TH E PE LV I S & PE R IN EU M
T ABLE OF C ONTENTS
Muscles of the Pelvic Cavity .................................................................................. 2
Walls of the Pelvis.................................................................................................... 3
Sacral Plexus ............................................................................................................. 4
Coccygeal Plexus ...................................................................................................... 6
Sympathetic Trunks ................................................................................................. 6
Parietal Branches of the Internal Iliac Artery ...................................................... 7
General Anatomy ..................................................................................................... 9
Peritoneal Relations ................................................................................................. 9
Relations of the Rectum ....................................................................................... 10
Arterial Supply to the Rectum ............................................................................. 10
Venous Drainage from the Rectum .................................................................... 11
Innervation of the Rectum ................................................................................... 11
Lymphatic Drainage of the Rectum.................................................................... 11
General Anatomy of the Bladder ........................................................................ 12
The Bladder Bed .................................................................................................... 13
Structure of the Bladder ........................................................................................ 14
Arterial Supply to the Bladder ............................................................................. 14
Venous Drainage from the Bladder .................................................................... 14
Innervation of the Bladder ................................................................................... 15
Lymphatic Drainage of the BLadder .................................................................. 15
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Ureters ..................................................................................................................... 15
Urethra ..................................................................................................................... 16
Vas Deferens........................................................................................................... 18
Seminal Vesicles ..................................................................................................... 18
Ejaculatory Ducts................................................................................................... 19
Prostate Gland ........................................................................................................ 19
Arterial Supply to the Prostate ............................................................................. 20
Venous Drainaige from the Prostate .................................................................. 20
Innervation of the Prostate .................................................................................. 20
Lymphatic Drainage of the Prostate ................................................................... 20
General Anatomy of the Anal Canal................................................................... 21
Arterial Supply to the Anal Canal ........................................................................ 22
Venous Drainage from the Anal Canal .............................................................. 22
Innervation of the Anal Canal ............................................................................. 22
Lymphatic Drainage of the Anal Canal .............................................................. 22
External Anal Sphincter ........................................................................................ 23
Internal Anal Sphincter ......................................................................................... 23
Internal Pudendal Artery ...................................................................................... 23
Pudendal Nerve ...................................................................................................... 23
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 T HE P ELVI C C AVIT Y

M U S C L E S OF T H E P E LV I C C AV I T Y

NAME. ORIGIN. INSERTION INNERVATION ACTION

1. Pelvic surfaces of Ileum and
Obturator Internus Ischium
2. Obturator membrane
1. Pelvic surface of 2nd to 4th
Sacral segments
Piriformis 2. Superior margin of Greater
Sciatic Notch
3. Sacrotuberous Ligament
1. Pubic Symphysis
Puborectalis
2. Superior Pubic Ramus
1. Superior Pubic Ramus
Pubococcygeus 2. Fascia of Obturator
Internus
Levator Ani
Passes through the Lesser Sciatic
Foramen to the Greater
Trochanter of Femur
Greater Trochanter of Femur
1. Pass posteriorly to unite
with its partner
2. Perineal Body
(Pubovaginalis)
1. Unite with its partner to
form a raphé behind the
Anorectal junction
2. Anococcygeal Body
1. Lateral rotation of thigh
Nerve to Obturator Internus
2. Assists holding head of
(L5, S1, S2)
Femur in the Acetabulum
1. Lateral rotation of thigh
2. Abduction of thigh
Ventral Rami of S1 & S2
3. Assists holding head of
Femur in the Acetabulum
1. Supports pelvic viscera
2. Resists inferior thrust of
increased abdominal
pressure
3. Raises pelvic floor
4. Support prostate or
Perineal branches of the S3 & S4
posterior wall of the vagina
nerves (enter the muscle’s pelvic
5. Raises the anal canal over a
surface)
descending mass of faeces,

1. Tendinous arch of and increases anorectal

Obturator Internus 1. Coccyx
Iliococcygeus angle  supports weight of
2. Pelvic aspect of Ischial 2. Anococcygeal Body
faeces and relieves external
Spine
anal sphincter
1. Assist Levator Ani in
1. Pelvic surface of Ischial
1. Lateral margin of Coccyx supporting pelvic viscera
Coccygeus Spine Branches of S4 & S5 nerves
2. S5 vertebra 2. Pull coccyx anteriorly 
2. Sacrospinous Ligament
elevate pelvic floor

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 WA L L S OF T H E P E LV I S

ANTERIOR WALL PELVIC FLOOR

 Pubic Symphysis  Funnel shaped Pelvic Diaphragm, composed of:

 Bodies of Pubic Bones + Superior and Inferior Rami
 Terminate laterally in the bodies and rami of the Ischium.
 Obturator Internus muscle, and its overlying fascia
LATERAL WALLS
 Obturator Internus covers most of these walls.
 Medial to this, are the Obturator nerves and vessels, and other
branches of the Internal Iliac Artery.
 Pelvic Fascia, near the pelvic brim
POSTERIOR WALL
 Sacrum
 Adjacent parts of the Ilium bones
 Sacro-iliac joints + associated ligaments
 Piriformis muscles line the lateral portion of the posterior wall.
 Medial to the piriformis, lie the sacral plexus and internal iliac vessels
 forms a muscular bed for the sacral plexus.
 2 Levator Ani muscles
 2 Coccygeus muscles – lying directly on the posterior border of the
Levator Ani muscles  continuous sheet of muscle.
 Pelvic Diaphragm closes the Pelvic Outlet, except for an anterior
deficiency:
 Bounded by the anterior margin of the Puborectalis fibres of Levator
Ani
 Filled with loose fascia around the Prostate Gland (male), or Vagina
(female).
 The Urogenital Diaphragm and its superior fascia close anterior
deficiency.
 Pelvic Diaphragm separates the pelvic cavity from the perineum.
 There are a number of midline structures associated with the Pelvic
Diaphragm:
 The rectum lies directly against the anterior aspect of the sacrum.
 At the level of the Pelvic Diaphragm, is the Anorectal Junction.
 Behind the anorectal junction, lies the Anococcygeal Body.
 Fibrous tissue in front of the anorectal junction, forms the Perineal
Body.

