INTRODUCTION AND HYPOTHESIS: The aim of this video is to provide a step-by-step description of our approach to the surgical management of intravesically localized transobturator tape after previous failure of repeated cystoscopic tape resection. METHODS: This video presents a patient with tape erosion to the urinary bladder after repeated cystoscopic tape resection, recurrent stone formation, and repeated lithotripsy, with recurrent urinary tract infections and overactive bladder (OAB) with urgency incontinence. RESULTS: During the laparoscopy procedure tape was identified in the left obturator muscle, cut near the obturator muscle, and dissected up to the bladder wall. Afterward, a vertical 2-cm incision was made in the bladder wall, the stone was removed, and the rest of the tape was dissected from the bladder wall. A two-layer suture of the bladder wall was performed. The postoperative course was uneventful. In follow-up visits 3 and 6 months after surgery the patient was continent with no symptoms of OAB. CONCLUSIONS: Cystoscopic resection of protruded mesh is inadequate in many cases. In such cases the mesh should be removed from the urinary bladder wall completely. Laparoscopy allows minimally invasive complete removal of the tape, combining resection of the extravesical and intravesical parts of the tape.

• Keywords
• Mesh, Midurethral sling complication, Surgery, Transobturator tape,
• MeSH
• Urinary Bladder Calculi * surgery   MeSH
• Laparoscopy * MeSH
• Humans MeSH
• Urinary Bladder surgery   MeSH
• Device Removal MeSH
• Urinary Incontinence, Stress * surgery   MeSH
• Suburethral Slings * adverse effects   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Video-Audio Media MeSH
• Journal Article MeSH

INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess the length of adjustable single-incision midurethral tape (SIMS; Ajust), which is needed to fix this tape to the obturator membrane. From these data, we can deduce the optimal length of the SIMS. METHODS: For this study, we employed the intra-operative data of patients included in a single-center randomized trial comparing the efficacy of Tension free vaginal tape obturator (TVT-O) and Ajust. The length of the Ajust tape was calculated using the formula: total length of the tape minus the length of the stylet used for the tape lock, minus the length of the lock minus the width of the two anchors. The length of the obturator tape was calculated using the formula: total tape length minus the snipped parts of the tape. The correlation coefficient of the tape length to basic biometric parameters, such as height, weight, and body mass index, was calculated. RESULTS: For this study, data from 50 women from each group, TVT-O and Ajust, were used. The mean length of the Ajust tape inside the body is 11.6 cm (SD 0.9), with a minimum length of 9.6 cm and a maximum length of 14.6 cm. The mean length of TVT-O tape inside the body is 20.3 cm (SD 2.1), with a minimum of 14.8 cm and a maximum length of 24.5 cm. CONCLUSIONS: This study demonstrates that to achieve continence it is necessary to use different lengths of single-incision tape. Inappropriate SIMS length could cause failure related to the tape itself and not to the TVT technique.

• Keywords
• Ajust, Single-incision midurethral sling, Stress urinary incontinence, Surgical treatment, TVT-O,
• MeSH
• Surgical Wound MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Urinary Incontinence, Stress surgery   MeSH
• Suburethral Slings * MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

INTRODUCTION AND HYPOTHESIS: The aim of the study was to describe fixation of the TVT ABBREVO and establish whether the tape penetrates through obturator muscles and membrane (obturator complex) into the adductor region and, if so, how far it penetrates. METHODS: Eight formalin-embalmed female cadavers were used to simulate TVT ABBREVO surgery (totalling 16 insertions). Following tape insertion, dissection was performed and ends of the tape were identified. In cases of penetration, the length of tape penetrating into the adductor region was measured. RESULTS: Of the 16 cases, the tape ended in the obturator membrane in eight, in the internal obturator muscle in one, and penetrated through the obturator membrane into the external obturator muscle in five, where it remained. In two cases, it penetrated through the obturator internus muscle, obturator membrane and obturator externus muscle into the group of thigh adductors; one penetration was by 3 mm and the second by 10 mm. No contact with the obturator nerve or its branches was noted in any case. CONCLUSIONS: No TVT contact with the obturator nerve was noted; tape penetrated into the adductor region in two of the 16 cases.

• Keywords
• Anatomy, Cadaver study, Complications, Sling fixation, TVT ABBREVO, Urogynecology,
• MeSH
• Gynecologic Surgical Procedures instrumentation   MeSH
• Muscle, Skeletal * MeSH
• Humans MeSH
• Suburethral Slings * MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION AND HYPOTHESIS: The objective was to describe the fixation site of the anchor of the Ajust mid-urethral minisling. METHODS: This cadaveric study was based on a group of 11 formalin-embalmed bodies with legs positioned in 30° flexion and 30° abduction, and a group of five fresh-frozen bodies with legs positioned as normal during the procedure. The groups were later compared. The fixation site was dissected and described. The distance to the obturator bundle was considered as the primary safety parameter. To compare the groups of fresh-frozen bodies and formalin-embalmed bodies, the Student's t test and Mann-Whitney test were used. RESULTS: In the group of formalin-embalmed bodies the mean distance from the anchoring device to the obturator nerve was 4.23 cm. In 19 cases out of 22 the anchor was within the complex of the obturator membrane and obturator muscles. In the group of fresh frozen bodies the mean distance to the obturator nerve was 3.15 cm. In 9 cases out of 10 the anchor was in the complex of the obturator membrane and obturator muscles. CONCLUSION: The distance from the anchor to the obturator nerve was more than 2 cm in all cases. Correct placement in the obturator membrane was achieved in 65.6 % of cases. In 87.5 % of cases the anchor was placed within the complex of obturator membrane and obturator muscles.

• MeSH
• Embalming MeSH
• Dissection MeSH
• Prosthesis Implantation methods   MeSH
• Cryopreservation MeSH
• Humans MeSH
• Cadaver MeSH
• Obturator Nerve anatomy & histology   MeSH
• Pelvis anatomy & histology   MeSH
• Patient Positioning MeSH
• Prosthesis Retention * MeSH
• Suburethral Slings * MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

INTRODUCTION AND HYPOTHESIS: To estimate distances from the mid-urethra to the obturator foramina and to explore correlations between pelvic dimensions and body height. METHODS: This is a secondary analysis of a parent case-control study on the mechanisms of stress urinary incontinence. We measured pelvic dimensions on magnetic resonance images of women with (cases, n = 50) and without (controls, n = 50) stress urinary incontinence. RESULTS: The mean distance from mid-urethra to the obturator membrane among cases is 31.8 mm (left) and 32.1 mm (right), with a range from 25.9 to 42.0 mm. There were no significant differences in these distances when comparing left with right, or cases with controls. Weak correlation was found between the urethra-to-obturator foramina distances and heights only in the case subjects. CONCLUSION: There is high variability in the distance from mid-urethra to the obturator foramina. Height should not be used as a predictor of dimensions in the lesser pelvis.

• MeSH
• Equipment Design MeSH
• Body Mass Index MeSH
• Hip anatomy & histology   pathology   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Pelvic Floor anatomy & histology   pathology   MeSH
• Pelvic Bones anatomy & histology   pathology   MeSH
• Urinary Incontinence, Stress pathology   MeSH
• Case-Control Studies MeSH
• Suburethral Slings MeSH
• Body Height MeSH
• Urethra anatomy & histology   pathology   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, N.I.H., Extramural MeSH