Lumbosacral

Sacrococcygeal

Sacroiliac

Pubic symphysis

Superior Pubic ligament

Inferior (arcuate) pubic ligament

Iliolumbar lig

Sacroiliac lig

Sacrotuberous lig

Sacrospinous lig

connects sacrum to ilium anteriorly and posteriorly. includes

-interosseous sacroiliac

-Anterior sacroiliac

-Posterior sacroiliac

lesser- sacrotuberous

greater- sacrospinous

-superior/inferior gluteal vessels and nerves

-Sciatic nerve

-Posterior femoral cutaneous nerve

-Pudendal nerve brandches and pudendal vessels

-piriformis m.

-branches of pudendal n.

-internal pudendal vessels

-obturator internus m/nerve

-Superior margin of pubic symphysis

-Pubic crest

-Arcuate line of ilium

-Anterior border of ala of sacrum

-Promontory of the sacrum

-abdominal wall

-iliac fossa

-L5 and S1 vertebrae

-Pubic symphysis, body of pubis, pubic rami

-Pelvic aspect of ilium and ischium

-Concave pelvic surface of sacrum and coccyx

-Pelvic diaphragm

A-P 11 cm

transverse 13.5

Ap 9-11.5 cm

Transverse 11-12 cm

Anthropoid- short transverse, long AP

Platypelloid- long transvers, short AP, requires C-section

Sacroiliac region

Ala of ilium

Pubic ramus

Pubo-obturator

O- Pelvic surfaces of ilium and ischium, obturator membrane

I- Greater trochanter of femur

Piriformis O&I

O- pelvic surfacr of 2nd to 4th sacral segments, superior margin of greater sciatic notch, and sacrotuberous lig

I- greater trochanter of femur

two levator ani

Two coccygeus muscles

Puborectalis

Pubococcygeus

Iliococcygeus

O-pubis

I-coccyx and anococcygeal ig

Cystocele

Cystourethrocele or urethrocystocele

Rectocele

Iliococcygeus m O&I

O-tendinous arch of the obturator fascia and the ischial spine

I- on coccyx and anococcygeal lig

lateral- pelvic surface of ischial spineand sacrospinous lig

Medial- lateral margin of coccyx and S5 vertebrae

tendinous arch

Levator ani muscles

uterosacral ligament

transverse cervical ligaments

pubovesical lig in females

puboprostatic lig in males

lumbosacral trunk

sacral plexus

coccygeal nerve

nerve to piriformis

perforating cutaneous nerves (S2-3)

nerves supplying the pelvic diaphragm

posterior branch of the ventral rami of the L4-S1 nerves

Innervates gluteus medius, minimus and tensor fascia lata muscles

posterior branch of ventral rami of L5-S2

Innervates gluteus maximus

Anterior branch of S2-3

Posterior branch of S1-2

Dorsal nerve of penis or clitoris

Perineal nerve

Inferior rectal nerve

Obturator nerve- not part of sacral plexus

arises from:

Supplies:

L2-4, leaves pelvis through obturator foramen

Medial compartment of the thigh

coccygeus muscle

part of levator ani

sacrococcygeal joint

small area of skin that covers coccyx bone

each of ventral rami of the sacral and coccygeal nerves

inferior hypogastric plexuses

middle rectal plexus

vesical plexus

prostatic plexus

uterovaginal plexus

from superior part of the inferior hypogastric plexus

extends to the internal anal sphincter

arises from the anterior part of the inferior hypogastric plexus

to the bladder, seminal vesicles, ductus deferens and prostate

arises from inferior part of the inferior hypogastric plexus

Enter to the fundus and sides of the prostate, seminal vesicles, ejaculatory duct, urethra, bulbourethral gland and penis

arises from part of inferior hypogastric plexus that lies in the base of the broad lig

Pass to vagina, cervix, body of uterus, urethra, bulbs of the vestibule, greater vestibular glands and clitoris

Internal iliac (paired)

Ovarian arteries (paired)

Median sacral (unpaired)

Superior rectal (unpaired)

Internal ilaic vascularizes:

anterior division-

Posterior division-

anterior- visceral and parietal

posterior- only parietal

superior gluteal

iliolumbar

lateral sacral

-superiorly and inferiorly on eacchc side of the sacrum

-branches pass through pelvic sacral foramina to supply spinal meninges

-branches through posterior sacral foramina to supply muscle and skin overlying sacrum

Obturator

Inferior gluteal

Internal pudendal

Umbilical

Superior vesical

Inferior vesical (in males)

Uterine and vaginal (in females)

Middle rectal

-piriformis and coccygeus muscles through the greater sciatic foramen

-passes over ischial spine or sacrospinous ligament entering ischioanal fossa through the lesser sciatic foramen

-Inferior rectal

-Dorsal artery of the penis or clitoris

-Perineal artery

seminal vesicles

ductus deferens

prostate

posteroinferior part of bladder

vagina

bladder

pelvic part of the urethra

(anastommoses with the vaginal branch of uterine artery)

body

fundus

(anastomoses with ovarian artery)

cervix

vagina

middle of the rectum

prostate and seminal vasicles in male

vagina in female

run anterior to the ureter, cross the proximal part of the external iliac vessels in the pelvic minor

-supply ovaries, uterine tubes

from- inferior mesentric artery

path- crosses left common iliac vessels

anastomoses with middle and inferior rectal arteries

Internal iliac veins

Ovarian veins

Superior rectal

Median sacral

Internal vertebral venous plexuses

umbilical vein

iliolumbar vein

Rectal plexus

Vesical Plexus

Prostatic plexus

Uterine plexus

Vaginal Plexus

Internal/External iliac lymph nodes

Sacral lymph nodes

Small lymph nodes in broad lig in female

Some lymph nodes in fascia sheath of bladder and rectum

Pubic symphysis

Inferior pubic rami

Ischial rami

Ischial tuberosities

Sacrotuberous ligament

Coccyx

thin sheet of striated muscle stretching between the two sides of the pubic arch

covers pelvic outlet

covered by deep fascia

-Root of clitoris

-Ischiocavernosus

-Bulbospongiosus

-Bulbs of vestibule

-Superficial transverse perineal m.

