Anthropometric Study Via Digital X-Rays of the Obturator Foramen in Surgical Treatment of Urine Incontinence in the South-Western Adult Female Population of Iran

Abstract

Background: The trans-obturator tape (TOT) procedure is an efficient treatment option that provides support for the urethra in cases of stress urinary incontinence (SUI). Objectives: This research aimed to ascertain the accuracy of anthropometric parameters of the female pubic arch and the obturator foramen (OF) and their application in clinical anatomy. Methods: In this cross-sectional observational research conducted from October 2021 to September 2022, the morphometric characteristics of the pubic arch and the OF were measured on digital pelvic radiographs of 500 adult women from southwestern Iran. They were grouped into three age categories, namely, 18 - 34, 35 - 50, and more than 50 years old, and compared within and between the groups. Results: Significant differences were observed in computed parameter indices of the OF and pubic arch based on age. Parameters such as inter-obturator foramina distance, pubic symphysis length, pubic ramus width, and length increased significantly with age (P ≤ 0.05). Additionally, as women's ages increased, their subpubic angle decreased significantly (P = 0.001). However, other parameters, such as the OF area and the anterior urogenital triangle area, did not show a significant increase with age (P ≥ 0.05). These findings indicate that anatomical pelvic measurements change significantly with age in women. Conclusions: The present study revealed a wide range of variant bony pelvic anatomy in southwestern Iranian adult women, distinct from norms in other groups. Our findings could be utilized in surgical approaches and the production of trans-obturator kits by companies.