The “Y”-shaped Denonvilliers’ fascia and its adjacent relationship with the urogenital fascia based on a male cadaveric anatomical study

Abstract

Background Controversies regarding the anatomical structure of Denonvilliers’ fascia and its relationship with surrounding fasciae have sparked a heated discussion, especially concerning whether Denonvilliers’ fascia is multilayered. This study aimed to expound on the anatomical structure of Denonvilliers’ fascia and its correlation with the peritoneum from the sagittal view and clarify the complex fascial relationship. Methods Our study was performed on 20 adult male pelvic specimens fixed in formalin, including 2 entire pelvic specimens and 18 semipelvic specimens. The local adjacent organs and fasciae were dissected, and Denonvilliers’ fascia was observed and removed for histological examination. Results Denonvilliers’ fascia was typically single-layered and tough. On the sagittal plane, the peritoneum constituting the peritoneal reflection and Denonvilliers’ fascia formed a “Y” shape. Denonvilliers’ fascia originated from the peritoneal reflection, extended along the ventral side of the seminal vesicles and prostate, continuing caudally; its bilateral sides closely connected to the urogenital fascia (UGF) of the pelvic wall. In addition, histology preliminarily indicated that the basal cell layers of the peritoneum and Denonvilliers’ fascia were continuous and formed a “Y” shape. Furthermore, the basal cells of the two peritonea extended to Denonvilliers’ fascia, creating a fused double-layered structure. Some tiny blood vessels or a network of such vessels extended from the peritoneum to Denonvilliers’ fascia. Conclusion Denonvilliers’ fascia, the extension of the peritoneum in the pelvic floor, appears as a single-layered “Y”-shape on the sagittal plane. Our study provides new support for the peritoneal fusion theory. Understanding the anatomical characteristics of Denonvilliers’ fascia and its relationship with the UGF is of guiding significance for inexperienced colorectal surgeons to conduct rectal cancer surgery.

The characteristics of the urogenital fascia in the retrorectal space based on male cadaveric dissection and its clinical application

“…Comprehending the characteristics of UGF and discerning the relevant, distinct fasciae are fundamental for colorectal surgeons to distinguish the surgical-related plane better, avoid nerve injury or bleeding, and conduct TME faster at the criteria plane. Establishing the retrorectal space based on the characteristics of UGF also provides a guide for separating the lateral rectal mesentery (namely, lateral rectal ligament) and discerning Denonvilliers’ fascia adjacent to the UGF [ 26 ]. Moreover, a complete comprehension of the distribution characteristics of the two-layered structure of UGF enhances the understanding of the lymphatic metastasis pattern of the low rectum and the pathway of retrorectal space infection spreading to the cranial side.…”

An Open-Book Approach to Pelvic Dissection for the Male Genitourinary System

“…If future studies demonstrate a positive impact on medical student learning, this research may be further expanded to be used by urologic and general surgery residents. Completion of this dissection could help these residents prepare to assist surgeons operating in or around Denonvilliers' fascia or the mesocolon [17][18][19].…”

Anatomical investigation of the pelvic urogenital fascia in 10 formalin-fixed female cadavers: novel insights into the laparoscopic total mesometrial resection

“…The anatomy of these pelvic fascial structures is currently poorly described and often misunderstood [ 7 ]. Through previous anatomical studies of 10 formalin-fixed male cadavers, the author’s team discovered the existence of an intact and continuous extraperitoneal fascial system surrounding the abdominal and pelvic cavities, located in the extraperitoneal space, originating from the renal fascia, crossing the pelvis posteriorly and extending into the preperitoneal space as a continuation of the fascial structure of the bladder, and entering the inguinal canal as a continuation of the internal spermatic fascia [ 8 – 11 ]. The author’s team through the embryonic development of human urogenital organs as a guide combined with the anatomical findings named it the urogenital fascia (UGF), which is similar to the localized findings of Diarra [ 12 ] et al but we made systematic additions and refinements.…”