Skip to main content

Advertisement

SpringerLink
Log in

Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Objectives

The objective of the study is to clarify potential risks to the dorsal nerve of the clitoris (DNC) and obturator canal using different minimally invasive slings.

Study design

Ten embalmed hemipelves were dissected to demonstrate the course of the DNC and the obturator canal. On each cadaver, tension-free vaginal tape (TVT), transobturator in–out (TVT-O) and transobturator out–in (Monarc) procedures were performed. Distances between the DNC and the obturator canal to the different devices were measured.

Results

The DNC passes beneath the pubic bone at a distance of 14.3±4.7 mm of the midline. The distances of the different devices to the DNC were similar. The distance to the obturator canal was significantly different, with TVT being the furthest (40.1±3.7 mm) and TVT-O the closest (19.3±3.1 mm; p<0.0001).

Conclusion

Given the course of the DNC along the medial aspect of the ischiopubic ramus, the out–in technique may be safer. The in–out technique is the closest to the obturator canal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ulmsten U, Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7(2):81–85; discussion 85–86

    Article  PubMed  CAS  Google Scholar 

  2. Ward KL, Hilton P (2004) A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol 190(2):324–331

    Article  PubMed  Google Scholar 

  3. Karram MM, Segal JL, Vassallo BJ, Kleeman SD (2003) Complications and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol 101(5 Pt 1):929–932

    Article  PubMed  Google Scholar 

  4. Meschia M, Busacca M, Pifarotti P, De Marinis S (2002) Bowel perforation during insertion of tension-free vaginal tape (TVT). Int Urogynecol J Pelvic Floor Dysfunct 13(4):263–265; discussion 265

    Article  PubMed  CAS  Google Scholar 

  5. Muir TW, Tulikangas PK, Fidela Paraiso M, Walters MD (2003) The relationship of tension-free vaginal tape insertion and the vascular anatomy. Obstet Gynecol 101(5 Pt 1):933–936

    Article  PubMed  Google Scholar 

  6. Delorme E (2001) Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 11(6):1306–1313

    PubMed  CAS  Google Scholar 

  7. de Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44(6):724–730

    Article  PubMed  Google Scholar 

  8. Delorme E, Droupy S, de Tayrac R, Delmas V (2004) Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 45(2):203–207

    Article  PubMed  Google Scholar 

  9. deTayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, Calvanese-Benamour L, Fernandez H (2004) A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 190(3):602–608

    Article  PubMed  Google Scholar 

  10. Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J et al (2000) Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 163(3):888–893

    Article  PubMed  CAS  Google Scholar 

  11. Maaita M, Bhaumik J, Davies AE (2002) Sexual function after using tension-free vaginal tape for the surgical treatment of genuine stress incontinence. BJU Int 90(6):540–543

    Article  PubMed  CAS  Google Scholar 

  12. Elzevier HW, Venema PL, Lycklama a Nijeholt AA (2004) Sexual function after tension-free vaginal tape (TVT) for stress incontinence: results of a mailed questionnaire. Int Urogynecol J Pelvic Floor Dysfunct 15:313–318

    PubMed  Google Scholar 

  13. Yeni E, Unal D, Verit A, Kafali H, Ciftci H, Gulum M (2003) The effect of tension-free vaginal tape (TVT) procedure on sexual function in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 14(6):390–394

    Article  PubMed  Google Scholar 

  14. Rogers RG, Kammerer-Doak D, Darrow A, Murray K, Olsen A, Barber M et al (2004) Sexual function after surgery for stress urinary incontinence and/or pelvic organ prolapse: a multicenter prospective study. Am J Obstet Gynecol 191(1):206–210

    Article  PubMed  Google Scholar 

  15. Whiteside JL, Walters MD (2004) Anatomy of the obturator region: relations to a trans-obturator sling. Int Urogynecol J Pelvic Floor Dysfunct 15(4):223–226

    PubMed  Google Scholar 

  16. Klink EW (1953) Perineal nerve block; an anatomic and clinical study in the female. Obstet Gynecol 1(2):137–146

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urogynaecology Department, Mercy Hospital for Women, Clarendon Street, East Melbourne, 3002, Victoria, Australia

    Chahin Achtari, Anna Rosamilia, Lore Schierlitz & Peter L. Dwyer

  2. Department of Anatomy and Cell Biology, The University of Melbourne, Melbourne, Victoria, 3010, Australia

    Bayden J. Mckenzie & Chris A. Briggs

  3. Anaesthesiology Department, Mercy Hospital for Women, East Melbourne, Victoria, 3002, Australia

    Richard Hiscock

Authors
  1. Chahin Achtari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bayden J. Mckenzie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Hiscock
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Rosamilia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lore Schierlitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chris A. Briggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter L. Dwyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chahin Achtari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Achtari, C., Mckenzie, B.J., Hiscock, R. et al. Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J 17, 330–334 (2006). https://doi.org/10.1007/s00192-005-0004-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-005-0004-7

Keywords

Search

Navigation