title: MRI anatomical study of the outside-in transobturator suburethral tape procedure.
abstract: BACKGROUND
  This study aims to clarify the relationship between the outside-in transobturator suburethral tape and the anatomical structures at the blind passage of the obturator foramen, and to detail the tape position, shape, and the factors on which they are dependent.
  
  
  METHODS
  MRI scans were performed on 30 patients operated on with a dermal porcine collagen suburethral tape, indicated for urodynamically proven stress incontinence.
  
  
  RESULTS
  The lateral bladder wall was the closest structure to the tape at the passage of the obturator foramen, whereas vascular injuries appeared to be minimal using the outside-in technique. The distance from tape to bladder neck was correlated with the distance from tape to pubococcygeal line (PCL) (p=0.001), and with urethral length (p=0.049). From the obturator foramen to its passage under the urethra, the tape was U-shaped with a cranio-caudal and antero-posterior orientation. The cranio-caudal tape shape was correlated with the distance between the tape and the PCL (p=0.002), and to the patient's anatomical characteristics: distance between the bladder neck and the pubis (p=0.01), and the urethral length (p=0.01). The antero-posterior shape was correlated with the urethral length (p=0.02).
  
  
  CONCLUSIONS
  The lateral bladder wall is the structure most at risk during the outside-in transobturator suburethral tape procedure. The distance from tape to bladder neck is dependent on the vertical position of the tape. The tape shape is dependent on both tape position under the urethra and the patient's anatomical characteristics.
authors.affiliation: Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris VII, Service de Radiologie, Paris, France.
authors.forename: Pedro
authors.initials: P
authors.lastname: Fernandez
authors.forename: Cyril
authors.initials: C
authors.lastname: Raiffort
authors.forename: Sarah
authors.initials: S
authors.lastname: Delaney
authors.forename: Laurence
authors.initials: L
authors.lastname: Salomon
authors.forename: Bruno
authors.initials: B
authors.lastname: Carbonne
authors.forename: Vincent
authors.initials: V
authors.lastname: Delmas
authors.forename: Yan
authors.initials: Y
authors.lastname: Ansquer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D053825:Suburethral Slings; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*