Urethral graciloplasty for treatment of female intrinsic sphincter deficiency: rationale for the transvaginal approach: an anatomical study.

Abstract

To compare the retropubic and transvaginal approaches in terms of the length of gracilis muscle available for female urethral graciloplasty. Two groups of female cadavers were submitted to bilateral gracilis muscle dissection, followed by urethral graciloplasty using either the standard retropubic approach or the transvaginal approach. The two groups were studied in terms of various muscle characteristics, in particular the length of muscle that could effectively be wrapped around the bladder neck. Because muscle transfer to the perineum was more direct, the transvaginal approach provided a greater functional length of gracilis for effective periurethral wrapping than the retropubic approach (mean: 8.4 cm. versus 5.2 cm., p = 0.0022). The transvaginal approach allows a more "proximal" graciloplasty and should therefore be evaluated clinically to provide circumferential bladder neck support without tension.