Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence

Figure 9

Placement of the AdVance sling [15]: (a) marking the point of entrance for the needle trocar just laterally and below the insertion of the adductor longus tendon (red star). (b) Protecting the urethra with the index finger. (c) The thumb is used to push the helical trocar, in order to deliver the needle tip straight into obturator fossa. (d) The index finger is used to protect the urethra, while rotating the handle of the introducer needle to deliver the needle tip into the perineal wound. (e) The tip of the introducer needle is guided into the perineal wound. (f) The connector attached on the plastic sheath that covers the sling and is clicked into position onto the tip of the introducer needle. (g) The needle tip is pushed back to the edge of the inferior pubic ramus. (h) The helical part of the needle is gripped and jerked a little towards the tip of the ipsilateral scapula, to dislodge it around the broad male inferior pubic ramus. (i) The sling can now be pulled through the obturator fossa. (j) The sling is held out of the way to prepare delivery on the contralateral side. (k) This image shows the sling connector and the helical needle trocar in situ. (l) The sling is pulled into position loosely flushed onto the bulb before fixating the distal edge of the midportion to the bulb with resorbable sutures (Vicryl 2/0).

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