Anatomy of Urinary Incontinence and Prolapse Flashcards
The pelvic floor seperates _______ (above) from ________ (below)
Pelvic cavity
Perineum
What is the role of the pelvic floor?
Supports pelvic organs
Role in maintaining urinary and faecal continence
List the three layers that make up the pelvic floor from deep to superficial
Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane
What is the deepest layer of the pelvic floor?
Pelvic diaphragm
What does the pelvic diaphragm look like?
A sling
Which muscle groups make up the pelvic diaphragm?
Levator ani
Coccygeus
What is the name for the anterior gap between the medial borders of the pelvic diaphragm? What is it’s role?
Urogenital sinus
Passage for urethra and vagina
Name the three parts of the levator ani muscle
Puborectalis
Pubococcygeus
Iliococcygeus
What is the role of the levator ani?
Tonically contracted most of the time, relaxes to allow urination and defecation
What is the innervation of levator ani?
Pudenal nerve
Nerve to levator ani
State the two types of endo-pelvic fascia
Loose areolar connective tissue
Fibrous pelvic ligaments
List the main pelvic ligaments providing additional support to pelvic organs
Uterosacral ligament
Transverse cervical (cardinal) ligament
Lateral ligament of bladder
Lateral rectus ligaments
Where is the deep perineal pouch?
Lies below the fascia covering inferior pelvic diaphragm
Lies above the perineal membrane
What vein lies above the external urethral sphincter in males and females respectively?
Dorsal vein of clitoris/ penis
List the contents of the deep perineal pouch in females
Urethra (external urethral sphincter) Compressor urethrae Vagina Dorsal vein of clitoris Extension of ischioanal fat pads/muscles
What is the function of the compressor urethrae muscle?
Wraps anteriorly around the urethra so when it contracts it squeezes the urethra
List the contents of the deep perineal pouch in males
Urethra (external urethral sphincter) Compressor urethrae Dorsal vein of penis Deep transverse perineal muscle Bulbourethral gland Extension of ischioanal fat pads/muscles
Where is the bulbourethral gland located in males?
Posterior and lateral to the membranous portion of the urethra at the base of the penis in the deep perineal pouch
Where is the perineal membrane located?
Superficial to the deep perineal pouch
Describe the structure of the perineal membrane
Thin sheet of tough, deep fascia
Where does the perineal membrane attach laterally? What is the function of this?
To the sides of the pubic arch, closing the urogenital triangle
Together with the perineal body, what is the function of the perineal membrane?
Last passive support of the pelvic organs
Where is the superficial perineal pouch?
Lies below the perineal membrane
List the contents of the superficial perineal pouch in males
Crura (‘legs’) and bulb of penis
Erectile tissue (corpus spongiousum, corpus cavernosum)
Muscles (bulbospongiosus, ischiocavernosus)
Proximal spongy penile urethra
Superficial transverse perineal muscle
Branches of internal pudenal vessels
Pudenal nerve
List the contents of the superficial perineal pouch in females
Crura and clitoris Paired bulbs of vestibule Erectile tissue (corpus cavernosum) Muscles (bulbospongiosus, ischiocavernosus) Bartholin's glands Superficial transverse perineal muscle Branches of internal pudenal vessels Pudenal nerve
Where is Bartholin’s gland location in females?
Located slightly posterior and to the left and right of the opening of the vagina in the superficial perineal pouch
Describe the layout of the crura and bulb of the genitalia
Bulbs are situated on either side of the vaginal opening or the base of the penis, and crura are ‘legs’ adjacent to this
What is the function of the bulbospongiosus and ischiocavernous muscles?
Contribute to erection by forcing blood towards the erectile tissues
What is the importance of the perineal body?
Supports the pelvic floor
How does the pelvic floor support pelvic organs?
Actively contracts during coughing, sneezing and vomiting
Which structures in the pelvic floor help maintain urinary continence?
External urethral sphincter
Compressor urethrae
Levator ani
What is the function of the puborectalis muscle?
Bends the anorectum anteriorly, and actively contracts to maintain continence after rectal filling
How is the pelvic floor injured during pregnancy and childbirth?
Stretching or tearing of muscle fibres causes pudenal nerve damage
Damage to the pelvic floor can result in…
Incontinence (involuntary loss of urine)
Prolapse (failure of pelvic organ support)
Continence depends on what factors within the pelvic floor?
Urinary bladder neck support
External urethral sphincter
Smooth muscle in urethral wall
Describe a vaginal prolapse
Herniation of urehtra, bladder, rectum or rectouterine pouch through supporting fascia
How does a vaginal prolapse present?
Lump in vaginal wall
Define ‘urethrocele’
Prolapse of the female urethra into the vagina.
Define ‘cytocele’
Prolapse of the female bladder into the vagina.
Define ‘rectocele’
Prolapse of the female rectum into the vagina.
Define ‘enterocele’
Prolapse of the female bowel into the vagina
What is a uterine prolapse?
Prolapse of the uterus into the vagina (1st, 2nd or 3rd degree)
How does prolapse present?
Dragging sensation
Feeling of ‘lump’
Urinary incontinence
What is sacrospinous fixation?
Sutures placed in sacrospoinous ligament, vaginally, to repair cervical/vault descent in uterine prolapse
What structures are at risk of injury in sacrospinous fixation?
Pudenal NVB
Sciatic nerve
Describe incontinence surgery using the tape procedure
Mesh through obturator canal in the obturator foramen, which creates a sling around the urethra