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 I NNERVATION AND B LOODY S UPPLY OF THE P ELVIC C AVITY

SACRAL PLEXUS

 Ventral 1º Ramus of L4 – runs laterally into Psoas Major, from which it  Branches of Ventral 1º Rami of S2 & S3, turn medially, and lie on the
sends a descending branch. anterior aspect of the sacrum.
 Ventral 1º Ramus of L5 – arises from behind the Lumbosacral  Form the Pelvic Splanchnic Nerves.
Intervertebral Disc.  Cell bodies lie within Lateral Horns of Grey Matter of Spinal Cord.
 Turns forwards and inferiorly.  Compose the Sacral part of the Cranio-Sacral Parasympathetic
 Lies in a small triangular recess: Outflow.
 Lateral boundary = Psoas Major  Ventral 1º Ramus of S4.
 Medial boundary = the Lumbosacral Intervertebral Disc  Emerges through the lowest Sacral Foramen, and enters the Pelvic
 Inferior boundary = Ala of Sacrum. Cavity.
 Passes down, anterior to the Ala of the Sacrum, and joined by the  Lies on the surface of Coccygeus muscle.
descending branch of the Ventral 1º Ramus of L4.  Ascending branch – joins the Sacral Plexus and eventually its fibres
 This forms the Lumbosacral Trunk. form the Pudendal Nerve.
 Lumbosacral Trunk lies anterior to the Sacroiliac joint, but behind the  Descending branch – turns inferiorly to join the Coccygeal Plexus.
Common Iliac Vessels.
 Runs down and across the anterior aspect of Piriformis.
 Passes through the lower part of the Greater Sciatic Foramen.
 Enters the tissue of the buttock.
 Ventral 1º Rami of S1, S2 (½ inch diameter) & S3 (a little smaller).
 Emerge through corresponding Sacral Foramina, and enter the
Pelvic Cavity.
 All lie on Piriformis (a muscular bed for the Sacral Plexus).
 Head to the lower border of the Greater Sciatic Foramen.
 As they pass through, they join together to form the Sacral
Plexus.
 Recombine to form efferent branches that emerge through the
foramen, and enter the tissue of the buttock.

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SCIATIC NERVE BRANCHES TO PIRIFORMIS (S1, S2)

 Nerve to the lower limb, with a root value of L4-S3. BRANCHES TO LEVATOR ANI AND COCCYGEUS (S3-S5)
 Largest nerve of the body (≈ 2 cm wide).
NERVE TO QUADRATUS FEMORIS (L4-S1)
 Passes through Greater Sciatic Foramen, inferior to Piriformis, to enter
the Gluteal region. NERVE TO OBTURATOR INTERNUS (L5-S2)

PUDENDAL NERVE
OBTURATOR NERVE
 Root value of S2-S4.
 Accompanies the Internal Pudendal Artery.  Arises from the Lumbar Plexus in the Abdomen.
 Leaves the pelvis through the Greater Sciatic Foramen, between  Enters the Pelvis Minor, and runs along the lateral wall of the Pelvis, in
Piriformis and Coccygeus muscles. the extra-peritoneal fat.
 Hooks around the Sacrospinous Ligament, and enters the perineum  Reaches the Obturator Foramen, where it divides into anterior and
through the Lesser Sciatic Foramen. posterior parts.
 Supplies the External Anal Sphincter, and other muscles of the  Leaves through the Obturator Canal, and supplies the Adductor muscles
perineum. of the thigh.
 Sensory supply to the external genitalia.
 Terminates as the Dorsal Nerve of the Penis/Clitoris.

SUPERIOR GLUTEAL NERVE

 Leaves through the Greater Sciatic Foramen, above Piriformis.

 Supplies Gluteus Medius, Gluteus Minimus, and the Tensor Fascia Latae
muscles.

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 C O C C YG E A L P L E X U S S Y M PA T H E T I C T RU N K S

 Formed by the:
 Descending branch of the Ventral 1º Ramus of L4
 Pass onto pelvic aspect of Coccygeus muscle.
 Ventral 1º Ramus of L5
 Coccygeal Spinal Nerves.
 Emerge from fibrous posterior wall of Sacral Canal.
 Turn forward to enter the Pelvic Cavity, by piercing Coccygeus
muscle.
 On the pelvic aspect of Coccygeus, these nerves are joined simply by 2
nerve loops  Coccygeal Plexus.
 Efferent branches supply part of Coccygeus.
 Efferent Cutaneous branches pass back through Coccygeus, and supply
an area of perineal skin just over the Coccyx.
 Tucked in behind the Abdominal Aorta and the Inferior Vena Cava.
 Lie on the posterior abdominal wall.
 Passing caudally, they run behind the Common Iliac Vessels  lie on the
anterior aspect of the Sacrum.
 Sympathetic Trunks lie just medial to the Anterior Sacral Foramina.
 On reaching the anterior aspect of the Coccyx, they terminate.
 Unite to form a single terminal ganglion = Ganglion Impar.
 White Rami Communicantes restricted to the Thoracolumbar
Sympathetic Outflow (T1-L2)
 Grey Rami Communicantes connect to Ventral 1º Rami of
corresponding spinal nerves.
 Convey post-ganglionic sympathetic fibres to all the branches of the
Sacral and Coccygeal Plexuses.
 Distribute to Sweat Glands, Hair Follicles, and Blood Vessels.
 Some branches of the segmental ganglia, turn medially, to form the:
 Autonomic Plexus – sends visceral branches.
 Left & Right Inferior Hypogastric Plexuses – innervate the pelvic
viscera.

