Relationship Between Retropubic Vessels and Pelvic Bony Anatomy: Retropubic Midurethral-Sling Placement Considerations

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Journal of Gynecologic Surgery


Objective: Retropubic midurethral sling placement (MUS) is a surgical procedure for treating stress urinary incontinence (SUI) in females that uses mesh to support the urethra to prevent leakage during episodes of increased abdominal pressure. Hematoma is a documented risk of MUS placement. The location of relevant pelvic vasculature was compared to pelvic bony dimensions with the aim of measuring these anatomic relationships in order to prevent hematomas during MUS placement.

Materials and Methods: The superficial epigastric, inferior epigastric, external iliac, and obturator arteries were dissected bilaterally from 13 formalin-embalmed cadavers. Distance was measured to a retropubic trocar placed in the typical fashion. Anteroposterior pelvic (AP) diameter and ischial interspinous distance were recorded. SPSS was used for statistical analyses.

Results: All arteries were identified lateral to the trocar site. Obturator arteries were the closest (30.60 ± 5.19 mm) and external iliac arteries were the furthest (48.08 ± 9.64 mm). There was a significant correlation between artery–trocar distance and AP diameter, but not interspinous distance.

Conclusions: Major vascular structures lie in close proximity to the path of the trocar used in MUS placement for treating SUI. The female AP diameter is correlated with the distance between these vessels and the trocar—and may be a clinically useful measure to determine which patients are at increased risk for hematomas during MUS.



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stress urinary incontinence, midurethral sling, retropubic vessels, vascular injury, female pelvis