Anatomy

Question 1

Describe the course of the ureter start at the IP

Answer 1

-lateral to medial under the IP
-next to genitofemoral nerve over the belly of the psoas, -then medially over the bifurcation of the common iliacs
-beneath the broad ligament
-under the uterine aretery
-1.5cm from the origin of the uterosacral ligament from the cervix
- medial to the vaginal artery
-into the trigone

Question 2

Bladder perf rate with retropubic slings

bladder perf rate with TOT

perf rate with fascial sling

6 other complications from TVT

Answer 2

5%

<1%

5%

1. over tensioning
2. mesh exposure
3. bowel injury (use t-burg to
4. venous plexus hematoma
5. arterial injury (inferior epigastric, supericial epigastric, external iliac)
6. nerve pain from abrasion of pubic bone

Question 3

Obturator trocar path in to out

Answer 3

1. periurethral fascia
2. obturator internus m.
3. obturator membrane
4. obturator externus m.
5. adductor brevis m.
6. gracilis
7. skin

Question 4

post op TOT has groin pain, what muscle did you hit

Answer 4

adductor longus. trocar should have been below that

Question 5

where in relationship to the urethra do burch stitches go?

Answer 5

one at mid urethra and one at the bladder neck

Question 6

Fascial sling harvest size

Answer 6

7-10cm long
1.5cm to 2 cm wide

Question 7

SSLF anatomy

1. What level on the sacrum does the SSL attach?
2. What muscle overlies the ligament?

Answer 7

1. S2-3, SSL and sacrotuberous ligament fuse together and attach to the sacrum
2. coccygeus

Question 8

Name the relationship between the anatomy and the SSL?

1. pudendal neurovascular bundle
2. inferior gluteal neurovasculature
3. sacral venous plexus

Answer 8

1. underlying ischial spine
2. superior midline of ligament
3. caudal to the ligament

Question 9

USLS anatomy, what can be injured?

vasculature:

nerves:

Answer 9

vasculature: sacral venous complex medially, vaginal vessels at the vagina

nerves: if too deep hypogastric /sacral plexus, too lateral obturator, levator

Question 10

McCalls Cauldoplasty

what is it?

Answer 10

obliterate the cul-de-sac by bring the uterosacral ligments together.

internal sutures between USL
external sutures go through posterior vagina, then to USL and across cul de sac to the other USL and then through the posterior vagina

Question 11

What muscle are you plicating with your levator plication?

Answer 11

puborectalis

Question 12

What is the rate of postop dyspareunia after posterior repair?

Answer 12

9-22%

Question 13

What muscles are you bring together when doing a posterior colporrhaphy

Answer 13

rectovaginal fascia
bulbocavernous
transverse perinei
(external anal sphincter)