INVESTIGATIVE UROLOGY

Anatomical risks of transobturator suburethral tape in the treatment of female stress urinary incontinence
Delmas V
Institut d’Anatomie, UFR biomedicale, Universite Paris 5, Service d’Urologie, Hopital Bichat, Paris
Eur Urol. 2005; 48: 793-8

• Introduction: The objective of this study was to define the anatomical structures crossed by transobturator tape.
• Materials: Ten fresh, female anatomical subjects aged 74 to 89 years.
• Methods: Transobturator tape was inserted by outside-in way. The position of the tape was verified by perineal and abdominal dissection.
• Results: Transobturator tape has a transverse course. It crosses the adductor muscles close to their pubic insertion and passes over the inferior border of the obturator foramen by crossing the obturator membrane, before reaching the middle plane of the perineum after having crossed the obturator internus muscle. The tape passes above the internal pudendal pedicle and then under the levator ani muscle, under the tendinous arch of the pelvic fascia and continues in the middle third of the urethrovaginal septum. It avoids femoral and obturator vessels in the thigh and pudendal vessels in the perineum.
• Conclusion: The anatomical course of transobturator tape shows that the anatomical structures crossed by the tape are muscle and fascia and, when the technique is performed correctly, no major neurovascular structures are in contact with the tape.
  
  
• Editorial Comment
  All versions of Tension-free Vaginal Tape present a risk of vesical, vascular, or intestinal lesions. Alternatively, a new transobturator approach has been proposed. Doctor Vincent Delmas, well-known anatomist and urologist, after studying 10 female subjects, presented a thorough study on the course of transobturator tape and identified the anatomical problems encountered. The author concluded that from an anatomical standpoint, the transobturator tape is much safer than any retropubic tape techniques. I strongly recommend carefully read of this paper for all surgeons involved with urethropexy for treating stress urinary incontinence.

Dr. Francisco J.B. Sampaio
Full-Professor and Chair, Urogenital Research Unit
State University of Rio de Janeiro
Rio de Janeiro, Brazil