Clinical Anatomy of the Pelvic Floor

Fritsch, Helga; Lienemann, Andreas; Brenner, Erich; Ludwikowski, Barbara

doi:10.1007/978-3-642-18548-9

Cited by 51 publications

(44 citation statements)

References 0 publications

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“…Fritsch et al [17] pointed out that the deep transverse perineal muscle (DTP) is absent in females. Does the morphology of a striated muscle show a strict intergender difference?…”

Section: Discussionmentioning

confidence: 99%

Female perineal membrane: a study using pelvic floor semiserial sections from elderly nulliparous and multiparous women

Katô

Matsubara

Murakami³

et al. 2008

Int Urogynecol J

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To describe the architecture and topohistology of the female perineal structures, especially the perineal membrane (PM), we examined frontal sections (one side) and horizontal or transverse sections (another side) of 15 bisectioned pelvic floors. The PM, notably comprising elastic fibers, extended mediolaterally or transversely on the immediately inferior side of the rhabdosphincter area. More posteriorly, the elastic fibers more tilted along the long axis of the vagina and became lining the lateral vaginal wall as a fibrous skeleton. The compressor urethrae and urethrovaginal sphincter were embedded in and interdigitated with the PM. The elastic fiber architecture of the PM was similar to the rectovaginal septum. We hypothesize that the PM plays a role of a shock-absorber at the interface between the levator ani and distalmost vagina. A standard diagram of the female perineal structures is necessary to be revised.

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“…Fritsch et al [17] pointed out that the deep transverse perineal muscle (DTP) is absent in females. Does the morphology of a striated muscle show a strict intergender difference?…”

Section: Discussionmentioning

confidence: 99%

Female perineal membrane: a study using pelvic floor semiserial sections from elderly nulliparous and multiparous women

Katô

Matsubara

Murakami³

et al. 2008

Int Urogynecol J

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“…Is there a laminar connection between the nerve sheath and other basic fascial components, such as the mesocolon, mesorectum, mesoureter (Ercoli et al, 2005) or vascular sheath? Although Fritsch et al (2004) ruled out this concept, the mesorectum is now described in Gray's Anatomy (Neil et al, 2005). According to Neil et al (2005), the hypogastric nerves (HGNs; major sympathetic inputs into the pelvic plexus) seem to run inferiorly along a narrow space between the mesorectal and presacral fasciae.…”

Section: Introductionmentioning

confidence: 96%

Development of the human hypogastric nerve sheath with special reference to the topohistology between the nerve sheath and other prevertebral fascial structures

Kinugasa

Niikura

Murakami³

et al. 2008

Clinical Anatomy

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Semi-serial sections from the lumbosacral region of nine fetuses (8-25 weeks gestation) were examined to clarify the lumbar prevertebral fascial arrangement. The prevertebral fasciae became evident after 12 weeks of age. After 20 weeks of age, the hypogastric nerve (HGN) was sandwiched by two fascial structures; the ventral fascia which seemed to correspond to the mesorectal fascia, whereas the dorsal fascia corresponded to the presacral fascia. These fasciae or the HGN sheaths extended laterally along the ventral aspects of the great vessels and associated lymph follicles. The ventral fascia is, to some extent, fused with the mesocolon descendens on the left side of the body. Notably, the lateral continuation of these two fasciae also sandwiches the left ureter, but not the right ureter, presumably due to modifications by the left-sided fusion fascia. A hypothetical common sheath for the HGN and ureter (i.e., the ureterohypogastric or vesicohypogastric fascia) might thus be an oversimplification. Before retroperitoneal fixation, the morphology of the peritoneal recess along the mesocolon descendens and mesosigmoid suggested interindividual differences in location, shape, and size. Therefore, in adults the ease of surgical separation of the rectum and left-sided colon from the HGN seems to depend on interindividual differences in the development of the embryonic peritoneal recess. On the caudal side of the second sacral segment, fascial structures were restricted along and around the HGN, pelvic splanchnic nerve, and pelvic plexus. The rectal lateral ligament thus seems to represent a kind of migration fascia formed by mechanical stress.

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“…In contrast, the compartment theory of the pelvic floor in females has been developed and adapted by pelvic surgeons. 20 Radical prostatectomy techniques have achieved postoperative continence during the first postoperative year. Recently, urologic research has also focused on the improvement of early postoperative continence.…”

Section: Discussionmentioning

confidence: 99%

Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients

Stolzenburg

Nicolaus²,

Kallidonis³

et al. 2011

Asian J Androl

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Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck (vesicourethral anastomosis) suspension on the outcome of extraperitoneal endoscopic radical prostatectomy (EERPE). In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE (nsEERPE) (n545), and Group 2 included patients who underwent nsEERPE with bladder neck suspension (BNS, n545). Groups 3 (n545) and 4 (n545) included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads (pad weighing test) on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were continent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group 1 and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.

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Clinical Anatomy of the Pelvic Floor

Cited by 51 publications

References 0 publications

Female perineal membrane: a study using pelvic floor semiserial sections from elderly nulliparous and multiparous women

Female perineal membrane: a study using pelvic floor semiserial sections from elderly nulliparous and multiparous women

Development of the human hypogastric nerve sheath with special reference to the topohistology between the nerve sheath and other prevertebral fascial structures

Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients

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