UROGENITAL REGION

• INTRODUCTION• LAYERS• SUPERFICIAL AND DEEP PERINEAL POUCHES• UROGENITAL DIAPHRAGM• PERINEAL BODY• APPLIED

Triangles

perineal muscles

Urogenital regionSuperficial fascia has two layers• The superficial or fatty layer• The deep or membranous layer

(superficial fascia of perineum or Colles’ fascia)

Anteriorly － it is continuous with:– Dartos of the scrotum– Fascia of the penis– Membranous layer of superficial fascia of

the abdominal wall known as the fascia of Scarpa

Deep fascia has two layers• Superior fascia of urogenital diaphragm• Inferior fascia of urogenital diaphragm

Superior fascia of urogenital diaphragm

Inferior fascia of urogenital diaphragm (Perineal Membrane)

superficial fascia of perineum (colles’ fascia)

Deep perineal space

Superficial perineal space Bucks Fascia of the penis

Fascia of Scarpa

Dartos of the scrotum

Cutaneous Innervation of Urogenital region

• Dorsal nerve of penis/clitoris• Ilioinguinal nerve & genital branch of

genitofemoral nerve• Perineal branch of post cutaneous nerve of

thigh• Post scrotal /labial nerve

Superficial perineal space(Pouch)

Boundaries• Lies between inferior fascia of

urogenital diaphragm and superficial fascia of perineum

• Anteriorly open and posteriorly closed by fused perineal membrane with colles’ fascia

• Space open anteriorly (In rupture of cavernous part of urethra, urine can extravasate from scrotum upward in front of symphysis pubis into anterior abdominal wall deep to membranous fascia of Scarpa)

Contents• Posterior part － superficial transverse perineal muscle• Lateral part － crus penis (male), crus of clitoris (female) and

ischiocavernousus covering them• Central part － bulb of penis (male), bulb of vestibule (female) and

bulbospongiosus covering them, urethra(in both)• Ducts of bulbourethral glands(male) greater vestibular glands(female)• Branches of pudendal nerves and internal pudendal vessels

Deep perineal space (Pouch)• Lies between superior and inferior fascia of urogenital diaphragm• Contents

– Membranous urethra(male),urethra and vagina(female)– Deep transverse perineal muscle, sphincter urethrae– Bulbourethral gland (male)– Branches of intenal pudendal vessels(artery of penis)– Branches of pudendal nerve(dorsal nerve of penis)

Urogenital diaphragm

• Triangular in shape• Attached laterally to

ischiopubic rami and ischial tuberosities

• Formed by sphincter of urethra, deep transverse perineal muscle, superior and inferior fascia of urogenital diaphragm

Perineal Membrane

Pierced by:• Urethra(+vagina)• Duct of bulbourethral gland(male)• Artery & nerve to bulb of penis/vestibule• Dorsal & deep artery of penis(/clitoris)• Urethral artery• Post. scrotal/labial nerve & vessels• Branches of perineal nerve to superficial muscles

Perineal central tendon(Perineal Body)• Wedge-shape fibromuscular mass• In female, between anal canal and lower end of vagina, • In male, between anal canal and root of penis• It is larger in the female than in the male and support to the posterior wall

of the vagina

• Origin or insertion of several small muscles and insertion of part of pelvic diaphragm

• These muscles are: – Superficial transverse

perineal muscles – Deep transverse perineal

muscles– Bulbospongiosus– Levator ani– Sphincter ani externus – Longitudinal muscle coat of

anal canal

Sphincter ani externus

Levator ani

Superficial transverse muscle perineum

Bulbospongiosus

Deep transverse muscles perineum

Applied

• Extravasation of urine is superficial or deep • Damage to perineal body:prolapse of uterus• Episiotomy: Median or Mediolateral• Pudendal nerve block

Episiotomy and pudendal nerve block

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