Architectural differences in the anterior and middle compartments of the pelvic floor of young‐adult and postmenopausal females

Wu, Yi; Dabhoiwala, N.F.; Hagoort, Jaco; Tan, Liwen; Zhang, Shao‐Xiang; Lamers, Wouter H.

doi:10.1111/joa.12598

Cited by 29 publications

(46 citation statements)

References 75 publications

(197 reference statements)

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“…In the present study we describe the topography of pelvic structures in the anterior compartment of three young adult males and compare these findings with our earlier findings in similarly aged females (Wu et al. ). In addition, we studied serial histological sections of two 26‐week‐old male fetuses.…”

Section: Introductionsupporting

confidence: 78%

“…Its lateral fibers did not reach ischial tuberosity, but inserted, as in the female (Wu et al. ), on the connective tissue septa of the fat in the ischiorectal fossa. The ischiocavernous muscles attached to the anterolateral side of the penal crus, whereas fibers of the bulbospongious muscle encircled the penal root posteriorly.…”

Section: Resultsmentioning

confidence: 99%

“…In the female, the middle (compressor) portion of the sphincter is U‐shaped where it passes the vagina laterally, whereas the superior portion, which reaches the bladder neck, is pseudo‐circular due to the presence of a dorsal connective‐tissue raphe (Wu et al. ). The transition between the inferior circular and superior U‐shaped portion of the urethral sphincter is just inferior to the entrance of the deferent ducts in the male and at the entrance of the vagina into the vestibule in the female.…”

Section: Discussionmentioning

confidence: 99%

“…,c; Wu et al. ). In addition, the existence of the deep transverse perineal muscle as the putative posterior part of the muscular urogenital diaphragm was questioned (Dorschner et al.…”

Section: Introductionmentioning

confidence: 98%

“…An example is the issue whether the urogenital triangle represents a (fibro-)muscular diaphragm. A common criticism of this concept is that its superior facia does not exist because the striated urethral sphincter extends superiorly up to the bladder neck in both men and women (Oelrich, 1980(Oelrich, , 1983Myers et al 1987;Tichy, 1989;Strasser et al 1996;Dorschner et al 1999;Sebe et al 2005a,c;Wu et al 2017). In addition, the existence of the deep transverse perineal muscle as the putative posterior part of the muscular urogenital diaphragm was questioned (Dorschner et al 1999;Mirilas & Skandalakis, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Architecture of structures in the urogenital triangle of young adult males; comparison with females

Dabhoiwala

Hagoort

et al. 2018

Journal of Anatomy

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The fibro‐muscular architecture of the urogenital triangle remains contentious. Reasons are small size of the constituting structures and poor visibility with most imaging methods. We reinvestigated the area in serial sections of three males (21–38 years old) of the American and Chinese Visible Human Projects and two 26‐week‐old male fetuses, and compared the findings with earlier observations in females. The mass of the levator ani muscle was approximately twofold smaller and its funnel shape steeper in males than females. In the levator hiatus, a strand of the smooth longitudinal muscle layer of the rectum, the ‘rectourethral (RU) muscle’, extended anteriorly from the anorectal bend to the penile bulb. Fibrous tissue that formed in the inferior reach of the fetal RU muscle identified the location of the developing perineal body (PB) and divided the muscle into posterior ‘rectoperineal’ and anterior ‘deep perineal’ portions. In males, the PB remained small and bipartite, so that the RU muscle presented as an undivided midline structure. The well‐developed female PB, instead, intertwined with the deep perineal muscle and both structures passed the vagina bilaterally to form the perineal membrane in the posterior portion of the urogenital triangle. The urethral rhabdosphincter extended in the anterior portion of the urogenital triangle between the penile bulb inferiorly and the bladder neck superiorly, and consisted of a well‐developed circular ‘membranous’ portion with bilateral posteroinferior ‘wings’ and a thinner ‘prostatic’ portion on the prostate anterior side. In men, muscles occupy the urogenital triangle, but additional tightening of the locally fibrous adipose tissue by the superficial transverse perineal muscle appears necessary to generate functional support in women. An interactive 3D pdf file with these anatomical details (available online) should allow more accurate interpretation of ultrasound, computed tomography and magnetic resonance images.

