Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings

Objectives: The objective of the study is to clarify potential risks to the dorsal nerve of the clitoris (DNC) and obturator canal using different minimally invasive slings. Study design: Ten embalmed hemipelves were dissected to demonstrate the course of the DNC and the obturator canal. On each cadaver, tension-free vaginal tape (TVT), transobturator in-out (TVT-O) and transobturator out-in (Monarc) procedures were performed. Distances between the DNC and the obturator canal to the different devices were measured. Results: The DNC passes beneath the pubic bone at a distance of 14.3 +/- 4.7 mm of the midline. The distances of the different devices to the DNC were similar. The distance to the obturator canal was significantly different, with TVT being the furthest (40.1 +/- 3.7 mm) and TVT-O the closest (19.3 +/- 3.1 mm; p < 0.0001). Conclusion: Given the course of the DNC along the medial aspect of the ischiopubic ramus, the out-in technique may be safer. The in-out technique is the closest to the obturator canal.