The role of variant anatomy of the neurovascular bundle of the perineum in the aspect of improving the technique of surgical treatment of urinary incontinence in women

Stress urinary incontinence is an urgent problem in modern urology. The main modern method of correcting this disease is surgical treatment and of the installation of a suburethral sling. This method is recognized as the gold standard in the treatment of stress urinary incontinence, but there is a need for anatomical studies to improve the long-term effectiveness of the intervention and reduce the risk of postoperative complications. The aim of this study was to study the features of the variant anatomy of the neurovascular bundle of the female perineum in terms of the installation of a trans-obturator suburethral sling. The study was on 30 polymer method embalmed preparations of the female pelvis from the collection of the Department of Normal Anatomy of the Kirov Military Medical Academy. All samples belonged to Caucasians women of mature age. To determine the likelihood of damage to the vessels and nerves of the perineum during the trans-obturator suburethral sling, the distances from the supposed point of perforation of the obturator complex to the neurovascular structures visualized in this area were measured. The distance between the anatomical structures was measured with a caliper. During the study, it was found that three main branches of the perineal nerve extend to the anterior surface of the pelvis in the perineal region: the dorsal nerve of the clitoris, the posterior labial nerve and the perineal branch of the posterior cutaneous nerve of the thigh. The branches of the perineal nerves - the posterior labial nerve and the dorsal nerve of the clitoris - have the greatest variability. The latter can be damaged when the trocar is carried medially from the middle third of the lower branch of the pubic bone. In this study, there was no evidence of significant anatomical variability of the internal genital artery, which indicates that, normally, with the standard implantation technique using the trocar rotation method around the inferior branch of the pubic bone, there is a minimal likelihood of massive bleeding. Thus, further studies of the variant anatomy of the female pelvis may contribute to the modification of the technique of implantation of the suburethral sling and the improvement of the clinical results of the treatment of stress urinary incontinence.