Midline structures of the pelvis

Question 1

What is the retropubic space?

Answer 1

The extraperitoneal space between the pubic symphysis and urinary bladder.

Question 2

What is the rectovesical pouch (male only)?

Answer 2

Pocket of peritoneum that lies between urinary bladder and rectum.

Question 3

What forms the broad ligament in females?

Answer 3

The peritoneum is draped over the uterus and uterine tubes forming a double-layered sheet of peritoneum on each side of the uterus, partially subdividing the pelvic cavity. This is the broad ligament.

Question 4

What is the uterovesical pouch?

Answer 4

Pocket of peritoneum between the uterus and the bladder.

Question 5

What is the rectouterine pouch?

Answer 5

Pocket of peritoneum between the uterus and the rectum.

Question 6

What is the normal capacity of the bladder?

Answer 6

400-600ml

Question 7

What is the arterial blood supply to the bladder?

Answer 7

Most are branches of the internal iliac. Superior vesicle supply anterolateral parts. In males the inferior vesicle arteries supply the fundus and neck. In females the vaginal arteries supply fundus, neck and postero-inferior parts. Also supplied by branches from obdurator and inferior gluteal.

Question 8

What is the venous drainage from the bladder?

Answer 8

Veins correspond to arteries. Tributaries of internal iliac vein. In males the vesicle venous plexus is continuous with the prostatic venous plexus.

Question 9

What is the nerve supply to the bladder?

Answer 9

Sympathetic - inferior thoracic and upper lumbar nerves to the vesical plexus via the hypogastric plexus.

Parasympathetic - from sacral spinal cord levels conveyed by pelvic splanchnic nerves and inferior hypogastric plexus.

Sensory - follow the same course as parasympathetic.

Question 10

Where does the ductus deferens originate and where does it enter the abdomen?

Answer 10

Originates at the duct of the epididymis. Penetrates the anterior abdominal wall via the inguinal canal.

Question 11

Describe the course of the epididymis.

Answer 11

Begins at the duct of the epdidymis. Ascends posterior to testis, medial to epididymis. Penetrates anterior abdominal wall via the inguinal canal. Crosses over the external iliac vessels and enters the pelvis. Passes along the lateral wall of the pelvis where it lies external to the parietal peritoneum. Ends by joining the duct of the seminal gland to form the ejaculatory duct.

Question 12

Which structures provide mechanical support for the uterus within the pelvis?

Answer 12

Pelvic diaphragm, round ligament, broad ligament, pubocervical ligament, perianal body, urogenital diaphragm, uterosacral ligament, transverse cervical ligaments, uterine axis.

Question 13

What name is given to the expanded lateral extremity of the uterine tubes?

Answer 13

Infundibulum.

Question 14

What name is given to the dilated portion of uterine tube just proximal to the infundibulum?

Answer 14

Ampulla

Question 15

What name is given to the part of the uterine tube most proximal to the uterus?

Answer 15

Isthmus

Question 16

What is the relationship between the uterine artery and the ureters?

Answer 16

Artery always flows over the ureters - ‘water always flows under the bridge’.

Question 17

What is the origin of the round ligament of the uterus?

Answer 17

Antero-inferiorly to the uterotubal junction.

Question 18

What is the course of the round ligament?

Answer 18

Leaves the pelvis via the deep inguinal ring. Passes through the inguinal canal and terminal at labia majora.

Question 19

Of what is the round ligament a remnant?

Answer 19

Gubernaculum.

Question 20

How is the ovary suspended in the pelvic cavity?

Answer 20

Attached to the posterior leaf of broad ligament by a double-layered fold of peritoneum - mesovarium.

Question 21

Where do the ovarian arteries originate? What do they supply?

Answer 21

Lateral branches of the abdominal aorta, just posterior to the renal arteries at the upper border of L2. Supply the uterine tubes, ureter and ovaries

Question 22

What nerve lies adjacent to the ovary against the lateral wall of the pelvis?

Answer 22

Obdurator nerve.

Question 23

The posterior fornix is closely related to which part of the peritoneal cavity?

Answer 23

Rectouterine pouch

Question 24

What is the lymphatic drainage of the vagina and uterus?

Answer 24

To the external iliac nodes (upper third of the vagina), the common and internal iliac nodes (middle third), and the superficial inguinal and perirectal nodes (lower third).

Question 25

What is the origin of the superior rectal artery?

Answer 25

Inferior mesenteric.

Question 26

What is the origin of the middle rectal arteries?

Answer 26

Internal iliac.

Question 27

What it the origin of the inferior rectal arteries?

Answer 27

Internal pudendal.