Comparative histological study of levels 1-3 supportive tissues using pelvic floor semiserial sections from elderly nulliparous and multiparous women

Hirata, Eiji; Koyama, Masayasu; Murakami, Gen; Ohtsuka, Aiji; Abe, Shinichi; Ide, Yoshinobu; Fujiwara, Hisaya; Kudo, Yoshiki

doi:10.1111/j.1447-0756.2010.01298.x

Cited by 20 publications

(26 citation statements)

References 29 publications

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“…Using late-stage fetuses, Kato et al [49] demonstrated the female cavernous nerve running through the putative paracolpium. Hirata et al [50] provided a beautiful diagram of the course of the female cavernous nerve covered by the pubocervical fascia, and, later, Hinata et al [19] provided a series of photographs demonstrating the morphology.…”

Section: Methodsmentioning

confidence: 99%

The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

Hinata

Murakami

2014

BioMed Research International

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Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter.

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Section: Methodsmentioning

confidence: 99%

The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

Hinata

Murakami

2014

BioMed Research International

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“…Muscles are not drawn in a dorsal part of the ischorectal fossa (asterisk). In the diagram, the ventral part of the female perineum is drawn according to our recent studies 20,30. ACL, anococcygeal ligament; ATLA, arcus tendineus for the levator ani; BS, bulbospongiosus muscle; CO, coccyx; COM, coccygeus muscle; EAS, external anal sphincter; IC, ishchiocavernosus muscle; LA, levator ani; OI, obturator internus muscle; PB, perneal body; PM, perineal membrane; SSL, sacrospinous ligament; STL, sacrotuberous ligament.…”

Section: Figmentioning

confidence: 99%

Anococcygeal Raphe Revisited: A Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers

Kinugasa

Arakawa²,

Abé

et al. 2012

Yonsei Med J

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PurposeWe recently demonstrated the morphology of the anococcygeal ligament. As the anococcygeal ligament and raphe are often confused, the concept of the anococcygeal raphe needs to be re-examined from the perspective of fetal development, as well as in terms of adult morphology.Materials and MethodsWe examined the horizontal sections of 15 fetuses as well as adult histology. From cadavers, we obtained an almost cubic tissue mass containing the dorsal wall of the anorectum, the coccyx and the covering skin. Most sections were stained with hematoxylin and eosin or Masson-trichrome solution.ResultsThe adult ligament contained both smooth and striated muscle fibers. A similar band-like structure was seen in fetuses, containing: 1) smooth muscle fibers originating from the longitudinal muscle coat of the anal canal and 2) striated muscle fibers from the external anal sphincter (EAS). However, in fetuses, the levator ani muscle did not attach to either the band or the coccyx. Along and around the anococcygeal ligament, we did not find any aponeurotic tissue with transversely oriented fibers connecting bilateral levator ani slings. Instead, in adults, a fibrous tissue mass was located at a gap between bilateral levator ani slings; this site corresponded to the dorsal side of the ligament and the EAS in the immediately deep side of the natal skin cleft.ConclusionWe hypothesize that a classically described raphe corresponds to the specific subcutaneous tissue on the superficial or dorsal side of the anococcygeal ligament.

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“…However, demonstration of both fasciae in a single histological section has been rare: Tamakawa et al [21] did so, but they did not use the common terminology. Hirata et al [11, 30] noted both of the fasciae, but these were beyond the scope of their study. Our present observations of nulliparous women showed that each of the fasciae was independently connected with the superior fascia of the levator ani.…”

Section: Discussionmentioning

confidence: 91%

“…Destruction of the fascial connection is not always evident even in multiparous women, as Hirata et al [11] have demonstrated. Thus, the tendinous arch seemed to be more resistant to vaginal delivery than the uterosacral ligament, which is histologically fragmented in multiparous women [11]. Moreover, in multiparous women, the fascial connection seemed to be replaced by the venous plexus, and the veins were embedded in elastic fiber-rich, loose paravaginal tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Using late-stage fetuses, Kato et al [10] demonstrated the female cavernous nerve running through the putative paracolpium. Hirata et al [11] provided an elegant diagram showing the course of the female cavernous nerve covering the pubocervical fascia, but they did not provide a photographic figure of the nerve. To identify the cavernous nerve, immunohistochemistry for neuronal nitric oxide synthase (nNOS) is necessary [12].…”

Section: Introductionmentioning

confidence: 99%

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Nerves and fasciae in and around the paracolpium or paravaginal tissue: an immunohistochemical study using elderly donated cadavers

et al. 2014

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The paracolpium or paravaginal tissue is surrounded by the vaginal wall, the pubocervical fascia and the rectovaginal septum (Denonvilliers' fascia). To clarify the configuration of nerves and fasciae in and around the paracolpium, we examined histological sections of 10 elderly cadavers. The paracolpium contained the distal part of the pelvic autonomic nerve plexus and its branches: the cavernous nerve, the nerves to the urethra and the nerves to the internal anal sphincter (NIAS). The NIAS ran postero-inferiorly along the superior fascia of the levator ani muscle to reach the longitudinal muscle layer of the rectum. In two nulliparous and one multiparous women, the pubocervical fascia and the rectovaginal septum were distinct and connected with the superior fascia of the levator at the tendinous arch of the pelvic fasciae. In these three cadavers, the pelvic plexus and its distal branches were distributed almost evenly in the paracolpium and sandwiched by the pubocervical and Denonvilliers' fasciae. By contrast, in five multiparous women, these nerves were divided into the anterosuperior group (bladder detrusor nerves) and the postero-inferior group (NIAS, cavernous and urethral nerves) by the well-developed venous plexus in combination with the fragmented or unclear fasciae. Although the small number of specimens was a major limitation of this study, we hypothesized that, in combination with destruction of the basic fascial architecture due to vaginal delivery and aging, the pelvic plexus is likely to change from a sheet-like configuration to several bundles.

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Comparative histological study of levels 1-3 supportive tissues using pelvic floor semiserial sections from elderly nulliparous and multiparous women

Abstract: Although all three sites were likely to be injured by delivery, the USCT seemed to be more severely damaged and/or more difficult to be recovered than the ATFP and PM.

Cited by 20 publications

References 29 publications

The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

Anococcygeal Raphe Revisited: A Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers

Nerves and fasciae in and around the paracolpium or paravaginal tissue: an immunohistochemical study using elderly donated cadavers

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