Hypothesis

A hypothesis for urinary stream divergence in the female: unilateral dislocation of the pubovisceral muscle

  • KAY U. SCHEFFLER
  • PETER E. PETROS
  • OLIVER W. HAKENBERG

Pelviperineology 2014;33(1):10-13

Objective:

Cure of diverted urinary stream with TFS tensioned minisling pubovisceral muscle re-attachment Aim and hypothesis: To surgically correct a urinary stream divergent to the left side hypothesized to be caused by right pubovisceral muscle (PVM) avulsion.

Patient and Methods:

The patient presented with a divergent urinary stream to the left side with deficient right PVM attachment to the symphysis. Micturating cystography confirmed diversion of bladder neck and proximal urethra to the right side during micturition. A TFS USling was used to re-attach the dislocated PCM to the tissues behind the pubic symphysis.

Results:

The direction of the stream returned to normal , the USI was cured and both conditions remained cured at 12 months review.

Conclusion:

We hypothesize that the TFS U-Sling works by penetrating the PVM fascia to “reglue” it to the tissues near ATFP origin, restoring the insertion point of the right backward urethral opening vectors and therefore, urinary stream direction.

Keywords: Diverted Urinary Stream; Pubovisceral Muscle Dislocation; TFS U-Sling; Minisling.