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Perineum2 rakesh vora


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its about only urogenital triangle(region) of perineum,a lecture of anatomy -abdomen region.

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Perineum2 rakesh vora

  2. 2. Trianglesperineal muscles
  3. 3. Urogenital regionSuperficial fascia has two layers• The superficial or fatty layer• The deep or membranous layer (superficial fascia of perineum or Colles’ fascia) Anteriorly- it is continuous with: – Dartos of the scrotum – Fascia of the penis – Membranous layer of superficial fascia of the abdominal wall known as the fascia of ScarpaDeep fascia has two layers• Superior fascia of urogenital diaphragm• Inferior fascia of urogenital diaphragm
  4. 4. Superior fascia of urogenital diaphragm Deep perineal spaceInferior fascia of urogenital diaphragm (Perineal Membrane) Fascia of Scarpa Superficial perineal space superficial fascia of perineum Bucks Fascia of the penis (colles’ fascia) Dartos of the scrotum
  5. 5. Cutaneous Innervation of Urogenital region• Dorsal nerve of penis/clitoris• Ilioinguinal nerve & genital branch of genitofemoral nerve• Perineal branch of post cutaneous nerve of thigh• Post scrotal /labial nerve
  6. 6. Superficial perineal space(Pouch)Boundaries• Lies between inferior fascia of urogenital diaphragm and superficial fascia of perineum• Anteriorly open and posteriorly closed by fused perineal membrane with colles’ fascia• Space open anteriorly (In rupture of cavernous part of urethra, urine can extravasate from scrotum upward in front of symphysis pubis into anterior abdominal wall deep to membranous fascia of Scarpa)
  7. 7. Contents• Posterior part-superficial transverse perineal muscle• Lateral part-crus penis (male), crus of clitoris (female) and ischiocavernousus covering them• Central part-bulb of penis (male), bulb of vestibule (female) and bulbospongiosus covering them, urethra(in both)• Ducts of bulbourethral glands(male) greater vestibular glands(female)• Branches of pudendal nerves and internal pudendal vessels
  8. 8. Deep perineal space (Pouch)• Lies between superior and inferior fascia of urogenital diaphragm• Contents – Membranous urethra(male),urethra and vagina(female) – Deep transverse perineal muscle, sphincter urethrae – Bulbourethral gland (male) – Branches of intenal pudendal vessels(artery of penis) – Branches of pudendal nerve(dorsal nerve of penis)
  9. 9. Urogenital diaphragm• Triangular in shape• Attached laterally to ischiopubic rami and ischial tuberosities• Formed by sphincter of urethra, deep transverse perineal muscle, superior and inferior fascia of urogenital diaphragm
  10. 10. Perineal MembranePierced by:• Urethra(+vagina)• Duct of bulbourethral gland(male)• Artery & nerve to bulb of penis/vestibule• Dorsal & deep artery of penis(/clitoris)• Urethral artery• Post. scrotal/labial nerve & vessels• Branches of perineal nerve to superficial muscles
  11. 11. Perineal central tendon(Perineal Body)• Wedge-shape fibromuscular mass• In female, between anal canal and lower end of vagina,• In male, between anal canal and root of penis• It is larger in the female than in the male and support to the posterior wall of the vagina
  12. 12. • Origin or insertion of several small muscles and insertion of part of pelvic diaphragm• These muscles are: – Superficial transverse perineal muscles – Deep transverse perineal muscles – Bulbospongiosus – Levator ani – Sphincter ani externus – Longitudinal muscle coat of anal canal
  13. 13. Bulbospongiosus Deep transverse muscles perineum Superficial transverse muscle perineum Levator aniSphincter ani externus
  14. 14. Applied• Extravasation of urine is superficial or deep• Damage to perineal body:prolapse of uterus• Episiotomy: Median or Mediolateral• Pudendal nerve block
  15. 15. Episiotomy and pudendal nerve block
  16. 16. THANK YOU