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Figures in Original article by PETER PETROS (*) (**) - PETER RICHARDSON (***)

Prepubic sling in curing non-stress leakage following complete cure of stress incontinence by a midurethral sling

(*) Royal Perth Hospital, Perth, Western Australia
(**) University of Western Australia
(***) Gallier’s Hospital, Armadale, Western Australia

Images reproduction prohibited without permission of Authors.

(Fig 1)

perineal descent, sigmoidocoele

Fig 1. - TFS pre-pubic and midurethral slings.
‘1’ = prepubic TFS sling. ‘2’= midurethral TFS sling; ‘PCM’= anterior portion of pubococcygeus muscle.


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(Fig. 2 )

Sigmoidocoele

Fig 2. – Proposed role of a lax external urethral ligament (EUL) in non-stress incontinence. The hammock (H) “tips down”, and so cannot be closed by the anterior portion of m. pubococcygeus ( small crooked arrow). The curved arrow represents the rotating force acting against the pubourethral ligament insertion point ‘F’ to close the bladder neck.2,3 PUL=pubourethral ligament; crooked arrow represents diminished muscle force consequent on loose EUL. A loose fibrosed mesh tape may interfere with this “sealing” mechanism by ‘holding open’ the urethra, and preventing ‘sealing’ by the hammock closure mechanism.


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(Fig. 3 )

functional enterocoele

Fig 3. –Proposed components of the “sealing” mechanism
PUL=pubourethral ligament; PCM=slow-twitch fibres of m.pubococcygeus


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