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 PA R I E TA L B R A N C H E S OF T H E I N T E R NA L I L I A C A RT E RY

 The common iliac artery divides, anterior to the Sacro-Iliac Joints, at the level of the Lumbosacral Intervertebral Disc.
 The Internal Iliac artery is 2.5 cm long.
 It turns over the Pelvic Brim
 Goes to the upper border of the Greater Sciatic Foramen.
 There it breaks up into a sheaf of Parietal and Visceral branches.

OBTURATOR ARTERY INTERNAL PUDENDAL ARTERY

 Arises close to where the umbilical artery arises (obliterated to form the  Passes infero-laterally, over Piriformis muscle and the ventral 1º rami of
medial umbilical ligaments, which form medial umbilical folds in the the sacral plexus.
peritoneum).  Passes between Piriformis and Coccygeus, to the inferior part of Greater
 Runs antero-inferiorly on the obturator fascia, on the lateral wall of the Sciatic Foramen.
pelvis.  Hooks around the Sacrospinous Ligament.
 Runs between the obturator nerve and vein.  Enters the perineum via the Lesser Sciatic Foramen.
 Leaves through the Obturator Canal.  Pass through the Pudendal Canal, in the lateral wall of the Ischioanal
 Supplies muscles of the medial compartment of the thigh. Fossa.
 Within the pelvis, it gives off muscular branches, and nutrient branches  Just prior to the Pubic Symphysis, it divides into its terminal branches.
to the Ilium and Pubis.  Deep arteries of the penis/clitoris.
 The Obturator Artery may abnormally arise from the Inferior Epigastric  Dorsal arteries of the penis/clitoris.
Artery (a branch of the External Iliac artery).
 In this case, it simply turns inferiorly over the pelvic brim, and goes
straight to the Obturator Canal.

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INFERIOR GLUTEAL ARTERY LATERAL SACRAL ARTERIES

 Runs over the ventral 1º rami of the sacral plexus.
 Passes posteriorly between S2 & S3 ventral 1º rami.
 Leaves pelvis through the Greater Sciatic Foramen, inferior to Piriformis.
 Supplies skin and muscles of the buttock and posterior thigh.
SUPERIOR GLUTEAL ARTERY
 Large artery; passes posteriorly between Lumbosacral Trunk and the
Ventral 1º Ramus of S1.
 Leaves the pelvis through the superior part of the Greater Sciatic
Foramen, above Piriformis.
 Supplies the Gluteal muscles of the buttock.
 Superior and inferior vessels on each side.
 Arise from the posterior aspect of the Internal Iliac artery.
 Descend, anterior to the Ventral 1º Rami of the Sacral Nerves.
 Superior – disappears through the 1st ventral foramen.
 Inferior – passes through the 2nd ventral foramen, sending branches to
the 3rd & 4th ventral foramina.
 Enter the sacral canal, and supply the Spinal Meninges, and the Roots of
the Sacral Nerves.
 Some branches of these pass from the sacral canal, through the dorsal
sacral foramina.
 Supply the muscles and skin overlying the dorsum of the sacrum.

ILIOLUMBAR ARTERY

 Arises from the posterior aspect of the Internal Iliac Artery

 Runs supero-laterally to the Iliac Fossa.
 Passes anterior to the Sacroiliac Joint, and posterior to the Psoas Major
muscle.
 Separating the Obturator Nerve from the Lumbosacral Trunk.
 Within the iliac fossa, it divides:
 Iliac branch – supplies Iliacus muscle, and the Ilium.
 Lumbar branch – supplies Psoas Major and Quadratus Lumborum
muscles.

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 T HE R ECTUM

G E N E R A L A NA TOM Y P E R I TON E A L R E L A T I O N S

 Fixed terminal part of the large intestine, continuous superiorly with the  Superior 1/3 – peritoneum covers the anterior and lateral surfaces.
Sigmoid Colon.  Lateral reflections of peritoneum form Para-Rectal Fossae on each
 Begins anterior to S3, and is 12-15 cm long. side.
 Terminates 3-4 cm antero-inferior to the tip of the coccyx.  Permit the rectum to distend as it fills with faeces.
 At the anorectal junction, there is a sharp angle maintained by the  Middle 1/3 – peritoneum covers only the anterior surface of the rectum.
Puborectalis fibres of Levator Ani.  Inferior 1/3 – has no peritoneal coverings.
 These fibres draw the anorectal junction anteriorly, to increase
the angle. MALE
 Prevents faeces from entering the anal canal and relieves the
pressure on the External Anal Sphincter.  Peritoneum is reflected from the anterior surface of the middle 1/3 of the
 The terminal part of the rectum has a dilation = Rectal Ampulla. rectum to the posterior wall of the bladder.
 Distensible  stores faeces, just before it is expelled during  Forms the floor of the Rectovesical Pouch.
defecation.  In male children, the peritoneum will extend down as far as the base of
 This inferior portion of the rectum lies just posterior to the Prostate the prostate, since the bladder has not yet descended from the abdomen.
Gland (male), or the Vagina (female).
FEMALE
 The termination of the rectum at the anorectal junction lies posterior to
the Perineal Body in both sexes.  The peritoneum is reflected from the anterior surface of the middle 1/3
 The rectum has 3 sharp flexures as it follows the sacrococcygeal curve  of the rectum to the Posterior Fornix of the Vagina.
within the coronal plane, it is “S”-shaped.  Forms the floor of the Recto-uterine Pouch (of Douglas).
 It first bends to the right, then to the left, and then to the right as it
returns to the midline at the anorectal junction.
 These flexures throw up folds of the mucous, submucous, and
circular muscle coats, at the concavities of the rectum.
 These Transverse Rectal Folds partly occlude the lumen of the
rectum, and are maintained by prolongations of the Taeniae Coli.
 Transverse Rectal Folds form a series of shelves within the rectal
lumen, which will support a column of faeces.

