General characteristics of the subperitoneal compartment
The subperitoneal floor of the pelvis is bounded superiorly by the parietal peritoneum and inferiorly by the parietal fascia. This space contains the extraperitoneal portions of internal organs, as well as large vascular plexuses, nerves, and lymph nodes. The pelvic organs are surrounded by visceral fascia, which forms isolated visceral spaces: the perirectal, parametrial, perivesical, and periprostatic spaces. The fascial spaces themselves are divided into parietal and visceral.
Parietal spaces: prevesical and retrovesical
The prevesical space (spatium prevesicale) lies between the transversalis fascia anteriorly and the prevesical fascia posteriorly. It contains loose adipose tissue, the vesical and prostatic venous plexuses, and the arteries of the urinary bladder. Inferiorly, the space is bounded by the pelvic diaphragm.
The retrovesical space (spatium retrovesicale) is located between the posterior wall of the urinary bladder and the rectovesical septum (Denonvilliers' fascia). It contains the prostate gland within Pirogov-Retzius capsule, seminal vesicles, ampullae of the vas deferens, and the terminal parts of the ureters.
Retropyelorectal (retrorectal) and lateral spaces
The retrorectal space (spatium retrorectale) is enclosed between the rectum with its fascial sheath and the sacrum. The adipose tissue of this space contains the superior rectal artery, sacral branches, nerve trunks, and sacral lymph nodes.
The lateral spaces (spatia lateralia) are located lateral to the internal organs. Medially, they are bounded by sagittal fascial septa, and laterally by the pelvic walls. The common and internal iliac vessels, nerve trunks of the sacral plexus, ureters, and vas deferens pass through the lateral spaces.
Parametrial space (parametrium)
The parametrium is located around the cervix and between the layers of its broad ligament, resting inferiorly on the fascia of the pelvic diaphragm. This space directly communicates with the parietal pelvic tissue.
Three parts of the parametrium are distinguished:
- Precervical (anterior) — separates the cervix from the bladder, bounded by the pubocervical ligaments.
- Retrocervical (posterior) — separates the vagina from the rectum, bounded by the uterosacral ligaments.
- Lateral — lies at the base of the broad ligament, containing the uterine and ovarian vessels, as well as the ureter crossing them.
Briefly: answers to topical questions
What anatomical regions and fascial spaces communicate with the prevesical space?
The prevesical space communicates with several adjacent regions where purulent collections can spread. Pathways of spread include the following directions:
- Thigh — infection spreads through the femoral and obturator canals.
- Lateral spaces — transition into the lateral parietal spaces of the pelvis.
- Perivesical tissue — penetration into the perivesical visceral tissue.
- Abdominal cavity — rupture into the free peritoneal cavity.
- Anterior abdominal wall — spread into the sheaths of the rectus abdominis muscles.
- Superficial layers — extension to the umbilical region and directly into the subcutaneous tissue.
Where can pus spread from the lateral fascial space of the lesser pelvis?
From the lateral fascial spaces of the lesser pelvis, pus can spread into several adjacent regions. The main pathways of collection spread include:
- Retroperitoneal tissue space — spread follows the course of vessels and nerves.
- Gluteal region — pus passes through the supra- and infrapiriform foramina.
- Adjacent parietal spaces — transition into the retrorectal and prevesical spaces.
- Adductor muscle region of the thigh — infection spreads through the obturator canal.
- Visceral fascial spaces — collections follow the vascular pathways to the pelvic organs.
Prevesical — anterior to the bladder behind the pubis; retrovesical — between the bladder and Denonvilliers' fascia; retrorectal — anterior to the sacrum posterior to the rectum.
Class and exam questions
What are the main boundaries of the prevesical space?
Anteriorly, the prevesical space is bounded by the transversalis fascia (the posterior wall of the rectus abdominis sheath) and posteriorly by the prevesical fascia. Laterally, it is separated from the lateral pelvic spaces by fascial valves.
What is located in the lateral fascial spaces of the lesser pelvis?
The lateral spaces contain the internal iliac vessels and their branches, lymphatic vessels and nodes, nerve trunks of the sacral plexus, as well as the ureters and vas deferens.
Which anatomical structures bound the retrovesical space posteriorly?
Posteriorly, the retrovesical space is bounded by the rectovesical septum, known as Denonvilliers' fascia.
What else to study on this topic
- Fascial structure of the subperitoneal compartment of the pelvis
- Pathways of purulent collection spread from the prevesical space
- Surgical approaches to the retrovesical space
- Topography of vessels and nerves in the lateral fascial space
- Clinical significance of the parametrium and pathways of infection spread
Master the complete topic in the "Topographic Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on the topic "Pelvic Fascial Spaces" and 2,777 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 91 video lessons on the subject
Other topics in the section "Topographic Anatomy of the Pelvis and Perineum"
Free video lessons: topographic anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.