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Surgical female urogenital anatomy

Author
Matthew D Barber, MD, MHS
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Gynecologic and urologic surgery is frequently performed using a vaginal or perineal approach. Pelvic surgery requires a comprehensive knowledge of the pelvic anatomy to safely attain access, maximize exposure, ensure hemostasis, and avoid injury to viscera, blood vessels, and nerves.

The anatomy of the female lower genital and urinary tract that is clinically pertinent to the pelvic surgeon when operating from a vaginal or perineal approach is reviewed here. Also included is a discussion of the contemporary understanding of female pelvic organ support, with an emphasis on the functional and surgical anatomy of the vagina, urethra, and pelvic floor. The anatomy of the female genital tract and lower urinary and gastrointestinal tracts relevant to the surgeon performing laparotomy or laparoscopy is discussed separately. (See "Surgical female pelvic anatomy".)

SURGICAL PEARLS

Anatomic features that are clinically applicable to female pelvic surgery are indented and bulleted throughout the text.

PELVIC BONES

At birth, the bones that make up the pelvis are the ilium, ischium, pubis, sacrum, and coccyx. The ilium, ischium and pubis fuse by age 16 to 18 years to form a single bone, referred to as the pelvic bone. Thus, in an adult, the bones of the pelvis consist of the right and left pelvic bones, the sacrum and the coccyx (figure 1 and picture 1). The bony pelvis is the rigid foundation to which all of the pelvic ligaments and muscles are anchored.

Ilium — The most superior component of the pelvic bone is the ilium. The upper part of the ilium expands to form a flat fan-shaped "wing," which provides support for the lower abdomen, and is also called the false pelvis. The medial surface of the ilium has two concavities forming the lateral borders of the pelvic outlet (the inferior opening of the pelvis). The superior and larger of these two concavities is the greater sciatic notch (boundaries are the sacrum, ilium, and ischial spine).

                                                    

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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 14 00:00:00 GMT+00:00 2015.
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