Transobturator surgical articles and methods

DETAILED DESCRIPTION The invention overcomes the deficiencies of the prior art and provides for a surgical apparatus and a method for the treatment of female stress urinary incontinence.
The invention provides a surgical instrument comprising a handle at one end and connecting means at the other end to receive, one at a time, two curved needle-like elements, each of which have a blunt tip and a constant or varying diameter.
The distal end of the needle comprises an interlocking coupling means for accepting a guide needle or, alternatively, a mesh.
In one embodiment each curved needle connects at its proximal end to separate ends of a mesh to be implanted within the body.
A guide needle, similar in structure to a Stamey needle, is passed through the abdomen and behind the pubic bone, passes along one side of the urethra and to an incision site at the anterior vaginal wall.
After the guide needle exits the body through the vagina, the guide needle couples to the distal end of the curved needle.
The curved needle is then pushed back through the vagina and through the fascia, following the path of the guide needle.
The curved needle and first end of the mesh pass over the pubis and through the abdominal wall.
The guide needle is again passed behind the pubic bone from the abdomen, passes along the other side of the urethra to the incision site in the vaginal wall.
The guide needle again couples to the distal end of the second curved needle, which then passes through the vagina and fascia, following the second path created by the guide needle.
The second end of the mesh is extended over the pubis and through the abdominal wall.
The mesh ends are cut at the abdominal wall, and the mesh is left in the body, creating a tension- free support between the vaginal wall and the mid urethra.
In an alternate embodiment a curved needle is passed through the abdomen and behind the pubic bone, passes along one side of the urethra and to an incision site in the anterior vaginal wall.
After the curved needle exits the body through the vagina, the distal end of the curved needle couples to one end of the mesh to be implanted within the body