The retropubic space is an extraperitoneal, avascular, potential space commonly encountered during anti-incontinence surgery. It is also known as the “space of Retzius” and lies between the pubic symphysis and the bladder, behind the transversalis muscle but in front of the peritoneum.
11 It is bound laterally by the pubic bone and obturator internus muscle, whereas the arcus tendinous fascia pelvis (ATFP) forms the posterolateral boundaries, and the floor is formed by the anterior vagina and its endopelvic attachments, inserting in to the ATFP.
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26 Specific to the Burch procedure, the points of interest include the midurethra, the urethrovesical junction, and the Cooper or iliopectineal ligament which can be found lateral to the pubic tubercle beneath the superior margin of the pubic ramus (
Fig. 31.3; Video 31.1). Vascular landmarks in this space include the external iliac vessels which are approximately 2.9 cm from the lateral Cooper ligament and the obturator neurovascular bundle which lies 2.6 cm away.
27 The obturator neurovascular bundle exits the pelvis at the level of the obturator foramen and can contribute to the “corona mortis” which is an anastomosis between the obturator and inferior epigastric vessels and can be a source of bleeding during retropubic surgery.
11 The anterior vaginal wall is composed of fibroadipose tissue, nerves, and blood vessels which can also bleed while placing sutures through the vaginal fibromuscular layer as recommended by Tanagho.
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