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Transvaginal Pelvic Floor Muscle Injection Technique: A Cadaver Study

Gupta, Priyanka MD; Ehlert, Michael MD; Sirls, Larry T. MD; Peters, Kenneth MD

Female Pelvic Medicine & Reconstructive Surgery: January/February 2017 - Volume 23 - Issue 1 - p 61–63
doi: 10.1097/SPV.0000000000000356
Original Articles
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Introduction Women with pelvic floor dysfunction can have tender areas on vaginal examination, which can be treated with trigger-point injections. There are no publications to evaluate the accuracy of pelvic floor muscle injections.

Methods Trigger-point injections were performed on 2 fresh cadaveric pelvises using a curved nasal cannula guide and 7-in spinal needle. This was performed using our standard template of 2 sets of injections at the 1-, 3-, and 5-o'clock positions distally and proximally. The first pelvis was dissected to examine dye penetration. Based on these results, we modified our technique and repeated the injections on the second cadaver. We dissected the second pelvis and compared our findings.

Results The 1-o'clock proximal and distal injections stained the obturator internus and externus near the insertion at the ischiopubic ramus. The 3-o'clock injections stained the midbody of the pubococcygeus and puborectalis. The distal 5-o'clock position was too deep and stained the fat of the ischiorectal space. The proximal 5-o'clock injection stained the area of the pudendal nerve. Our goal at the distal 5-o'clock position was to infuse the iliococcygeus muscle, so we shortened the needle depth from 2 to 1 cm beyond the cannula tip. In our second dissection, the distal 5-o'clock injection again stained only the fat of the ischiorectal space.

Conclusions This is the first study to characterize the distribution of pelvic floor muscle injections in a cadaver model and confirms the ability to deliver medications effectively to the pelvic floor muscles.

A study of the anatomic distribution of pelvic floor muscle injections in a cadaver model to confirm the ability to deliver medications effectively to the pelvic floor muscles.

From the *Beaumont Health, Royal Oak, MI; †Metro Urology, Minneapolis, MN; and ‡Oakland University William Beaumont School of Medicine, Royal Oak, MI.

Reprints: Priyanka Gupta, MD, Beaumont Health System, Medical Office Building, 3535 W 13 Mile Rd, Suite 438, Royal Oak, MI 48073. E-mail: prigupta83@gmail.com.

The authors have declared they have no conflicts of interest.

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