Outside-in transobturator midurethral sling and the dorsal nerve of the clitoris.
OBJECTIVE
An anatomical study on fresh cadavers was done to determine the vulnerability of the dorsal nerve of the clitoris to injury during "outside-in" transobturator sling procedures.


METHODS
The dorsal nerve of the clitoris was identified bilaterally in ten fresh cadavers. Transfixing needles marked the inferomedial border of the obturator foramen. The distance between the foramen border and the nerve was measured.


RESULTS
The nerve ran medially in close approximation to the ischiopubic ramus and inferior to the obturator foramen in all specimens. In no instance did the nerve follow an aberrant course traversing the obturator foramen. The mean distance between the inferomedial border of the obturator foramen and the nerve was 9.3 mm, range 3-14 mm.


CONCLUSIONS
When the "outside-in" technique is used, the introducer cannot come into contact with the dorsal nerve of the clitoris because the introducer would have to pass through the ischio-pubic ramus. This is not anatomically possible.
Tate
Susan B
SB
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, & Women's Health, University of Louisville School of Medicine, Louisville, KY 40202, USA. sbtate01@louisville.edu
Culligan
Patrick J
PJ
Acland
Robert D
RD
D000368:Aged; D000369:Aged, 80 and over; D002987:Clitoris / Q000033:anatomy & histology / Q000294:innervation*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007512:Ischium / Q000033:anatomy & histology; D008875:Middle Aged; D011630:Pubic Bone / Q000033:anatomy & histology; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery*