pelvic structure

1. MORPHOLOGY OF THE MALE
PELVIC
AND UROGENITAL
DIAPHRAGMS
Dr. Andrea D. Székely
Semmelweis University
Department of Anatomy, Histology and Embryology
Budapest

2. • It makes a fundamental contribution to movement and stability
• Functions in coordination with the abdominal, back, and hip muscles
• Especially important is its relationship to the Transversus Abdominis (the
deepest layer of the abdominal muscles), and the Multifidus muscles in
the low back, to maintain the integrity of pelvic, sacral, and spinal joints
during movement
• It supports the prostate, bladder, rectum, and seminal vesicles
• It regulates continence, opening and closing the urethra and anus as
needed
• It plays an essential role in sexual function
• It acts reciprocally with the respiratory diaphragm in breathing.
• It is a flexor of the coccyx (tail bone)
• The pelvic floor is the center of gravity in your frame, the place where
movement is initiated, and is essential to your overall sense of well-
being.
FUNCTIONS AND ROLES OF THE PELVIC FLOOR

3. BONY AND LIGAMENTOUS FRAMEWORK

4. PERINEUM
Surface features
EXTERNAL GENITALS
Homologous organs

5. UROGENITAL TRIANGLE
ANAL TRIANGLE
PERINEUM
Surface regions

6. MORPHOLOGICAL DIMORPHISM
Male and female perineal muscles

7. PERINEAL LAYERS OF MUSCLES AND FASCIAE

8. MUSCLE LAYERS OF THE PELVIC FLOOR
1. Pelvic diaphragm :
levator ani and the fasciae
1. (ant) pubococcygeus
2. pubovaginalis
3. puborectalis
4. (post) iliococcygeus
5. coccygeus (ischiococcygeus)
External anal sphincter
2. Urogenital Diaphragm :
deep transverse perineal
and the fasciae
1. urethrovaginal sphincter
2. compressor urethrae
3. urethral sphincter
PERINEAL
BODY
3. Urogenital trigone :
- ischiocavernosus
- bulbospongiosus
- superficial transverse
perineal
m. corrugator cutis ani
(smooth muscle)

9. FASCIAL LAYERS
Fascia transversalis
continues as the endopelvic fascia lining the pelvic cavity
PELVIC FASCIA
Lamina parietalis (obturator internus + Piriformis)
Lamina visceralis (M. levator ani and M. coccygeus) =
= superior fascia of the pelvic diaphragm *
surrounding the pelvic viscera)
* to be joined by the
inferior fascial layer -
see later

10. M. pubococcygeus (+ rectococcygeus)
ORIGIN: Sup. Ramus of pubic bone
INSERTION: Anococcygeal lig., Sacrum,
Coccyx, M. sphincter ani ext.
Fibres cross in an 8 shape limiting 2 openings
Urogenital Hiatus
Anal Hiatus
M. iliococcygeus
ORIGIN: Tendinous arch of the obturator int. +
ischiac spine
INSERTION: anococcygeal ligament
joined by the
M. coccygeus from posterior
ORIGIN: Ischiac spine
INSERTION: sacrotuberal lig., Coccyx, Sacrum)
Function:
Strengthens the pelvic floor
PELVIC DIAPHRAGM LEVATOR ANI

11. ORIGIN: Obturator membrane + foramen
INSERTION: Trochanteric Fossa
Completes the lateral wall of the pelvis
M. obturator internus
Inferior fascia of the pelvic diaphragm
FURTHER MUSCLES AND FASCIAE OF THE PELVIC WALL
The piriformis or the
triceps coxae will NOT
contribute to the pelvic
floor or wall
covers the lower surface
* Joins the superior fascial layer - see earlier
Below the tendinous arch (of the
levator ani) this fascia forms the lining
of the isciorectal fossa together with
the obturator fascia

12. PELVIC FLOOR LAYERS,
LEVATOR ANI ORIGINS AND DIVISIONS
Urogenital hiatus – anal hiatus
iliococcygeus
(ischio)coccygeus
pubococcygeus
piriformis
puborectalis
Anococcygeal
ligament

