15 concise topics with breakdowns: definitions, key facts, and class questions.
This section is dedicated to the complex architecture of the lesser pelvis and perineum. Here we thoroughly analyze the bony framework, ligaments, muscles, and the pelvic diaphragm. Special attention is paid to the peritoneal reflections, the fascial system, and the critical cellular spaces where pelvic phlegmon can develop. You will study the vessels and nerves of the lesser pelvis, the topography of the urinary bladder and rectum, as well as the detailed syntopy of male and female pelvic organs—from the uterus with its appendages to the structures of the male genital region.
Practical classes and exams traditionally focus on "tricky" topics. You will definitely be asked about the boundaries and contents of the ischioanal fossa, the pathways for the spread of pus collections, and the features of blood supply. A precise understanding of the topography of these zones is critically important, as surgical errors here can lead to the most severe complications.
The bony framework is formed by the paired pelvic bones (ilium, pubis, and ischium), as well as the sacrum and coccyx.
Where does the iliopsoas muscle pass as it exits the pelvis?
The m. iliopsoas leaves the pelvic cavity and emerges onto the thigh through the muscular lacuna (lacuna musculorum), after which it inserts into the lesser trochanter of the femur.
What is the source of the formation of the pelvic fascia?
The pelvic fascia is formed as a direct continuation of the extraperitoneal fascia (endopelvic fascia) as it transitions into the pelvic cavity.
Which structure represents the lowest point of the male pelvic cavity?
The lowest point is the rectovesical pouch (excavatio rectovesicalis), the floor of which is fixed to the Denonvilliers-Salishchev fascia.
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.
Into which trunks does the internal iliac artery divide and at what location?
It divides into anterior and posterior trunks at the level of the upper margin of the iliopsoas muscle, which corresponds to the level of the sacroiliac joint.
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