Endopelvic Fascia in Women: Shape and Relation to Parietal Pelvic Structures

Otcenasek, Michal1,3; Baca, Vaclav2,3; Krofta, Ladislav1; Feyereisl, Jaroslav1

doi: 10.1097/AOG.0b013e3181649e5c
Original Research

OBJECTIVE: The endopelvic fascia is a confluent suspensory apparatus of the female pelvic organs. The aim of the study was to construct a three-dimensional model of the endopelvic fascia, defining its shape and its connections to the surrounding parietal structures.

METHODS: We created a three-dimensional multiple-source computer model to simultaneously visualize and analyze all the structures within the female pelvic floor. This model integrates data from magnetic resonance imaging of 15 nulliparas under age 30 with no symptoms of pelvic floor dysfunction. The model also includes data from direct observation in the dissection laboratory and in surgical rooms, together with the relevant scientific literature.

RESULTS: The endopelvic fascia has the shape of a semifrontally oriented septum, which surrounds the vagina and part of the uterine cervix and divides the pelvic floor into the anterior and posterior compartments. This confluent septum has specific connections to the pubic bone, anterior perineal membrane, perineal body, and superior fascia of the levator ani muscle. Additionally, the uterosacral part of the septum has three subdivisions— the “vascular part,” the “neural part,” and the true uterosacral ligament. Each of these subdivisions has a different physical link to the parietal structures. Three-dimensional illustrations and schemes were created to facilitate the understanding of the anatomy of these complex structures.

CONCLUSION: Connecting descriptions of the geometry of the organs visible by magnetic resonance imaging with descriptions of their individual connections to the endopelvic fascia gave us unique information about the three-dimensional representation of the anatomy of the female lesser pelvis. The endopelvic fascia divides the lesser pelvis in a manner that is similar to the way the urorectal septum divides the embryonic cloaca.

LEVEL OF EVIDENCE: III

The endopelvic fascia divides the lesser pelvis in a similar manner as the urorectal septum divides the embryonic cloaca.

From the 1Institute for the Care of Mother and Child (UPMD), Department of Obstetrics and Gynecology, Prague, Czech Republic; the 2Department of Anatomy, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; and 3Center for Integrated Study of Pelvis (CISP), Charles University, Prague, Czech Republic.

Supported by Czech Ministry of Health, grant no. IGA 9309-3/2007.

Corresponding author: Michal Otcenasek, MD, PhD, Institute for the Care of Mother and Child (UPMD), Podolske nabrezi 157, Prague 4 – Podoli, Czech Republic; e-mail: otcenasm@volny.cz.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists