Jinyang Chen1, Chunlin Chen1, Yige Li1, Lan Chen1, Juan Xu2, Ping Liu3. 1. Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, NO.1838, Guangzhou Northern Avenue, Guangzhou, 510515, China. 2. Department of Radiology, Nanfang Hospital of Southern Medical University, Guangzhou, China. 3. Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, NO.1838, Guangzhou Northern Avenue, Guangzhou, 510515, China. lpivy@126.com.
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.
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.
Authors: R C Bump; A Mattiasson; K Bø; L P Brubaker; J O DeLancey; P Klarskov; B L Shull; A R Smith Journal: Am J Obstet Gynecol Date: 1996-07 Impact factor: 8.661
Authors: Giacomo Novara; Walter Artibani; Matthew D Barber; Christopher R Chapple; Elisabetta Costantini; Vincenzo Ficarra; Paul Hilton; Carl G Nilsson; David Waltregny Journal: Eur Urol Date: 2010-04-23 Impact factor: 20.096
Authors: Rosa M Laterza; Karl-Dietrich Sievert; Dirk de Ridder; Mark E Vierhout; Francois Haab; Linda Cardozo; Philip van Kerrebroeck; Francisco Cruz; Con Kelleher; Christopher Chapple; Montserrat Espuña-Pons; Heinz Koelbl Journal: Neurourol Urodyn Date: 2014-02-12 Impact factor: 2.696