Perineum Anatomy PDF

PERINEUM By dr. Mahmoud E. Salem  PERINEUM Urogenital Site ; overlies the pelvic outlet below the pelvic floor Divided into two triangles ; Urogenital pelvic 1-anteri...

PERINEUM By dr. Mahmoud E. Salem  PERINEUM Urogenital Site ; overlies the pelvic outlet below the pelvic floor Divided into two triangles ; Urogenital pelvic 1-anterior one named floor Urogenital triangle Anal triangle 2-posterior one named Anal triangle Urogenital triangle ; lies & protected between the sides of the pubic arch Anal triangle CONTENTS OF ANAL TRIANGLE Ano-coccygeal body A - Anal canal ; Lies in the middle B - Ischio-anal fossa ; On each side of anal canal ISCHIO-ANAL FOSSA Wedge – Shaped Fossa Base ; Downwards & Formed by the Skin Edge ; Upwards ; At the Tendinous Arch Medial boundary formed by ; External anal sphincter & Levator ani Lateral boundary formed by ; Obturator internus ,fascia & ischial tuberosity  ISCHIO-ANAL FOSSA Anterior boundary formed by; Urogenital triangle Posterior boundary formed by ; Sacro-tuberous ligament covered by Gluteus maximus CONTENTS OF ISCHIO-ANAL FOSSA 1-Pudendal canal containing : Pudendal nerve Internal pudendal vessels 2-Inferior Rectal N. & vessels 3-Perineal branch of 4th sacral nerve to external anal sphincter 4-Pad of Fat POUCHES OF UROGENITAL TRIANGLE Urogenital triangle formed of two pouches : Superficial one ; Covered only by Skin & Superficial Fascia Deep one ; Covered by Deep fascia Stretched between the sides of the pubic arch  DEEP PERINEAL POUCH Flattened Closed space Stretched between the sides of the pubic arch like a diaphragm So named Urogenital Diaphragm Fascia of this closed pouch ; 1-Sup. Surface covered by; Superior Fascia of urogenital diaphragm 2-inferior surface covered by; Inferior Fascia of urogenital diaphragm  Transverse perineal ligament Superior and Inferior Fascia of urogenital diaphragm Fused anteriorly and posteriorly forming thickened borders The anterior border named Transverse perineal ligament External urethral sphincter Transverse perineal ligament  CONTENTS OF DEEP POUCH IN FEMALE 1-Urethra surrounded by External urethral sphincter 2-Vagina surrounded by Deep Transverse Perineal muscles 3-Nerves & Vessels ; [Dorsal nerve clitoris &Vessels of clitoris]  CONTENTS OF DEEP POUCH IN MALE 1-Membranous Urethra surrounded by; A-External urethral sphincter B-Bulbourethral glands 2-Deep transverse perineal muscles 3-nerves & vessels ; [Dorsal nerve penis & Penis Vessels]  PERINEAL MEMBRANE Thickened Inferior Fascia of urogenital diaphragm Separates the two perineal pouches Perineal membrane in Female Pierced by ; 1-Vagina & Urethra Clitoris Artery 2-Vessels of the Bulb 3-Deep vessels of Clitoris 4-Dorsal vessels of Clitoris 5-Dorsal nerve of clitoris PERINEAL MEMBRANE IN MALE Pierced by ; 1-Membranous Urethra 2-Bulbourethral ducts 3-Bulb Vessels 4-Urethral vessels 5-Deep vessels of Penis 6-Dorsal vessels of Penis 7-Dorsal nerve of Penis  SUPERFICIAL PERINEAL POUCH Position ; Below the perineal membrane Between the perineal membrane and membranous layer of superficial fascia Opened anteriorly & continuous with the anterior abdominal wall Testis Closed posteriorly CONTENTS OF SUPERFICIAL PERINEAL POUCH IN MALE A-root of penis ; 1-Bulb of the penis 2-Crura of penis B-Superficial perineal muscles ; 1-Bulbospongiosus 2-Ischiocavernosus 3-Superficial transverse perineal C-Branches of pudendal nerve & internal pudendal vessels D-Part of Urethra E-Testis CONTENTS OF SUPERFICIAL POUCH IN FEMALE A-root of clitoris ; 1-Bulb of the vestibule 2-Crura of clitoris B-Superficial perineal muscles 1-Bulbospongiosus 2-Ischiocavernosus 3-Superficial transverse perineal C-Branches of pudendal nerve & internal pudendal vessels D-Urethra E-Vagina & Greater Vestibular gland  PERINEAL BODY Fibromuscular mass in the Center of the perineum Receives the following muscles ; 1-levators ani 2-external anal sphincter 3-bulbospongiosus 4-transverse perineal muscles  PUDENDAL NERVE Origin ; Inside the pelvis From sacral plexus ; S2,3,4 Leaves the pelvis through the greater sciatic foramen Enters the perineum through the lesser sciatic foramen Passes in the pudendal canal & ends at the lower end of the canal  Dorsal nerve of Penis Perineal n. Branches of pudendal nerve Inferior Rectal A-Inferior Rectal ; Supplies Levator ani & external anal sphincter B-Two Terminal branches ; 1-Dorsal nerve of Penis or clitoris 2-Perineal nerve which gives ; Muscular & posterior Scrotal nerves BRANCHES OF PUDENDAL NERVE IN MALE A-inferior rectal nerves B-two terminal branches ; 1-Dorsal nerve of Penis 2-Perineal nerve gives ; Muscular & Posterior Scrotal BRANCHES OF PUDENDAL NERVE IN FEMALE A-inferior rectal nerves B-two terminal branches ; 1-Dorsal nerve of Clitoris 2-Perineal nerve gives ; Muscular & Posterior Labial  Internal iliac Anterior division Internal pudendal Has the same course of the nerve inferior rectal nerves Perineal artery Branches of internal pudendal : A-inferior rectal nerves B-two terminal branches ; 1-Artery of Penis 2-Perineal artery gives ; Posterior Scrotal & Transverse Perineal arteries  ARTERY OF PENIS Gives 4 branches ; Deep artery 1-Artery of the Bulb 2-Urethral artery [bulbo-urethral artery] Penis art. 3-Deep artery of Penis [Cavernous artery] 4-Dorsal artery of Penis INTERNAL PUDENDAL VEIN Ends in internal iliac vein Deep dorsal vein of penis or clitoris ends in the pelvic plexuses : Prostatic or vesical plexuses Superficial dorsal vein of penis ends in external pudendal vein