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Department of Anatomy
REGIONAL ANATOMY OF THE PELVIS
MUDr. Marek Joukal, Ph.D.
Pelvis – inner border
Border between pelvis major et minor = aditus pelvis
Superior:
promontorium
linea terminalis
superior margine of
symphysis
Lateral:
pelvic wall
(m. obturatorius int. + fascia
m. piriformis)
Inferior:
diaphragma pelvis
diaphragma urogenitale
Diaphragma pelvis et diaphragma urogenitale
Diaphragma pelvis:
funnel shape
wider around pelvis
narrow around anus
ventral opening – hiatus urogenitalis
Diaphragma urogenitale:
triangular (symphysis, tubera ischiadica)
encloses hiatus urogenitalis (superiorly)
Diaphragma pelvis musculus levator ani
musculus pubococcygeus (m. levator prostatae)
origo: os pubis near symphysis
encircle hiatus urogenitalis
musculus iliococcygeus
origo: arcus tendineus m. levatoris ani
(fascia obturatoria)
insertio: anus
lig. anococcygeum
os coccygis
os sacrum
musculus coccygeus (lig. sacrospinale)
origo: spina ischiadica
insertio: os coccygis, os sacrum
Innervation: plexus sacralis
Fascia diaphragmatis pelvis sup. et inf.
Diaphragma urogenitale
Morphology:
lig. transversum perinei
m. transversus perinei profundus
m. transversus perinei superficialis
m. sphincter urethrae
centrum perineale
(male: urethra – rectum; female: vagina – rectum)
innervation and blood supply: n. pudendus a vasa pudenda
interna
fascia diaphragmatis urogenitalis sup. et inf.
Fascia pelvis parietale
covers the pelvic cavity
its part - fascia diaphragmatis pelvis et urogenitalis
sup.
Fascia pelvis viscerale
goes to pelvic organs
Arcus tendineus fasciae pelvis
transition of parietal and visceral fascia
Peritoneum
cavum pelvis peritoneale
cavum pelvis subperitoneale
Fascia pelvis
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Male pelvis
symphysis + spatium retropubicum
lig. pubovesicularia
lig. puboprostatica
paracystium (fascia vesicoumbilicalis)
vesica urinaria, vesiculae seminales, ductus deferens,
prostata
septum rectovesicale
rectum
4cm
Peritoneal transition: anterior abdominal wall
vesica urinaria
cranial part of vesiculae seminales
rectum (Kohlrausch´s fold)
Excavatio rectovesicalis !!!
Female pelvis
symphysis + spatium retropubicum
lig. pubovesicalia
paracystium (fascia vesicoumbilicalis)
vesica urinaria, urethra feminina
septum urethrovaginale
vagina
septum rectovaginale
centrum perineale
perineal body
rectum
Nullipara
fossa ovarica
(infront of a. iliaca int. and
ureter)
Multipara
Claudius fossa
(behind a. iliaca int. and
ureter)
Female pelvis – ovary
Peritoneal fold:
lig. latum uteri
mesosalpinx
mesovarium
Lig. latum uteri
Female pelvis – perimetrium (visceral peritoneum)
Lig. pubouterinum
lig. pubovesicale
lig. vesicouterinum
Lig. cardinale uteri
Lig. sacrouterinum
plica sacrouterina
m. rectouterinus
Lig. teres uteri
Female pelvis – parametrium Female pelvis
Transition of peritoneum:
anterior abdominal wall
vesica urinaria
uterus
fornix vaginae post.
rectum (Kohlrausch´s fold)
Excavatio vesicouterina
Excavatio rectouterina (cavum Douglasi!!!)
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excavatio
rectovesicalis
excavatio
rectouterina
(Douglasi)
excavatio
vesicouterina
Female pelvisMale pelvis
Parietal branches
a. Iliolumbalis
a. sacralis lat.
a. obturatoria
(r. pubicus - corona mortis)
a. glutaea sup. et inf.
a. pudenda interna
Blood supply – a. iliaca int.
Visceral branches
aa. vesicales sup.
