Tendinous arch of the pelvic fascia: application to the technique of paravaginal colposuspension

The authors give a description of the anatomy and topography of the tendino us arch of the pelvic fascia (TAPF), in order to facilitate its location du ring surgery. 35 TAPF in 25 female cadavers were dissected. The reproducibi lity of the landmarks was then verified at laparotomy. The TAPF can be easi ly identified and its resistance remains constant, even when the pelvic flo or is hypotrophic. Its anterior extremity (d2) is at about 46 mm on a line perpendicular to the anterior edge of the pectineal ligament (35-55 mm), ne xt to the pubovesical ligament. Its median part (d1) is perpendicular to th e obturator foramen at a site located at an average of 30 mm below the obtu rator foramen (25-50 mm). Its posterior end is located at the ischial spine . These anterior landmarks, the only ones useful during surgery, allow its very easy location with the palmar surface of the finger. Testard and Delan cey demonstrated the major role of the TAPF in stabilising the urethra subm itted to strain. Richardson described a technique of paravaginal suspension for curing paravaginal fascial defect. The TAPF has never been well descri bed, but his work allows its easy location during surgery. The suture of th e vagina to the TAPF allows a more physiologic and stronger suspension of t he bladder neck than other classical techniques.