The mid-urethral tape (TVT — tension-free vaginal tape) was originally designed to support which anatomical structure to restore continence in stress urinary incontinence?
- A The mid-urethra at the level of the pubourethral ligaments ✓
- B The bladder neck (urethro-vesical junction)
- C The proximal urethra at the level of the internal urethral meatus
- D The posterior wall of the bladder
Correct answer: A. The mid-urethra at the level of the pubourethral ligaments
Explanation
The integral theory of continence (Petros and Ulmsten) proposes that stress urinary incontinence results from laxity of the pubourethral ligaments, which normally stabilise the mid-urethra during intra-abdominal pressure rises. TVT (Ulmsten 1996) places a polypropylene tape beneath the mid-urethra (not the bladder neck), acting as a neosupport/neoligament. This contrasts with older bladder-neck suspension procedures (Burch colposuspension, Marshall-Marchetti-Krantz) which targeted the urethro-vesical junction.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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