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 RELATIONS OF THE REC TUM A RT E R I A L S U P P LY TO T H E R E C T U M

ANTERIOR  Superior Rectal artery – continuation of the Inferior Mesenteric artery.

 Supplies the terminal part of the sigmoid colon, and the superior part
Male of the rectum.
 At the level of S3, behind the origin of the rectum, it divides into 2:
 Fundus of the Urinary Bladder.  These right and left branches cross the Left Common Iliac
 Rectovesical Septum – 2 layers of peritoneum in the median plane, Vessels
separating the rectum from the urinary bladder.  Descend into Pelvis Minor, via the Sigmoid Mesocolon.
 Terminal parts of the Ureters  Descend along each side of the rectum.
 Vasa Deferentes  Middle Rectal arteries – branches of the Internal Iliac arteries.
 Seminal Vesicles  Supply the middle and inferior parts of the rectum.
 Prostate Gland  Inferior Rectal arteries – branches of the Internal Pudendal artery (a parietal
branch of the Internal Iliac).
Female  Supply the inferior part of the rectum.
 Originate in the Ischioanal Fossae.
 Vagina  Small branches of the Median Sacral Artery supply the rectum posteriorly.
 Recto-uterine Pouch – separates posterior fornix of vagina and the
cervix, from the rectum.
 (Weak) Recto-uterine Septum – separates the vagina and rectum.

POSTERIOR

 Inferior 3 Sacral Vertebrae (S2-S5) + loosely attached fascial sheath.

 Coccyx
 Anococcygeal Body
 Median Sacral Vessels (terminal continuation of the abdominal aorta).
 Branches of the Superior Rectal Artery
 Inferior ends of the Sympathetic Trunks & Sacral Plexuses.

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 V E N O U S D R A I NA G E F R OM T H E R E C T U M I N N E RVA T I ON O F T H E R E C T U M

 Drained by the Superior Rectal Vein  Inferior Mesenteric Vein.
 Middle and Inferior Rectal Veins  Internal Iliac Vein.
 Rectal Venous Plexus:
 Internal Rectal Venous Plexus – just deep to the epithelium of the
rectum.
 Drains to the Superior Rectal Vein
 Communicates freely with the External Rectal Venous Plexus.
 External Rectal Venous Plexus – lies outside the muscle coats of the
rectum.
 Superior part drains to the Superior Rectal Vein too.
 Middle part drains to the Middle Rectal Vein.
 Inferior part drains to the Internal Pudendal Vein.
 Middle Rectal Plexus is derived from the Inferior Hypogastric Plexus (a
sympathetic ganglion)
 4-8 nerves pass directly to the rectum – sympathetic,
parasympathetic and sensory supply.
 Parasympathetic supply is derived from S2-S4.
 Join the Inferior Hypogastric Plexus, via the Pelvic Splanchnic
Nerves.
 Sensory fibres follow the path of the Pelvic Splanchnic Nerves, and
respond to distension of the rectum.

LY M P H A T I C D R A I NA G E O F T H E R E C T U M

 Superior ½ - Superior Rectal vessels  Para-rectal Lymph Nodes  Inferior Mesenteric Lymph Nodes  Aortic Lymph Nodes.
 Inferior ½ - lymph vessels pass superiorly with the middle rectal arteries  Internal Iliac Lymph Nodes.

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 U RINARY O RGANS

G E N E R A L A NA TOM Y O F T H E B L A D D E R

 Hollow muscular vesicle, for storing urine (up to 500 ml).  Apex – the anterior end of the bladder, points anteriorly to the superior
 Infants – the bladder lies in the abdomen, even when empty. edge of the pubic symphysis.
 Enters the Pelvis Major at the age of 6.  Infero-lateral Surfaces – direct relations with the fascia over Levator Ani
 Not entirely within the Pelvis Major, until puberty. and Obturator Internus.
 Adult – when empty, it lies almost entirely within the Pelvis Minor,  Converges posteriorly with Fundus, to form the Neck of the
posterior and slightly superior to the pubic bones. Bladder.
 Separated from the pubic bones by the Retro-pubic Space.  This is where the lumen of the bladder opens into the prostatic
 As it fills with urine, it distends into the Pelvis Major, and even up to urethra of the male.
the level of the Umbilicus.  In the male, the Neck of the Bladder rests on the Prostate Gland.
 Its shape, size and position vary with the amount of urine it contains, and  Lie just anterior to the Perineal Body.
with age.  From the neck of the bladder, the Median Umbilical Fold of peritoneum
 The mucous membrane of the bladder is loosely attached to its muscular passes superiorly to the Umbilicus.
walls.  This fold is raised by the Median Umbilical Ligament, that is the
 Therefore thrown into numerous Rugae (folds). remnant of the embryonic Urachus.
 Except for a small triangular area on the Fundus (base) of the
Bladder = Trigone.
 Here the mucous membrane is smooth and firmly bound down
to the muscular wall.
 From its lower end, the urethra leaves the bladder at the Internal
Urethral Orifice.
 Posterior to this is a small elevation = Uvula Vesicae.
 The middle lobe of the Prostate Gland produces it.
 The cadaveric, empty bladder has 4 surfaces: superior surface, 2 antero-
inferior surfaces (that face anteriorly), and a Fundus (posterior surface).
 Fundus – closely related to the anterior wall of the vagina (female), and
rectum (male).

