Transobturator Surgery in Presence of Corona Mortis: A Study in 13 Women

Abstract

Purpose

Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis damage. The aim of this study is to evaluate safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic-organ prolapse (POP) repair in the presence of corona mortis.

Materials and methods

Thirteen women with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight women underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by a single experienced pelvic surgeon.

Results

Surgery was uneventful in all cases. No major bleeding was seen during surgery. No pelvic hematoma was identified 24 hours after the procedure. All women were discharged 1 day after surgery.

Conclusions

Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.

Keywords

Bleeding Complication Corona mortis Surgical mesh Transobturator Vaginal surgery

Get full access to this article

View all access options for this article.

References

Milsom

Altman

Lapitan

Nelson

Sillén

Tho

Epidemiology of urinary and faecal incontinence and pelvic organ prolapse. In: Abrams

, Cardozo

, Khoury

, Wein

, eds. Incontinence, 4^rd International Consultation on Incontinence. Plymouth, United Kingdom Health Publications 2009;46-64.

Maher

Feiner

Baessler

Schmid

Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2013304CD004014

Botlero

Urquhart

Davis

Bell

Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues. Int J Urol 2008 15 3 230–234

Ulmsten

Henriksson

Johnson

Varhos

An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996 7 2 81–85 discussion 85-86.

Wagner

Bentkover

Leblanc

Zhou

Hunt

Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology 2004 63 3 461–465

Subak

Waetjen

van den Eeden

Thom

Vittinghoff

Brown

Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 2001 98 4 646–651

Serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ prolapse and stress urinary incontinence. October 20, 2008. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm. Accessed April 15, 2016.

Novara

Galfano

Boscolo-Berto

. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol 2008 53 2 288–308

Balachandran

Curtiss

Duckett

The management of massive haematomas after insertion of retropubic mid-urethral slings. Int Urogynecol J Pelvic Floor Dysfunct 2015 26 10 1449–1452

10.

Rehder

Glodny

Pichler

Mitterberger

Massive retropubic hematoma after minimal invasive mid-urethral sling procedure in a patient with a corona mortis. Indian J Urol 2010 26 4 577–579

11.

Larsson

P-G

Teleman

Persson

A serious bleeding complication with injury of the corona mortis with the TVT-Secur procedure. Int Urogynecol J Pelvic Floor Dysfunct 2010 21 9 1175–1177

12.

Gobrecht

Kuhn

Fellman

Injury of the corona mortis during vaginal tape insertion (TVT-Secur™ using the U-Approach). Int Urogynecol J Pelvic Floor Dysfunct 2011 22 4 443–445

13.

Rusu

Cergan

Motoc

AGM

Folescu

Pop

Anatomical considerations on the corona mortis. Surg Radiol Anat 2010 32 1 17–24

14.

Smith

Gregorius

Breazeale

Watkins

The corona mortis, a frequent vascular variant susceptible to blunt pelvic trauma: identification at routine multidetector CT. J Vasc Interv Radiol 2009 20 4 455–460

15.

Bump

Mattiasson

Bø

. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996 175 1 10–17

16.

Moore

Clinically Oriented Anatomy. Baltimore Williams & Wilkins 1992.

17.

Jimenez

Vrahas

Surgical approaches to the acetabulum. Orthop Clin North Am 1997 28 3 419–434

18.

Davies

Coupland

Gray's Anatomy, 34th eds.

London

Longmans, Green and Co. Ed. 1967.

19.

Darmanis

Lewis

Mansoor

Bircher

Corona mortis: an anatomical study with clinical implications in approaches to the pelvis and acetabulum. Clin Anat 2007 20 4 433–439

20.

Tornetta

III Hochwald

Levine

Corona mortis. Incidence and location. Clin Orthop Relat Res 1996 329 329 97–101

21.

Karakurt

Karaca

Yılmaz

Burma

Serin

Corona mortis: incidence and location. Arch Orthop Trauma Surg 2002 122 3 163–164

22.

Berberoğlu

Özmen

. Corona mortis: an anatomic study in seven cadavers and an endoscopic study in 28 patients. Surg Endosc 2001 15 1 72–75

23.

Burch

Urethrovaginal fixation to Cooper's ligament for correction of stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol 1961 81281–290

24.

Hubka

Svabik

Martan

Masata

A serious bleeding complication with injury of the corona mortis with the TVT-Secur procedure: two cases of contact of TVT-S with the corona mortis during cadaver study. Int Urogynecol J Pelvic Floor Dysfunct 2010 21 9 1179–1180

25.

Delmas

Anatomical risks of transobturator suburethral tape in the treatment of female stress urinary incontinence. Eur Urol 2005 48 5 793–798