Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

Betschart, Cornelia; Scheiner, David; Maake, Caroline; Vich, Magdalena; Slomianka, Lutz; Fink, Daniel; Perucchini, Daniele

doi:10.1007/s00192-008-0669-9

Cited by 19 publications

(19 citation statements)

References 20 publications

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“…Histological evidence for all of these structures has been provided in the form of photos in this review. Likewise, for measurement of thickness using clinical imaging, Betschart et al [87] considered the perineal membrane as en mass that includes striates muscle, smooth muscle, and connective tissues. Because the deep transverse perineal muscle is sometimes thick and wide, even in elderly men [63] (Figure 5(a)), we do not need to rule out the concept of the urogenital diaphragm.…”

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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“…5). Thus, conversely, we did not evaluate whether or not the lateral extension of the PM 14 was attached to the bony pubic ramus. We tried to classify the PM into a thick and thin group (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The rectovaginal septum joins the ligament to form the arcus tendineus fasciae pelvis 8–10 . Recently, the morphology of the perineal membrane or level 3 support has also been described in detail 11–14 . The tissue architecture and components vary between nulliparous and multiparous women 12,13 .…”

Section: Introductionmentioning

confidence: 99%

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

Hirata¹,

Koyama²,

Murakami³

et al. 2010

Journal of Obstetrics and Gynaecology Research

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“…The present study clearly demonstrated the topographical relationship of the elastic fiber-rich smooth muscle-poor PM with the inferomedial edge of the levator ani muscle. Although various amounts of smooth muscle have been reported in the PM [13], these might have represented the lateral or superior part. Previous data on the thickness of the PM (mean, 5.5 mm) [13] had suggested that it was much thicker than in the present series of specimens (5.5 mm at maximum), but this difference may have simply been attributable to the definition employed, i.e.…”

Section: Discussionmentioning

confidence: 99%

The Perineal Membrane: Its Composite Fibers and Nerve Content, and Relationship to the Levator Ani and Deep Transverse Perineal Muscles

Kurokawa¹,

Hinata²,

Sasaki³

et al. 2014

OJOG

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The perineal membrane (PM) is a thick, elastic fiber-rich, smooth muscle-poor membrane extending along the vestibule and lower vaginal wall and embedding the urethrovaginal sphincter and compressor urethrae muscles. To provide a better understanding of the topographical relationship between the PM and the levator ani muscle, we examined histological sections from 15 female cadavers. The composite fibers of the PM were usually continuous with that of a fascia covering the inferior or lateral surface of the levator ani (fascia diaphragmatis pelvis inferior) rather than the endopelvic fascia covering the superior or medial surface of the latter muscle. However, this fascial connection was sometimes interrupted by a venous plexus. The deep transverse perineal muscle was consistently adjacent to the posterolateral aspect of the PM, but whether it extended superficially or deeply to the PM depended on size of the muscle. In contrast to the endopelvic fascia embedding abundant middle-sized nerves (cavernous and sphincter nerves; 0.05-0.1 mm in thickness), the PM contained very thin nerves: many in 10 cadavers but few in 5 cadavers. Most of the nerves seemed to be sensory on the basis of immunohistochemistry. The levator ani muscle was considered likely to provide traction force to the PM, but active elevation appeared to be difficult because of the highly elastic nature of the PM and the interrupting venous plexus. Loss of nerves in the PM might be one of a number of factors that can accelerate pelvic organ prolapse.

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Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

Cited by 19 publications

References 20 publications

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

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

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

The Perineal Membrane: Its Composite Fibers and Nerve Content, and Relationship to the Levator Ani and Deep Transverse Perineal Muscles

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