[Anatomy of obturated foramen. Application to trans-obturator slings]

The development of the trans-obturator sling in the treatment of female incontinence created a renewal of interest for the study of the anatomy of the obturator region, as shows the recent anatomical studies published on the subject. The objective being to consider the risks of bladder and vasculo-nervous injuries of this new way. The risk of wound of the bladder is small as concerns this technique of the mode of insetion of the sling (outside inside or inside outside) because the sling is in a strictly perineal way. The risk of damage caused in the vasculo-nervous elements of the obturator region is weak considering the position of the sling with regard to the main pedicles. These are either for distance of the sling for the obturator and femoral vessels and the saphenous vein, or protected by the obturator bone frame for the pudendal pedicle and the anterior branch of the obturator artery, or they are reduced to the state of capillaries or nerve ending. The trans-obturator sling presents the advantage to allow a strictly perineal, horizontal situation of the sling, which restores the system of a natural sub-urethral vaginal sling, avoiding complications due to the penetration of the Retzius space and of the pelvian cavity.