title: Outside-in transobturator midurethral sling and the dorsal nerve of the clitoris.
abstract: 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.
authors: 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
authors: Susan B
authors: SB
authors: Tate
authors: Patrick J
authors: PJ
authors: Culligan
authors: Robert D
authors: RD
authors: Acland
mesh_terms: 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*