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Section: Introductionsupporting

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…,c; Wu et al. ). In addition, the existence of the deep transverse perineal muscle as the putative posterior part of the muscular urogenital diaphragm was questioned (Dorschner et al.…”

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Architecture of structures in the urogenital triangle of young adult males; comparison with females

Dabhoiwala

Hagoort

et al. 2018

Journal of Anatomy

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Interactive three‐dimensional teaching models of the female and male pelvic floor

Hikspoors

Dabhoiwala

et al. 2019

Clinical Anatomy

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Controversies regarding structure and function of the pelvic floor persist because of its poor accessibility and complex anatomical architecture. Most data are based on dissection. This "surgical" approach requires profound prior knowledge, because applying the scalpel precludes a "second look." The "sectional" approach does not entail these limitations, but requires segmentation of structures and threedimensional reconstruction. This approach has produced several "Visible Human Projects." We dealt with limited spatial resolution and difficult-to-segment structures by proceeding from clear-cut to more fuzzy boundaries and comparing segmentation between investigators. We observed that the bicipital levator ani muscle consisted of pubovisceral and puborectal portions; that the pubovisceral muscle formed, together with rectococcygeal and rectoperineal muscles, a rectal diaphragm; that the external anal sphincter consisted of its subcutaneous portion and the puborectal muscle only; that the striated urethral sphincter had three parts, of which the middle (urethral compressor) was best developed in females and the circular lower ("membranous") best in males; that the rectourethral muscle, an anterior extension of the rectal longitudinal smooth muscle, developed a fibrous node in its center (perineal body); that the perineal body was much better developed in females than males, so that the rectourethral subdivision into posterior rectoperineal and anterior deep perineal muscles was more obvious in females; that the superficial transverse perineal muscle attached to the fibrous septa of the ischioanal fat; and that the uterosacral ligaments and mesorectal fascia colocalized. To facilitate comprehension of the modified topography we provide interactive 3D-PDFs that are freely available for teaching purposes.

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The series of smooth muscle structures in the pelvic floors of men: Dynamic coordination of smooth and skeletal muscles

et al. 2020

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Introduction Recent studies have revealed the extended nature of smooth muscle structures in the pelvic floor, revising the conventional understanding of the “perineal body.” Our aim was to clarify the three‐dimensional configuration and detailed histological properties of the smooth muscle structures in the region anterior to the rectum and anal canal in men. Materials and methods Four male cadavers were subjected to macroscopic and immunohistological examinations. The pelvis was dissected from the perineal side, as in the viewing angle during transperineal surgeries. Serial transverse sections of the region anterior to the rectum and anal canal were stained with Masson's trichrome and immunohistological stains to identify connective tissue, smooth muscle, and skeletal muscle. Results There was a series of smooth muscle structures continuous with the longitudinal muscle of the rectum in the central region of the pelvic floor, and three representative elements were identified: the anterior bundle of the longitudinal muscle located between the external anal sphincter and bulbospongiosus; bilateral plate‐like structures with transversely‐oriented and dense smooth muscle fibers; and the rectourethral muscle located between the rectum and urethra. In addition, hypertrophic tissue with smooth muscle fibers extended from the longitudinal muscle in the anterolateral portion of the rectum and contacted the levator ani. Conclusions The series of smooth muscle structures had fiber orientations and densities that differed among locations. The widespread arrangement of the smooth muscle in the pelvic floor suggests a mechanism of dynamic coordination between the smooth and skeletal muscles.

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Architectural differences in the anterior and middle compartments of the pelvic floor of young‐adult and postmenopausal females

Cited by 29 publications

References 75 publications

Architecture of structures in the urogenital triangle of young adult males; comparison with females

Architecture of structures in the urogenital triangle of young adult males; comparison with females

Interactive three‐dimensional teaching models of the female and male pelvic floor

The series of smooth muscle structures in the pelvic floors of men: Dynamic coordination of smooth and skeletal muscles

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