Urogyn Anatomy > Anatomy > Flashcards

Anatomy Flashcards

(57 cards)

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1
Q

Female urethra runs

A

From the ladder to the urethral meat is in the anterior aspect of the vulvar vestibule; passes from the retropubic space and perforates the perineal membrane

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2
Q

Periurethral gland location

A

Medially and posteriorlatterally along the distal 2/3rds of the urethra and drain into the distal third of the urethra

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3
Q

Periurethral gland secrete

A

Mucin; acts as a seal and and contributes to continence

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4
Q

Skene glands are

A

Periurethral glands found either side of urethra (like a male prostate)

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5
Q

Skene glands arise from

A

Urogenital sinus

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6
Q

Cellular structure of proximal urethra

A

Transitional epithelium

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7
Q

Cellular structure of distal 2/3rds of urethra

A

Squamousepithilium

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8
Q

Bony pelvis consists of

A

Ilium, ischium, pubic rami, sacrum and coccyx

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9
Q

Superficial transverse perineal muscles

A

Origin:internal surface of ichiopubic rami and ischial tuberosities
Insertion: perineal body
Innervation: deep perineal nerve
Fix to the perineal body to support abdo pelvic viscera

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10
Q

Bulbspongiosus

A

Origin:perineal body
Insertion: pubic arch
Innervation:deep perineal nerve
Wraps around bulbs of the vestibule
Acts to anchor perineal body, constrict vaginal orifice, compress greater vestibular glands, contributes to erection of the clitoris

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11
Q

Ischiocavernosus

A

Origin:ischiopubic rami and ischial tuberosities
Insertion: inferior and medial sides of the Curran
Innervation: deep perineal nerve
Acts to maintain erection of the blitoris. By compressing the veins that drain it

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12
Q

Pelvic diaphragm

A

Coccyges and levators

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13
Q

Pelvic diaphragm

A

Coccyges and levators

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14
Q

Levator hiatus

A

Space which urethra and vagina and rectum pass

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15
Q

Levator plate

A

Fusion of the levator ani in the midline
Forms basis of pelvic support
May be thin and attenuated in the elderly

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16
Q

Coccyges

A

Flexes coccyx during sitting
Origin:ischial spine and SSL
Insertion: lateral lower sacrum and coccyx and overlies SSL
Innervation: S4, S5

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17
Q

Levator ani complex boundaries

A

Arcus tendinous levator ani, ischial spines, body of pubic bone

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18
Q

Puborectalis

A

-posterior surface of the pubic bones
-Forms a sling around the anorectal junction
-maintains fecal continence

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19
Q

Pubococcygeus

A

Origin:pubic bone and tendinous arch
Insertion:midline onto anococcygeal raphe and anterolateral borders of coccyx
Maintains urinary continence
Further subdivides into fibers that bled with vagina, perineal body and puboanalis

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20
Q

Iliococcygeus

A

Origin:ischial spines and arcus tendinous levator ani
Insertion:coccyx and anococcygeal body/raphe
-usually poorly developed

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21
Q

Obturator internus

A

Origin: inferior margin of the superior pubic ramps. And pelvic surface. Of obturator. Membrane
Insertion: greater trochanter. Of. Femur
Acts to: laterally rotate thigh
Vascular supply: obturator vessels

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22
Q

Piriformis

A

Located dorsal and lateral to Coccygeus
Origin:anterolateral sacrum
insertion: greater trochanter
Lumbosacral plexus lays on top of piriformis

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23
Q

Two layers of endopelvic fascia

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A

Visceral and parietal

24
Q

Visceral endopelvic fascia

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A

Throughout the pelvis as a mesh work of loosely arranged collagen, elastin, and fat through which the blood vessels, lymphatics and nerves travel to reach the pelvic organs
-condensation of this=discrete ligaments

