title: Transobturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence: anatomical considerations.
abstract: OBJECTIVE
  We have recently described a novel surgical technique for female stress urinary incontinence, that is the transobturator vaginal tape inside out, which uses specific instruments for the passage of a synthetic tape from beneath the urethra toward the thigh folds. Herein we report the results of cadaver dissection performed to determine the anatomical trajectory of the tape and its relationships with neighboring neurovascular structures and organs.
  
  
  METHODS
  Insertion of the transobturator vaginal tape inside out tape was performed by different surgeons in 12 freshly frozen female cadavers according to the standard procedure. The thigh, obturator, perineal and pelvic regions were dissected and tape trajectory was recorded. An additional cadaver was dissected without prior tape placement.
  
  
  RESULTS
  The tape was inserted according to a certain consistent path, that is penetration from the suburethral space into a strictly perineal region limited medial and cranial by the levator ani muscle, caudal by the perineal membrane and lateral by the obturator internus muscle. This region corresponded to the most anterior recess of the ischiorectal fossa. The tape then perforated the obturator membrane and muscles, and exited through the skin after traversing adductor muscles and subcutaneous tissue. The tape was coursed away from 1) the dorsal nerve to the clitoris located more superficially below the perineal membrane, 2) the obturator nerve and vessels, and 3) the saphenous and femoral vessels.
  
  
  CONCLUSIONS
  These findings strongly suggest that our transobturator technique is highly accurate, reproducible and safe, and it does not require perioperative cystoscopy.
authors.affiliation: Department of Urology, Institute of Human Anatomy, University of Liège, Liège, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bonnet
authors.forename: David
authors.initials: D
authors.lastname: Waltregny
authors.forename: Olivier
authors.initials: O
authors.lastname: Reul
authors.forename: Jean
authors.initials: J
authors.lastname: de Leval
mesh_terms: D000368:Aged; D002102:Cadaver; D004210:Dissection; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology; D005268:Femoral Vein / Q000033:anatomy & histology; D006801:Humans; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation; D009776:Obturator Nerve / Q000033:anatomy & histology; D010388:Pelvis; D010502:Perineum / Q000033:anatomy & histology / Q000294:innervation; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D012501:Saphenous Vein / Q000033:anatomy & histology; D013526:Surgical Mesh; D013848:Thigh / Q000098:blood supply / Q000294:innervation; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*