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Vessels and lymphatics of organs of urogenital systemsPelvic floor, Perineumlecture for students of general medicine and dentistryMiloš GrimInstitute of Anatomy, 1st Faculty of Medicine, Summer semester 2012 / 2013

Internal iliac artery, blood vessels of the pelvis

Retroperitoneal space, topography of its organs and main vessels

Internal iliac vein

Vessels of pelvic organsvenous vesical plexus, venous vesicovaginal plexus

Parietal pelvic lymph nodes

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Lymph nodes: common iliac, external iliac, inguinal

Nerves of retroperitoneal and subperitoneal spacesLumbar and sacral plexuses,Abdominal and pelvic plexuses andganglia of autonomic system

Inferior hypogastric plexus

Perineal region - blood supply, innervation

Suprapiriform forameninfrapiriform foramen

Pelvic floorPelvic diaphragmUrogenital diaphragmPerineal muscles

Pelvic diaphragmLevator aniPubic part – pubococcygeal m.pubovaginal m.puboprostatic m.puborectal m.Iliac part – iliococcygeal m.Urogenital and anal hiatus,Coccygeal muscleFibrous structures:anococcygeal lig., perineal body,tendinous arch of levator ani,tendinous arch of pelvic fascia,

Pelvic diaphragm

Pelvic diaphragm

Levator ani, tendinous arch of levator ani

Development of levator ani et external anal sphincter

Urogenital diapragmDeep transverse perineal muscle (in male only)+ variable superficial transversal perineal muscle,perineal membraneFibrous structure - perineal body

Ischioanal fossa

Ischioanal fossa, anterior part

Ischioanal fossa, middle part

Perineal muscles of female, blood supply, inmnervationPerineal region, regio perinealis - Urogenital triangle, regiourogenitalis - Anal triangle, regio analis, - Ischio-analfossa, fossa ischioanalis (ischiorectalis) Perineum

Perineal musclesMm. of urogenital triangle:External urethral sphincter(+ Urethrovaginal sphincter +Compressor urethrae )Ischiocavernosus,Bulbospongiosus,M. of anal triangleExternal anal sphincterFibrous structures:Perineal body, Anococcygeal lig.

Perineal muscles of male and femalePerineal region - Urogenital triangle, Anal triangle,Ischio-anal fossa, Perineum

Female external genitalia and perineal muscles - Bulbospongiosus,Ischocavernosus, Compressor of urethra, Urethrovaginal sphincter,Superficial transverse perineal muscle

Peritoneal spaces of lesser pelvis in maleRectovesical pouch(extends to the fundus of seminal vesicles, to the levelof Kohlrausch fold - the lowest point of the pelvic cavity in male),Rectovesical foldsSubperitoneal spaces of lesser pelvis in maleRetropubic space, paracystium, paraproctium,lined by visceral and parietal pelvic fascia,Pubovesical ligaments, puboprostatic ligaments, urorectal septum,infra- et suprapiriform foramen,Ischioanal space in male and femaleIschioanal fossa, pudendal canal (of Alcock)

Peritoneal and subperitoneal spaces of lesser pelvis in male

Peritoneal space of lesser pelvis in femaleVesicouterine pouch, rectouterine pouch (pouch of Douglas) - the lowestpoint of the pelvic cavity, extends to the fornix of vagina, to the levelof Kohlrausch fold), rectouterine folds,broad ligament, mesosalpinx, mesometrium, mesoovariumSubperitoneal space of lesser pelvis in femaleRetropubic space, paracystium, parametrium, paracolpium,Paraproctium, lined by visceral and parietal pelvic fascia,Tendineous arch of pelvic fascia,Pubovesical ligaments, cardinal ligament,Vesicovaginal septum, rectovaginal septum

Peritoneal space of lesser pelvis in female

Subperitoneal space of lesser pelvis in female

Attachments ofthe cervix andvagina to pelvicwalls (uterinecorpus and thebladder havebeen removed)Obturator int.Tendinous archof endopelvicfasciaVaginaTendinous archof levator aniLevator aniProjection oftrigon of thebladder

Sources of used illustrations:Gray´s Anatomy,Sobotta: Atlas der Anatomie des MenschenGrim, Druga: Základy anatomie, 5. dílBenninghoff, Drenckhahn: Anatomie I., II.Recommended Textbooks:R. S. Snell: Clinical Anatomy. 7th Edition, Lippincott Williams& Wilkins, 2004, pp. 478 – 562orK. L. Moore: Clinically oriented Anatomy, 3rd Edition,Williams & Wilkins 1992, pp. 501 – 635andW. Platzer: Color Atlas of Human Anatomy, Vol. 1 LocomotorSystem. Thieme, 5th English Edition, 2004, pp. 137 - 183