25
Parietal fascia
Covers the pelvic skeletal muscles and provides attachment of muscles to the bony pelvic Borders: attaches uterus and vagina to pelvic side wall - extending from uterine artery to point where vagina fuses w levators —condensation of this=discrete ligaments
26
Defects in visceral fascia account for how much prolapse
80% ant 60% post
27
Arcus tendineous levator ani
Is linear thickening of the fascia covering of the obturator internus muscle
28
USL structure
Condensation of fascia Contains smooth muscle that attaches to the dorsal surface of. The. Cervix
29
3 levels of vaginal support (DeLancey)
Level 1: USL and cardinal ligaments Level 2: Anterior and posterior paravaginal attachments along length of vagina Level 3: perineal body, perineal membrane, superficial and deep perineal muscles and endopelvic fascia
30
Vessels at risk in presacral space
L common iliac vein Middle sacral vessels R ureter R common iliac artery Hypogastric nerves (superior hypogastric plexus, hypogastric nerves,portions of inferior hypogastric)
31
Neurovascular structures that pass through the greater sciatic notch close to ischial spine and SSL
Inferior gluteal artery Pudendal nerve and vessels Sciatic nerve
32
Describe the anatomy of the proximal ureter
segment extending from the renal pelvis to the iliac bifurcation, buried mostly within the retroperitoneal fat, except where it passes directly over the psoas muscle; genitofemoral nerve lies on the surface of the psoas muscle, just posterior to the proximal ureter.
33
Describe the anatomy of the distal ureter
extends from the iliac bifurcation to the bladder; takes a sharp turn posteriorly immediately upon entering the pelvis; from there, curves back and follows the lateral pelvic wall inferiorly to connect with the posterolateral bladder wall
34
anatomy of intramural ureter
lies at the UVJ and is typically about 2cm long; buried within the urinary bladder wall on either side and covered by the fibromuscular Waldeyer's sheath -->starts 2 to 3cm from the outer bladder wall and continues longitudinallly until the ureter merges with the trigone; narrowest portion of ureter (calculus obstruction)
35
CSSL length and thickness
30-65.4mm, 0.3cm thick
36
IGA in relation to SSL
superior border (3.4mm) and 2.4cm medial to ischial spine
37
internal pudendal in relation to SSL
either directly behind spine (90%) or within 1.5mm
38
s3 nerve root in relation to SSL
superior border of CSSL
39
s4 nerve root in relation to SSL
lies over medial third of complex
40
lateral third of SSL anatomy
pudendal and nerves to cocygeus and LA muscles nerve to levator on superior surface of complex, 2.5cm nerve to coccygeus lies underneath muscle inferior rectal (from pudental) - variant of this perforates complex 1.9cm medial to ischial spine
41
where to put SSL suture
2cm medial to ischial spine Not above complex and not full thickness right more commonly used than left (greater risk of injury to rectum)
42
Name attachments of the USLs suspension
3 sections - distal, proximal, intermediate
43
distal portion of USL
2-3cm, thick distal portion (5-20mm) is attached to cervix and upper vagina and confluent laterally with the cardinal ligament
44
intermediate portion of USL
(5cm), wide, thick, >2cm from ureter, lowest count of neural fibres This is where you should put your stitch
45
proximal portion of USL
5-6cm, generally thinner and diffuse attachment attaches to the posterior aspect of the cerviovaginal junction, fuses to cardinal ligament for 2cm then goes posteriorly on medial side of cardinal ligament as well-defined bundle of connective tissue
46
Risk of nerve injury with USL
lateral and deep of USL and CL, contain large nerve truncks from superior hypogastric plexus (1-S4), hypogastric plexus and pelvic splanchnic nerves
47
Risk of vascular injury USL
middle rectal artery located close to caudal border of sacral section of USL, upper border of sacral section, but lateral=superior gluteal artery and vein; 4-5cm lateral to USL
48
USL relation to ureter
ureter runs anterior to the ligament, 2-3cm from the cervical attachment
49
URETHRAL ANATOMY - OVERVIEW
The female urethra is 3.5-4cm long, 6mm in diameter, comprising four histological layers: * Mucosa (stratified squamous epithelium, transitional near bladder) * Submucosa (vascular cushions contributing 1/3 of urethral tone) * Internal urethral sphincter (smooth muscle) * External urethral sphincter/urethral rhabdosphincter (striated muscle)
50
INTERNAL URETHRAL SPHINCTER - SMOOTH MUSCLE COMPONENT
Anatomy: * Located at bladder neck/junction of bladder and urethra * Composed of oblique (hold) and longitudinal (pee) smooth muscle fibers * Continuous with bladder smooth muscle * Supported by pubovesical ligaments and endopelvic fascia Innervation: Sympathetic (T11-L2) via hypogastric nerve: * Maintains tonic contraction of internal sphincter * Prevents urine outflow during storage * Promotes urethral closure and bladder neck closure Parasympathetic (S2-S4) via pelvic splanchnic nerves: * Inhibits internal sphincter contraction * Allows sphincter relaxation during micturition * Permits urine passage from bladder to urethra
51
URETHRAL RHABDOSPHINCTER/EXTERNAL URETHRAL SPHINCTER - STRIATED MUSCLE COMPONENT - anatomy
Anatomy: The urethral rhabdosphincter consists of three distinct parts forming the external urethral sphincter complex: 1. Sphincter urethrae (innermost part): * Circular striated muscle fibers surrounding proximal 2/3 of urethra * Thicker anteriorly than posteriorly * Forms true annular sphincter around urethra * The only component forming a complete ring 2. Compressor urethrae (middle part): * Bilateral extensions from sphincter urethrae * Arises from ischiopubic rami bilaterally * Fibers pass anteriorly to join counterpart * Forms loop-like band arching over distal 1/3 of urethra * Located superior to perineal membrane 3. Urethrovaginal sphincter (outer part): * Broad flat band of fibers * Passes posteriorly to surround both urethra and vagina as one unit * Extends to bulb of vestibule * Also arches over distal 1/3 of urethra
52
URETHRAL RHABDOSPHINCTER/EXTERNAL URETHRAL SPHINCTER - STRIATED MUSCLE COMPONENT - histo
Histological composition: * Striated muscle surrounded by endomysium and Type 4 collagen * Accompanied by smooth muscle and elastic fibers * Continuous with smooth muscle components (cadaveric studies demonstrate continuity of smooth and skeletal muscle)
53
anatomical relationships urethral rhabdosphincter
Anatomical relationships: * Located within deep perineal space/pouch (between pelvic diaphragm and perineal membrane) * Spans urogenital hiatus of pelvic diaphragm * Closely related to levator ani muscle (puborectalis forms open circle around external sphincter, creating ventral hiatus) * Associated with perineal body posteriorly * Striated muscle blends inferiorly with smooth muscle of urethra and vagina
54
INNERVATION OF URETHRAL RHABDOSPHINCTER
Somatic motor innervation: * Pudendal nerve (S2-S4), specifically via perineal branches * Alternative innervation: Deep perineal nerve (branch of pudendal) Neural origin: * Motor neurons originate from Onuf's nucleus in sacral spinal cord * Onuf's nucleus receives descending fibers from pontine micturition center (PMC)
55
innervation of urethral rhabdosphincter - functional control
Functional control: During storage: * Onuf's nucleus stimulated → increased resting tone in external sphincter * Voluntary contraction possible for enhanced continence * Reflex contraction during sudden increase in intra-abdominal pressure During micturition: * CNS inhibition of Onuf's nucleus → external sphincter relaxation * PMC coordinates sphincter relaxation with detrusor contraction * Facilitates complete voiding
56
MUSCLE FIBER COMPOSITION & FUNCTIONAL SIGNIFICANCE - urethra
Fiber types: * Type I (slow-twitch) fibers: maintain constant resting tone * Type II (fast-twitch) fibers: provide rapid reflex contractions during sudden stress (cough, sneeze) Contribution to continence: * Sphincters contribute 2/3 of urethral tone * Vascular cushions + urethral mucosa contribute remaining 1/3 * External sphincter provides voluntary augmentation of continence mechanism
57
INTEGRATED NEURAL CONTROL OF MICTURITION
Continence (storage phase): * Sympathetic: internal sphincter contracted * Somatic (pudendal): external sphincter contracted * Levator ani muscles contracted (maintaining urethral support) Micturition (voiding phase): * Parasympathetic: internal sphincter relaxed * Somatic inhibition: external sphincter relaxed * Levator ani relaxed → urethra descends, obliterating posterior urethrovesical angle * Upper 2/3 of urethra (mobile portion) descends during voiding
Urogyn Anatomy
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