Relation of Obturator Nerve to Selected Perineal Surgical Procedures in a South African Population

Introduction: This study estimates a secure route for the needles via the obturator foramen. The therapy of stress urinary incontinence (SUI) is done by using needles to secure a mesh around the urethra. These procedures use the obturator foramen as a pathway for placing a trans obturator sling. However, the needles are not catered to the South African population and, together with variability in pelvic osteology, may pose a threat to the obturator nerve. The purpose of the study is thus to suggest the safest route for the insertion of transobturator tape without endangerment of the obturator nerve. Methods: After placement of the tapes, the right medial compartment of 14 females and 14 males was dissected. Measurements were taken between landmarks of the obturator region, mesh, and obturator nerve. Results: It was found that the average distance between the mesh and the posterior branch of the obturator nerve (PBON) in the male transobturator tape (TOT) inside-out procedure was 15.32mm, 21.49mm in the female transobturator tape (TOT) outside-in and 13.73mm in the tension-free vaginal tape-obturator (TVT-O) inside-out procedures. As reported by clinicians, the distances were found to be half of the suggested safe distances. Conclusions: The findings may be attributed to the South African population’s differences in body size and pelvic osteology. A suggested safe route for the passage of the needles is inferior to the most medial point of the obturator foramen and closer to the lateral border of the ischiopubic ramus. We suggested standardization of these needles for a South African population.