(a. umbilicalis)
a. vesicalis inf.
a. rectalis media
♂ a. ductus deferentis
♀ a. uterina
Arteria uterina – anastomosis with a. ovarica (ovarial arcade)
Crossing of a. uterina with ureter
(2 cm from the uterine margine
1,5 cm from fornix vaginae)
Parietal tributaries:
Corresponds to arterial branches
Visceral tributaries:
plexuses around organs
plexus venosus vesicalis
♂ plexus prostaticus
♀ plexus uterovaginalis
plexus venosus rectalis
plexus venosus sacralis
Blood supply of pelvis – v. iliaca int.
constitution – from venous plexus above foramen ischiadicum majus
Submucous - inner
v. rectalis superior (vena portae)
Perirectal - outer
vena rectalis superior (vena portae)
vena rectalis media (vena iliaca interna)
vena rectalis inferior (vena pudenda
interna)
Plexus venosus rectalis – portocaval anastomosis
Regio perinealis
Regio urogenitalis
borders:
symphysis
sulcus genitofemoralis
line between tubera ischiadica
Regio analis:
borders:
line between tubera ischiadica
inferior margine of os coccygis
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Regio urogenitalis feminina
Content: external genital organs
spatium perinei spf. (between fascia diaphragmatis urogenitalis inf. + fascia perinei superficialis)
spatium perinei prof. (between fascia diaphragmatis urogenitalis sup. + inf.)
Spatium perinei spf.
m. ischiocavernosus
crura clitoridis
m. bulbospongiosus
bulbi vestibuli
gll. vestibulares
majores
Regio urogenitalis feminina
Spatium perinei prof.
urethra feminina
vagina
centrum perineale (between vagina and anus)
septum rectovaginale
perineal body
m. sphincter urethrovaginalis
(from centrum perineale encircles urethra
and vagina)
m. compressor vaginae (m. pubovaginalis)
m. compressor urethrae (m. pubourethralis)
m. puborectalis
Regio urogenitalis masculina
Spatium perinei spf.
m. ischiocavernosus
crura penis
m. bulbospongiosus
bulbus penis
gll. bulbourethrales
Spatium perinei prof.
urethra masculina
m. puboprostaticus
Content: external genital organs
spatium perinei spf. (between fascia diaphragmatis urogenitalis inf. + fascia perinei superficialis)
spatium perinei prof. (between fascia diaphragmatis urogenitalis sup. + inf.)
Regio analis
skin:
anus
plice circumanales
raphe perinei
subcutaneus tissue:
glandulae circumanales
fatty tissue continues to fossa ischiorectalis
m. sphincter ani externus
centrum tendineum perinei – ventrally from anus
lig. anococcygeum
Borders:
mediocranial:
diaphragma pelvis
lateral:
m. obturatorius int.
fascia obturatoria
canalis pudendalis (n. pudendus, vasa
pudenda int.)
ventral:
recessus pubicus (above diaphragma
urogenitale)
dorsal:
m. glutaeus maximus
lig. sacrotuberale
Fossa ischiorectalis Regio perinealis – blood supply and innervation
a. + v. pudenda int.
a. + v. rectalis inf.
a. + v. perinealis – rr. scrotales post. (rr.
labiales post.)
a. + v. penis (a. clitoridis)
n. pudendus
n. rectalis inf.
n. perinealis – nn. scrotales post. (nn. labiales
post.)
n. dorsalis penis (a. clitoridis)
n. coccygeus (rr. musculares, rr. anococcygei)
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Čihák, R.: Anatomie 3. Praha, Grada, (2004).
Platzer, W. et al.: Atlas topografické anatomie. Grada Publishing, (1996).
Grim, M. a kol.: Základy anatomie. 5. Anatomie krajin těla. Galén, (2002).
Moore, K. L.: Clinical oriented anatomy. Third edition. Williams & Wilkins, A Waverly Company, (1992).
Gilroy, A. M. et al.: Atlas of Anatomy. Thieme New York, Stuttgart. (2009).
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