-Perineal body

-Greater vestibular gland

-Related vessels and nerves

-Root of penis

-Ischiocavernosus

-Bulbospongiosus m.

-Superficial transverse perineal m

-Perineal body

-Contents of scrotum

-Proximal part of the spongy urethra

-Branches of internal pudendal vessels and pudendal nerve

-Part of urethra

-Sphincter urethra m.

-Deep transverse perineal m.

-Vagina

-Related vessels and nerves

-Sphincter urethra

-Membranous urethra

-Bulbourethral gland

-Deep transverse perineal m.

-Related vessels and nerves

Prostatic urethra

Membranous urethra

Penile urethra

O- medial surface of ischial ramus

I- perineal body (and vagina for females)

-Transverse perineal m

-Bulbospongiosus m

-Levator ani

-Some fibers of the external anal sphincter

tip of coccyx

imaginary line joining the anterior ends of the ischial tuberosities

sacrotuberous ligaments

ischium and obturator internus m.

Anal canal

Sacrotuberous lig and glut max m.

Base of urogenital diaphragm and its fascia

Dorsal nerve of penis or clitoris

Perineal nerve

Inferior rectal nerve

Ampulla of the ductus deferens

Ejaculatory duct

inferior vesicle

Middle rectal arteries

Inferior vesical

Middle rectal arteries

vesical plexus

Vertebral venous plexus

Visceral layer of the tunica vaginalis

Tunica albuginea or capsule of the testes

Tunica vasculusa

Veins form pampiniform plexus that lead to testicular vein

Right testicular v. drains into IVC

Left testicular v drains into L renal v

skin

dartos fascia

Parietal layer of tunica vaginalis

anterior- external pudendal a.

posterior- internal pudendal a.

branches from testicular and cremasteric arteries

anterior- ilioinguinal nerve

posterior- medial and lateral scrotal branches of perineal nerve, perineal branch of the posterior femoral cutaneous nerve

begins at deep inguinal ring, lateral to inferior epigastric artery

ends at posterior border of the testis

Ductus deferens

Arteries, veins, nerves

Testicular arteries

Cremasteric artery

Branch of interior vesical artery

Testicular vein

Pampiniform plexus

Sympathetic on arteries

Sympathetic and parasympathetic fibers (on ductus deferns)

Genital branch of the genitofemoral nerve

Bulbospongiosus

Ischiocavernosus

branches from internal pudendal artery

-dorsal arteries

-deep arteries

-artery to the bulb

Cavernous: venous plexus-> deep dorsal vein -> prostatic venous plexus

Superficial: Superficial dorsal vein _> superficial external pudendal vein

-Ilioinguinal nerve

-Perineal branch of posterior femoral cutaneous nerve of the thigh

-Posterior scrotal branch of perineal nerve

-branches from prostate artery

-artery to the bulb

-urethral artery

Pudendal nerve

Inferior hypogastric plexus

ovary

Uterine tube

anastomoses with uterine artery

pelvic diaphragm

Urogenital diaphragm

(visceral fascia also slightly)

-Transverse cervical ligaments

-Uterosacral ligaments

(both are condensations of pelvic fascia containing smooth muscles)

ovarian ligament lies posteroinferiorly

Round ligament of uterus lies anterosuperiorly within the broad lig

Uterine artery

-asceding branch for body and fundus

-descending branch for cervix and vagina

Ovarian artery

Infundibulum

Ampulla

Isthmus

Intramural

Uterine artery

Ovarian artery

pubovaginalis muscle

urogenital diaphragm

bulbospongiosus muscle

-vaginal artery which may arise from uterine or internal iliac

-internal pudendal artery

-vaginal branch of middle rectal artery

Vaginal venous plexus drains into internal iliac vein and communicates with:

Vesical venous plexus

Uterine venous plexus

Rectal venous plexus

cystocele

rectocele

two external pudendal arteries

two internal pudendal arteries

-Ilioinguinal nerve

-Genital branch of genitofemoral nerve

-Perineal branch of the femoral cutaneous nerve

-Perineal branch of pudendal nerve

-increase secretions from paraurethral glands

-greater vestibular glands

-erection of clitoris

-enlargement of bulbs of vestibule

-inferior three sacral vertebrae

-coccyx

-anococcygeal ligament

-Median sacral vessels

-Branches of the superior rectal artery

-Inferior ends of sympathetic trunks

-Sacral plexus

-Superior rectal artery

-two middle rectal

-Inferior rectal artery

-Small branch posteriorly from median sacral artery

-Superior rectal vein

-Middle rectal vein

-Inferior rectal vein

Internal iliac

External iliac

Branches of uterine arteries in female

Inferior vesical arteries in male

-pubic bones

-obturator internus

-levator ani muscles

-rectum

-Mucous membrane

-Muscular layer (detrusor)

-Outer connective tissue

Superior vesical arteries (anterosuperior part)

Inferior vesical/vaginal a. (posterinferior part)

Branches of obturator arteries

Branches from inferior gluteal arteries

base of bladder

prostate

seminal vesicles

ductus deferentes

inferior end of ureters

neck of bladder

pelvic part of urethra

dorsal vein of clitoris

communicates with vaginal plexus