It passes through the following structures in the following order: gracilis, adductor brevis muscle, obturator externus muscle, obturator membrane, and beneath or through the obturator internus muscle
and periurethral endopelvic connective tissue; it finally exits through the opened vagina.
5 cm--for me to reach a finger behind the obturator internus muscle after having sharply dissected the suburethral tissue and fascia.
To place the sling, I have one hand with an index finger in the midurethral tunnel under the obturator internus muscle to protect the urethra.
CT examination of the abdomen and pelvis (with oral and IV contrast) demonstrated a large, complex, multiloculated fluid collection involving the left gluteal musculature, left illiacus muscle, left obturator internus muscle
, left iliopsoas muscle, and the left iliopsoas bursae (Figures 2A, C and D) In addition, bone windows demonstrated erosive changes in the left sacroiliac joint (Figure 2B).
The obturator canal is a defect in the tendinous insertion of the obturator internus muscle
onto the posterior aspect of the superior pubic ramus, which is a passage way for the obturator neurovascular bundle (Fig.
The goal in this deep passage is to pass the guide through the posterior aspect of the obturator membrane and through the obturator internus muscle so that the tip of the cannula is about 1 cm inferior (and a bit anterior) to the ischial spine as it pops through the muscle into the paravaginal space.
With my finger in the paravaginal space, I dissect any intervening tissue away from the fascia of the obturator internus muscle at this junction.
The obturator internus muscle
lies between the obturator neurovascular bundle and the antero-inferior quadrant of the acetabulum.