Tables in Original article by THOMAS MOUCHEL - FRANÇOIS MOUCHEL
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Basic anatomic features in perineology
Clinique du tertre Rouge, Le Mans, France
Images reproduction prohibited without permission of Authors.(Fig 1)
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Fig 1. – Superior and lateral view of superficial perineum and its innervation. This layer plays an important role in the transversal support of the pelvic floor. 1: perineal body, 2: transverse muscle, 3: bulbocavernosus muscle, 4: sub-cutaneous external anal sphincter = base loop of Shafik, 5: ano-coccygeus ligament = intermediate loop of Shafik, 6: pudendal nerve in Alcock’s canal. |
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Fig 2. – Example of long term consequences of perineal body’s injury: cystocele arising because of lack of support (2A: normal anatomy, 2B: perineal body’s injury and cystocele). Perineal body’s repair is one of the most important surgical procedures available to restore pelvic floor anatomy and to treat efficiently genital prolapses. |
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Fig 3. – Pubo-rectalis muscle (PR). Its resting tone takes part in the support of pelvic floor. Its contraction ensures continence keeping. Its relaxation is involved in micturition and defecation. These pictures show the Shafik’s triple-loop system which compresses opposed alternating anal segments. The top loop is equivalent to puborectalis muscle and exerts traction to the front. The intermediate loop is equivalent to the top part of the external sphincter that merges with the ano-coccygeus ligament and pulls to the back. The base loop is equivalent to the bottom part of the external sphincter that merges with the perineal body and pulls to the front. |
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Fig 4. – Levator plate (LP) and its innervation (4A : Superior and lateral view, 4B : lateral view with hemisection of levator plate and puborectalis muscle).13, 15 It is easier to consider this structure as unique, instead of describing several muscles. This muscular plate plays a passive role in supporting viscera. Its contraction could take part in supporting function and defecation. |
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Fig 5. – Several views of pelvic fascia (in blue color): this conjonctive structure stretches transversally and, from front to back, from its nearly circonferencial insertion.It presents thicker and stronger areas like the utero-sacral ligaments and the pubo-urethro-vaginal ligaments. The vagina is included between the anterior and the posterior layers that merge with the perineal body. Pelvic fascia is insufficient to ensure by itself the stability of the pelvic floor. The integrity of the other perineal structures is really essential. |