The ends of the graft sling suture (often referred to as arms or tails) are passed upward through the
retropubic space using the eyelets of the Stamey needle or the clamp.
The transobturator approach, on the other hand, offers the potential advantage of avoiding the
retropubic space completely.
Furthermore, as our standard technique to midurethral sling removal involves a combined vaginal and laparoscopic approach with dissection of the
retropubic space, the inclusion of a laparoscopic Burch urethropexy at time of surgery would not entail any further dissection given that the space was already open [14, 16, 17].
After the sling "pops" into the
retropubic space, I remove my hand from the vagina and place it on the abdominal wall at the ipsilateral suprapubic poke site.
Thread the free ends of the sutures affixed to the sling into the ends of the Stamey needles--or grasp them with clamps--and pull each suture up to the anterior abdominal wall through the
retropubic space (FIGURE 5).
A second type of retropubic sling--the suprapubic urethral support sling (SPARC, American Medical Systems)--utilizes a downward-pass, or top-down, approach in which a metal trocar is passed through suprapubic incisions and down through the
retropubic space to exit a vaginal incision.
1: A computed tomography scan showing a 6-cm fluid collection at the mons pubis connected to inflammation within the
retropubic space. [Figure omitted]
Some place smaller, 3-mm trocars in a similar "bottom-up" fashion, as the TVT sling does; others utilize smaller trocars that are placed "top down" through the
retropubic space into the vagina.
However, because of the blind passage of the needle through the
retropubic space, it is associated with significant potential complications.[sup.3] In 2001, transobturator tapes (TOT) were introduced to lower the number of bladder perforations and vascular injuries associated with TVT.[sup.4] To further decrease the complication rate, the TVT-Secur (Gynecare, Ethicon, Somerville, NJ) was introduced in 2006.
* Inject local anesthetic or saline into the
retropubic space to push the bladder away from the trocar.