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MALE
 The peritoneum is reflected from the middle 3 of the rectum, onto the
1/
superior surface of the bladder.
 From the bladder it is then reflected onto the superior surfaces of
the Vasa Deferentes and Seminal Vesicles.
 The neck of the bladder is firmly fixes by Medial and Lateral
Puboprostatic Ligaments, on each side of the midline.
 The rest of the bladder is relatively free, within loose extra-peritoneal
fatty tissue.
 As the bladder fills, it can easily expand superiorly into the extra-
peritoneal fatty tissue of the anterior abdominal wall
 This movement, thus strips the peritoneum from the Transversalis
Fascia of the abdominal wall.
FEMALE
 The peritoneum is reflected from the bladder near its posterior border,
onto the anterior wall of the uterus.
 At the junction of its body, and cervix.
 The vesico-uterine pouch extends between the bladder and the uterus.
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THE BLADDER BED
 Shape of the bladder is largely determined by the structures related to it.
 Bladder is enveloped by loose connective tissue = Vesical Fascia.
 Within which is the Vesical Venous Plexus
 The bladder bed is formed by the Pubic Bones, the Levator Ani muscles,
and the Obturator Internus muscles.
 Posteriorly formed by the rectum.
 Female – fundus of the bladder is separated from the rectum, by the
cervix and superior part of the vagina.
 The neck of the bladder lies directly on the pelvic fascia, surrounding
the short urethra.
 Male – fundus of the bladder is separated from the rectum, by the
ampullae of the Vasa Deferentes and Seminal Vesicles.
 Its neck fuses with the Prostate Gland.
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 S T RU C T U R E O F T H E B L A D D E R
 Wall of the bladder composed mainly of smooth muscle = Detrusor
Muscle.
 External & Internal longitudinal layers
 Intermediate Circular layer.
 Towards the neck of the bladder, the circular fibres form the involuntary
Internal Sphincter Vesicae.
 Male – the muscle fibres from the neck of the bladder are
continuous with the connective tissue stroma of the prostate.
 Female – muscle fibres of the neck of the bladder are continuous
with those in the wall of the urethra.
 Mucous membrane of the bladder is lined with transitional epithelium 
can be stretched.
 The Ureteric Orifices are located at the lateral angles of the Trigone.
 Ureters pass infero-medially through the bladder wall, to prevent
urine back-flow.
 Increased intra-vesical pressure will press the walls of the ureters
together.
 Urine cannot pass retrogradely and damage the kidneys.
 Internal Urethral Orifice is at the inferior angle of the Trigone.
 The small slit-like Ureteric Orifices are connected by a narrow Inter-
ureteric Ridge – forms the superior margin of the Trigone.
 Caused by the continuation of the internal longitudinal coat of the
right ureter meeting that of the left ureter.
 The terminal portions of the ureter as they travel obliquely through the
fundus wall.
 Cause a depression, lateral to each Ureteric Orifice = Ureteric Folds.
C REATED BY M ICHAEL C HEERAN D AVID
A RT E R I A L S U P P LY TO T H E B L A D D E R
 Superior Vesical arteries – branches of the Umbilical arteries (= branches
of the Internal Iliac arteries).
 Supply the antero-superior parts of the bladder.
 Males – the Inferior Vesical arteries (branches of the Internal Iliac
arteries), supply the Fundus of the Bladder.
 Females – the Vaginal Arteries replace the Inferior Vesical arteries, and
supply the postero-inferior parts of the bladder.
 Obturator and Inferior Gluteal arteries also send branches to the bladder.
V E N OU S D R A I NA G E F R OM T H E B L A D D E R
 Correspond to the arteries, and are tributaries of the Internal Iliac Vein.
 Males – the Vesical and Prostatic Venous Plexuses envelop the base of
the bladder, the prostate, the seminal vesicles, vasa deferentes, and the
terminal parts of the Ureters.
 Male Vesical Venous Plexus  Inferior Vesical Veins  Internal
Iliac Veins.
 Females – the Vesical Venous Plexus envelops the pelvic part of the
urethra, and the neck of the bladder.
 The Female Vesical receives blood from the Dorsal Vein of the
Clitoris, communicates with the Vaginal Venous Plexus.
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 I N N E RVA T I O N O F T H E B L A D D E R
 Pelvic Splanchnic Nerves (S2-S4) – provide parasympathetic fibres.
 Motor to the Detrusor muscles.
 Inhibitory to the Internal Vesical Sphincter.
 Stimulated by stretch.
 Cause the bladder to contract, and the sphincter to relax.
 Urine flows into the urethra.
 Sympathetic fibres are derived from T11-L2.
 Inhibitory to the Detrusor muscles.
 Constrict the sphincter.
 Innervation of the bladder is from the Vesical Nerve Plexus.
 Sympathetic, parasympathetic, and sensory.
 Sensory fibres are visceral, and transmit pain.
 Continuous with the Inferior Hypogastric Plexus.
LY M P H A T I C D R A I NA G E O F T H E B L A D D E R
 Superior part of bladder  External Iliac Lymph Nodes.
 Inferior part of bladder  Internal Iliac Lymph Nodes.
 Neck region  Common Iliac Lymph Nodes.
C REATED BY M ICHAEL C HEERAN D AVID
URETERS
 Thick-walled, expandable muscular ducts, with narrow lumina.
 Each is continuous superiorly with the funnel-shaped Renal Pelvis.
 Emerges through the Hilum, and descends the medial margin of the
Kidney to the inferior pole – here begins the Ureter Proper.
 The abdominal part of each ureter is 12.5 cm long, and 5 mm wide.
 Adheres closely to the parietal peritoneum, lying retro-peritoneally.
 Descends vertically, anterior to Psoas Major Muscle.
 Both ureters cross the pelvic brim, and the External Iliac Artery – just
beyond the bifurcation of the Common Iliac Artery.
 The pelvic parts of the ureters run postero-inferiorly on the lateral wall of
the pelvis.
 Run external to the parietal peritoneum, and anterior to the Internal
Iliac Arteries.
 Continue to a point about 1.5 cm superior to the Ischial Spines.
 Then curves antero-medially, above the Levator Ani muscle,
adhering closely to the peritoneum.
 Male – Vas Deferens passes between the Ureter and the Peritoneum.
 The ureter lies lateral to the Vas, and enters the postero-superior
angle of the Bladder, just superior to the Seminal Vesicles.
 Females – ureter descends on the lateral wall of the Pelvis Minor
(forming the posterior boundary of the Ovarian Fossa).
 Passes medial to the origin of the Uterine Artery.
 Continues to descend to the level of the Ischial Spine – here it is
crosses superiorly by the Uterine Artery.
 Passes close to the lateral fornix of the Vagina, as it passes down the
posterior fixed margin of the Broad Ligament
 Runs horizontally forward, to enter the postero-superior angle of the
Bladder.
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 URETHRA

MALE URETHRA Membranous Urethra

 Long muscular tube – 15-20 cm long.  Lies in the Deep Perineal Space, which is enclosed by the superior and
 Conveys urine from the bladder to the exterior, via the External Urethral inferior fascial layers of the Urogenital Diaphragm.
Orifice at the tip of the Glans Penis.
 Also provides a route of exit for semen. Spongy Urethra
Prostatic Urethra  Longest part of the male urethra (15-16 cm long).
 Passes through the Bulb of the Penis, and the Corpus Spongiosum.
 3 cm long, beginning at the Internal Urethral Orifice, at the apex of the  Ends at the External Urethral Orifice – the narrowest part of the urethra.
Trigone of the Bladder.  The lumen of the spongy urethra is ≈ 5mm in diameter.
 Descends through the Prostate Gland, with a gentle anterior concavity.  Expanded in the Bulb of the Penis, to form the Intrabulbar Fossa.
 Terminates by piercing the Superior Fascia of the Urogenital Diaphragm.  Also expanded in the Glans Penis, to form the Navicular Fossa.
 Its lumen is narrower superiorly and inferiorly, than in the middle.  Slender ducts of the Bulbourethral Glands open into the proximal part of
 The prostatic urethra is the widest and most dilatable part of the entire the Spongy Urethra.
urethra, even though it is within the substance of the Prostate Gland.  About 3 cm distal to the Perineal Membrane.
 Urethral Crest – median longitudinal ridge on the external aspect of its  On the dorsal surface of the Spongy Urethra, there are minute openings
posterior wall. of the mucous-secreting Urethral Glands.
 This has a groove on each side = Prostatic Sinuses.
 Into which open up most of the Prostatic Ductules.
 Others open up into the sides of the Urethral Crest.
 In the middle part of the Urethral Crest, is a rounded eminence =
Seminal Colliculus.
 On which is a slit-like orifice, that leads to a vestigial cul-de-sac (≈ 5
mm long).
 This is the Prostatic Utricle – on each side of its orifice, are the slit-
like apertures of the Ejaculatory Ducts.

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FEMALE URETHRA

 Short muscular tube (≈ 4 cm long), lined by mucous membrane.

 Superior ½ corresponds to the male prostatic urethra.
 Inferior ½ is homologous with the male membranous urethra.
 Female Urethra passes antero-inferiorly from the urinary bladder.
 Posterior and inferior to the Pubic Symphysis.
 The urethra lies anterior to the vagina.
 Inferiorly, it is so closely related to the vagina, that it appears
embedded in it.
 Together they pass through the Pelvic & Urogenital Diaphragms,
and the Perineal Membrane.
 External Urethral Orifice is located within the Vestibule of the Vagina.
 2-3 cm posterior to the Clitoris, but immediately anterior to the
Vagina.
 Surrounded by the Sphincter Urethrae muscle.
 Para-urethral Glands (homologous with the Prostate), open into the
urethra, via a duct on each side, near the external urethral orifice.

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 M ALE P ELVI C V ISCERA

VA S D E F E R E N S SEMINAL VESICLES

 Thick walled, muscular tube, ≈45 cm long.
 A continuation of the Duct of the Epididymus.
 Begins in the tail of the Epididymus.
 Terminates by joining the duct of the Seminal Vesicle, to form the
Ejaculatory Duct.
 Ascends in the Spermatic Cord.
 Passes through the Inguinal Canal.
 Crosses over the external iliac vessels.
 Enters the Pelvis Minor.
 Passes across the lateral wall of the pelvis.
 Lies external to (but adherent to) the Parietal Peritoneum.
 Lies medial to the vessels and nerves there.
 No other structure intervenes between it and the peritoneum.
 Near the postero-lateral angle of the bladder, it meets the Ureter, as it
descends towards the Bladder.
 It crosses the ureter, and then turns inferiorly.
 Runs down between the ureter and peritoneum, until it reaches the
Fundus of the Bladder.
 The Vas Deferens now enlarges to form the Ampulla of the Vas, as it
passes posterior to the bladder.
 Its wall becomes thinner, and its lumen widens.
 The 2 Ampullae of the Vasa gradually approach each other, as they
descend.
 The Ampullae of the Vasa descend medial to the Seminal Vesicle.
 Finally, they narrow as they unite with the ducts of the Seminal Vesicles,
to form the Ejaculatory Ducts.
 Thin-walled, pear-shaped structure, about 5 cm long.
 Actually consists of a coiled tube that is 10-15 cm long.
 Honeycombed mucous membrane.
 Each extends supero-laterally from the Ampulla of the Vas, above the
Prostate.
 Do not store sperm.
 Secrete a thick alkaline fluid, which mixes with the sperm in the
Ejaculatory Ducts.
 Provide 70% of the ejaculate volume, and is expelled during orgasm, as
the seminal vesicles contract.
 The superior end of each Seminal Vesicle, is covered with peritoneum.
 Lies posterior to the Ureter.
 Separated from the Rectum, by the peritoneum of the Rectovesical
Pouch.
 The inferior end of each Seminal Vesicle, is more closely related to the
Rectum.
 Only separated by the Rectovesical Septum.
 The duct of the each Seminal Vesicle joins the Ampulla of each Vas
Deferens, to form the Ejaculatory Duct.