13. PERINEAL MUSCLES, UROGENITAL DIAPHRAGM
Deep transverse perineal muscle
Trapezoid in shape, pulls between the inferior rami of the pubic bones. Forms
the inferior cover of the pelvic diaphragm (fused to it at the perineal body)
Passes the dorsal penile nerves and vessels between the arcuate pubic lig. and the
transverse pelvic lig.
Spalteholz
M. bulbospongiosus
ORIGIN: external anal
sphincter + raphe of penile
bulb, fused to the perineal
body (erection + ejaculation)
M. ischiocavernosus
ORIGIN: ischiac tuberosity
INSERTION: Crus penis
+ cavernous bodies (erection)
Superficial transverse
perineal muscle
ORIGIN ischiac tuberosity
INSERTIONperineal body)

14. SUPERFICIAL PERINEAL FASCIA
LAMINA SUPERFICIALIS
thick areolar CT, continues in the tunica dartos,
fused to the skin in the midline
LAMINA PROFUNDA (fascia Colles)
thin, fibre rich CT membrane, continues in the
tunica dartos, deep penile fascia, deep spermatic
fascia, covers the muscles. Fused to the superficial
lamina in the midline
DEEP PERINEAL FASCIA (TRIANGULAR LIGAMENT)
LAMINA INFERIOR
Anteriorly - open towards the arcuate ligament,
posteriorly fuses to the perineal body, covers the
deep transverse perineal muscle
LAMINA SUPERIOR
Continuation of the obturator fascia, anterior attm
to the pubic arch, posteriorly merges with the
deep lamina (ligamentum transversum pelvis)
UROGENITAL TRIGONE
(perineal pouch)
superficial transverse perineal
bulbospongiosus
ischiocavernosus
PERINEAL FASCIAE AND SPACES

15. THE ISCHIORECTAL FOSSA
WALLS
ANTERIOR (recessus anterior)
MED: levator ani
LAT: obturator internus
INF: deep transverse perineal
POSTERIOR
MED: anal fascia, sphincter ani ext.
LAT: ischiac tuberosity, obturator fascia
ANT: superfic and deep perineal fasciae
POST: sacrotuberal lig., gluteus maximus
CONTENT
Adipose CT, containing :
inferior hemorrhoidal aa., vv., nn.
cutaneous br. of the pudendal plexus
posterior scrotal aa., vv., nn.
Alcock’s canal :
Fascial duplication of the obturator internus
CONTENT
pudendal n.
internal pudendal a.
internal pudendal v.

16. DEEP AND SUPERFICIAL PERINEAL SPACES

17. PELVIC CONNECTIVE TISSUE SPACES
Corning
Prevesical space (of Reitzus)
Contains the prostatic
venous plexus (of Santorini)
Paracysticum
Retrovesical space
Paraproctium
Retrorectal space
Contains the sup. rectal, median and lateral sacral
arteries; pelvic and sacral splanchnic nerves;
branches of the hypogastric & sacral plexus

18. Branches of the internal
pudendal a./v.
Branches of the pudendal n.
VASCULAR AND NERVOUS SUPPLY

20. PELVIC PASSAGES – THE MALE URETHRA

21. External anal sphincter
Voluntary action (striated muscle)
Pars profunda
Pars superficialis
(between the perineal body and
the anococcygeal ligament)
Pars subcutanea
Rauber-Kopsch
Sobotta
PELVIC PASSAGES – THE ANAL SPHINCTER

22. PELVIC PASSAGES – THE ANAL CANAL

23. CLINICAL RELEVANCES

24. ECTOPIC TESTICLE VARICOCELE HYDROCOCELE
INGUINAL CANAL
CLINICAL RELEVANCES

25. CLINICAL RELEVANCES - HAEMORRHOIDS

26. THANK YOU FOR YOUR ATTENTION!