The retropubic Space which is also called the Space of Retzius was first described by Anders Adolf Retzius in 18491. The modern era of retropubic surgery for stress incontinence began in 1949, with Marshall et al2. A variety of modifications of this operation were then performed to expose the space of Retzius and attach the periurethral or perivesical endopelvic fascia to another supporting structure in the anterior pelvis. 
Rates of injury of the external iliac vein and the aberrant obturator vessels have been quoted to be as much as 25% during colposuspension3. It is important to be aware of the retropubic anatomy, especially with increased numbers of colposuspension being performed due to increasing concerns regarding vaginal meshes. This video looks at this anatomy in a woman who has a laparoscopic colposuspension so that greater familiarity of this space is obtained.

This is a video demonstrating the anatomy of the retropubic space in a patient who has had a laparoscopic colposuspension. 

The retropubic space is also called the pre-vesical space or the space of Retzius. It can be visualised after opening the fold of peritoneum between the bladder and the anterior abdominal wall. It is bounded anteriorly by the pubic symphysis and the superior pubic ramus laterally. The ileo-pectineal ligament runs on the pectineal line of the pubic bone. As we go laterally, inferior to the superior pubic ramus is the obturator foramen. Further lateral dissection would reveal the neuro-vascular bundle that runs into this foramen.

Superior to the superior pubic ramus, we can see the pulsation of the external iliac artery. Superior to this, we can also see the origin of the inferior epigastric artery from the external iliac artery which then enters the anterior abdominal wall. In the majority of the cases, we can see the aberrant obturator artery arising from the external iliac artery, crossing the superior pubic ramus and entering the obturator foramen.

The area of the iliopectineal ligament that is safe to places sutures on during a laparoscopic colposuspension is defined.

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Awareness of the landmarks in the retropubic space reduces rates of complications during this procedure. This includes avoiding the aberrant obturator vessels which is a relatively common anatomic variation4 and therefore important in clinical practice.

Breimer L. Anders Adolf Retzius (1796- 1860). Investigative Urology. 1978;16(253).
Marshall V, Marchetti A, Krantz K. The correction of stress incontinence by simple vesicourethral suspension. Surgery, Gynecology & Obstetrics. 1949;88:509–518.
Negura A, Andreescu G, Marderos G, Marderos G, Margarit L. Hemorrhagic risks in the Burch procedure. International Urogynecology Journal. 1993;4:310–313.