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 E JA C U L A TO RY D U C T S P RO S TA T E G L A N D

 Each is a slender tube formed by the union of the ducts of the Seminal
Vesicle and Vas Deferens.
 Posterior to the neck of the urinary bladder.
 About 2.5 cm long.
 Run close together, antero-inferiorly, through the posterior part of the
Prostate Gland (in the median plane).
 Now run along the sides of the Prostatic Utricle, traversing the
substance of the Prostate Gland.
 Converge to open into the Seminal Colliculus of the posterior wall of
the Prostatic Urethra.
 They do so via 2 slit-like apertures, on each side of the Orifice
for the Prostatic Utricle.
 Largest gland of the male reproductive system – partly glandular and
partly fibromuscular.
 The size of a walnut.
 Surrounds the Prostatic Urethra.
 Enveloped in a thin, dense fibrous capsule (true capsule).
 This is then enveloped in a loose Prostatic Sheath (false capsule), derived
from pelvic fascia.
 Continuous inferiorly with the superior fascia of the Urogenital
Diaphragm.
 Posteriorly forms part of the Rectovesical Septum.
 Separates the bladder, prostate, and seminal vesicles from the
rectum.
 The prostatic venous plexus lies beneath the fibrous capsule and
prostatic sheath – within the pelvic fascia.

BASE

 Closely related to the neck of the urinary bladder.

 The prostatic urethra enters the middle of the base, near its anterior
border.

APEX

 Directed inferiorly, and closely related with the superior fascia of the
Urogenital Diaphragm.
 Apex rests on the Sphincter Urethrae muscle.
 Embraced by the antero-medial free margin of the Levator Ani muscle.

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INFEROLATERAL SURFACES  Prostatic Secretion – thin milky fluid.
 Expelled into prostatic urethra by contraction of smooth muscle in
 Meet the sides of the convex anterior surface. the Prostate.
 Rest on the fascia covering Levator Ani muscles.  Provides 20% of the volume of the ejaculate.
POSTERIOR SURFACE
A RT E R I A L S U P P LY TO T H E P R O S TA T E
 Triangular – facing posteriorly, and slightly inferiorly.
 Lies directly on the anterior wall of the Ampulla of the Rectum.
 Palpable via a rectal examination.  Inferior Vesical Artery
 Shallow median groove, demarcating the Lateral Lobes.  Middle Rectal Artery – both branches of the Internal Iliac Artery.
 Often fused  referred to as a single posterior lobe.
 Superiorly, there are another shallow grooves, where the ejaculatory V E N OU S D R A I NA I G E F RO M T H E P R O S TA T E
ducts pierce the Prostate.
 Indicates the Middle Lobe – the section of the Prostate between the
 The veins of the Prostate form the Prostatic Venous Plexus, around its
Ejaculatory Ducts and the Prostatic Urethra.
sides and base.
 Middle Lobe lies posterior to the lower end of the bladder,
 Located between the fibrous capsule and the fascial sheath.
producing the Uvula Vesicae.
 Communicates with the Vesical and Vertebral Venous Plexuses.
 Middle Lobe is superiorly in contact with the inferior portion of the
Trigone of the Bladder.  Drains to the Internal Iliac Vein.
 The Prostatic Utricle is located within the Middle Lobe.
I N N E RVA T I ON O F T H E P RO S TA T E
ANTERIOR SURFACE

 Transversely narrow and convex.  Parasympathetic supply – Pelvic Splanchnic Nerves (S2-S4).
 Extends from the apex to the base.  Sympathetic supply – Inferior Hypogastric Plexus.
 Prostatic Ductules (20-30) open chiefly into the prostatic sinuses, on
each side of the Urethral Crest on the posterior surface of the Prostatic LY M P H A T I C D R A I NA G E O F T H E P R OS TA T E
Urethra.
 Because most of the glandular tissue lies postero-lateral to the
prostatic urethra.  Lymph vessels terminate chiefly in the Internal Iliac & Sacral Lymph
Nodes.
 Some vessels from the posterior surface of the Prostate, pass with the
lymph vessels of the bladder to the External Iliac Lymph Nodes.

