• The Journal of urology · Dec 2014

    Following the needles: an anatomical study to evaluate the postoperative safety and symptoms of patients receiving a transobturator male sling implant.

    • João Antonio Pereira-Correia, Carolina Gama Rodrigues dos Santos, Bernardo Gonçalves Bastian-Pinto, Fernanda Cascardo Bilouro, Caroline Fagundes Facó Hauaji, André Luis Santos Saud, Fábio Sant'anna de Moraes, and Valter José Fernandes Muller.
    • Department of Anatomy, Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil. Electronic address: joaoapc@ig.com.br.
    • J. Urol. 2014 Dec 1; 192 (6): 1750-5.

    PurposeImplanting 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.Materials And MethodsNeedles 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.ResultsAll 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.ConclusionsThe 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.Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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