Turner-Warwick Vagino-Obturator Shelf Urethral Repositioning Procedure

Abstract

The vagino-obturator shelf (VOS) urethral repositioning operation (Turner-Warwick 1969, 1986) was a urodynamically conceived procedure (Turner-Warwick et al. 1974; Turner-Warwick 1978) designed to reposition the urethra and the bladder neck sphincter mechanisms most efficiently, but leaving them free-lying in an elevated position without compromising their occlusive function by fixation or paraurethral tethering. Furthermore, the development of secondary retropubic fibrotic adhesions is positively prevented by interposing a supple omental pedicle graft between the back of the pubis and the urethra; this not only ensures the mobility of the functional movements of the intrinsic sphincter mechanisms in the long term but ensures the circumferential transmission of intra-abdominal pressure changes to the urethra.