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 T HE A NAL C ANAL
G E N E R A L A NA TOM Y O F T H E A NA L C A N A L
 Terminal and most inferior part of the GI-Tract – 4 cm long.
 Begins at the Anorectal Junction, at the level of the “U”-shaped sling
formed by the Puborectalis fibres of Levator Ani.
 Ends at the anus, the external outlet of the GI Tract.
 When not defecating, the anus is contracted into an antero-posterior slit.
 Internal and external sphincters surround anal canal.
 Also surrounded by the Levator Ani muscles.
 Descends postero-inferiorly, between the Anococcygeal and Perineal
Bodies.
 The Taeniae Coli of the anterior and posterior surfaces of the Rectum
and Anal Canal become increasingly fibro-elastic.
 Form the Conjoint Longitudinal Tendon.
 Spread out as a series of septa, into the Ischioanal Fossae on either
side of the Anal Canal (beneath the pelvic diaphragm).
 Divide up the Ischioanal Fossae into lobules of supporting fatty
tissue.
 These support the anal canal, but allow distension.
 Individual lobules can be filled with blood and pus, and since
innervated by branches of the Pudendal Nerve, result in
excruciating pain.
C REATED BY M ICHAEL C HEERAN D AVID
INTERIOR OF THE ANAL CANAL
 Superior ½ of the mucous membrane has a series of longitudinal Anal
Columns.
 Contain terminal branches of the Superior Rectal Artery.
 This is the site of a portal-systemic anastomosis.
 Anorectal Line – indicated by the superior ends of the anal columns.
 Demarcates the anorectal junction.
 Anal Valves – join the inferior ends of the anal columns.
 Semilunar folds of epithelium.
 Superior to these are a number of Anal Sinuses.
 Exude mucus when compressed by faeces.
 Pectinate Line – formed by the inferior comb-shaped limit of the anal
valves.
 Indicates the junction of the superior part of the anal canal (derived
from the embryonic hindgut), and the inferior part of the anal canal
(derived from the embryonic anal pit).
 Indicates the squamo-columnar epithelial junction.
 Superior ½ = columnar epithelium.
 Lower ½ = stratified squamous epithelium.
 In the lower part of the anal canal, the mucous membrane is
arranged in a cushion pattern (at 3 o’clock, 7 o’clock and 11 o’clock).
 Highly vascular and spongy.
 Provides a watertight enclosure, which assists in continence.
 At the anus, the moist hairless mucosa of the anal canal, becomes dry
hairy skin.
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 A RT E R I A L S U P P LY TO T H E A N A L C A NA L I N N E RVA T I O N O F T H E A NA L C A N A L

 Superior to the Pectinate Line:  Superior to the Pectinate Line:

 Superior Rectal Artery (a continuation of the Inferior Mesenteric
artery).
 Its terminal branches run distally through the mucosa of the Anal
Columns.
 They form anastomotic loops in the Anal Valves.
 Inferior to the Pectinate Line:
 Inferior Rectal Arteries supply this region as well as the surrounding
muscles and peri-anal skin.
 The Middle Rectal Arteries assist by communicating between the
Superior and Inferior Rectal arteries.
 Derived from the Inferior Hypogastric Plexus (sympathetic).
 The sympathetic nerves run mainly along the Inferior Mesenteric and
the Superior Rectal arteries.
 The parasympathetic supply is via the Pelvic Splanchnic nerves (S2-
S4), which run to the Inferior Hypogastric Plexus.
 Sensitive to stretch only.
 Inferior to the Pectinate Line:
 Derived from Inferior Rectal Nerves, branches of the Pudendal
Nerve.
 Sensitive to pain, touch and temperature.

V E N O U S D R A I NA G E F R O M T H E A N A L C A NA L LY M P H A T I C D R A I NA G E O F T H E A N A L C A N A L

 Superior to the Pectinate Line:  Superior to the Pectinate Line:

 Internal Rectal Venous Plexus  Superior Rectal Vein  Inferior  Internal Iliac Lymph Nodes  Common Iliac & Lumbar Lymph
Mesenteric Vein. Nodes.
 Inferior to the Pectinate Line:  Inferior to the Pectinate Line:
 Internal Rectal Venous Plexus  Inferior Rectal Veins (around the  Horizontal group of Superficial Inguinal Lymph Nodes.
margin of the external anal sphincter)  Internal Iliac Vein.
 Middle Rectal Veins – drain the muscle wall of the Ampulla of the
Rectum and Anal Canal.
 Communicates between the Superior and Inferior Rectal Veins.
 A tributary of the Internal Iliac Vein.

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 E X T E R NA L A N A L S P H I N C T E R I N T E R NA L A N A L S P H I N C T E R

 Large voluntary sphincter – surrounds the inferior 2/3 of the anal canal.  Involuntary sphincter, surrounding the upper 2/3 of the anal canal.
 Forms a broad band (2-3 cm wide) on each side of the anal canal.  An inferior extension of the circular muscle of the rectum.
 Consists of 3 parts: Subcutaneous, Superficial and Deep.  Controlled by the Autonomic Nervous System:
 Many branches of the Inferior Rectal nerve and artery, runs between the  Sympathetic – closed.
superficial and deep parts.  Parasympathetic – open (Pelvic Splanchnic Nerves).
 Fibres of the external anal sphincter run from the Perineal Body to the  Stimulated by the pressure of faeces in the Ampulla of the Rectum.
Anococcygeal Body and Coccyx.
 Fibres blend superiorly with the Puborectalis fibres of Levator Ani.
I N T E R NA L P U D E N DA L A R T E RY
 The fibres also overlap superiorly, with those of the internal anal
sphincter.
 Subcutaneous Part – lies most inferiorly.  Main arterial supply to perineal structures – lies in Pudendal Canal.
 Slender, and surrounds the anus.  Branches:
 Annular fibres have no bony attachment.  Inferior Rectal artery
 Superficial Part – elliptical in shape.  Posterior Scrotal/Labial arteries
 Fibres extend from the tip of the Coccyx & Anococcygeal Body,  Artery to the Bulb
around the anus, to the Perineal Body.  Deep artery of the Penis/Clitoris
 Moors the anus in the median plane.  Dorsal artery of the Penis/Clitoris.
 Deep Part – thick annular band, surrounding the anus like a collar.
 Arise from the Perineal Body.
P U D E N DA L N E RV E
 Some fibres cross to join the opposite Superficial Transverse
Perineal Muscle.
 Superior fibres merge with the Puborectalis fibres of Levator Ani.  Major nerve of the Perineum – also lies in the Pudendal Canal.
 Together form the Chief Muscle of Continence.  Branches:
 Innervation – Inferior Rectal Nerve + Perineal Branch of S4.  Inferior Rectal nerve
 Actions – assists in closing anus and anal canal.  Posterior Scrotal/Labial nerve
 The deep part assists the Puborectalis fibres draw the anal canal  Perineal Nerve
anteriorly  increasing Anorectal Angle.  Dorsal Nerve of the Penis/Clitoris.

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