in Prague; Prague Czech Republic
| | - Michael HALAŠKA
- Department of Obstetrics and Gynecology; Charles University and Faculty Hospital, Bulovka; Prague Czech Republic
| | - Lukáš HORČIČKA
- GONA - Outpatient Clinic of Obstetrics and Gynecology; Prague Czech Republic
| | - Roman ZACHOVAL
- Department of Urology; Thomayer Hospital; Prague Czech Republic
- Department of Urology; 1st Faculty of Medicine, Charles University and General Faculty Hospital; Prague Czech Republic
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Hubka P, Nanka O, Martan A, Svabik K, El-Haddad R, Masata J. Fixation of the Ajust minisling based upon cadaveric study. Int Urogynecol J 2013; 24:2119-23. [DOI: 10.1007/s00192-013-2139-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 05/17/2013] [Indexed: 11/28/2022]
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