TVT-S in the U position--anatomical study

Area of Science:

• Urogynecology
• Female pelvic anatomy
• Surgical anatomy

Background:

• Urinary incontinence is a common condition affecting women.
• Surgical treatment, such as tension-free vaginal tape Secur (TVT-S), is widely used.
• Understanding anatomical risks associated with TVT-S placement is critical for patient safety.

Purpose of the Study:

• To determine the anatomical position of the TVT-S device in the U position.
• To assess potential risks of injury to adjacent structures, specifically the obturator bundle.
• To evaluate the fixation site of the TVT-S.

Main Methods:

• The study utilized 13 embalmed and 5 fresh frozen female cadavers.
• TVT-S inserters were placed bilaterally in the U position.
• Dissection and measurement of distances from the obturator bundle were performed.

Main Results:

• In embalmed bodies, the mean distance from the obturator bundle was 2.83 cm (left) and 2.92 cm (right).
• Fascia of the obturator internus muscle perforation occurred in 38.5% of cases.
• Similar results were observed in fresh frozen specimens, indicating anatomical consistency.

Conclusions:

• TVT-S placement carries a risk of injury to the obturator bundle and urinary bladder.
• There is a significant risk of inserter placement outside the obturator internus muscle, into the lesser pelvis.
• Mal-positioning of the legs during surgery did not significantly alter the final TVT-S tape position.