Perineum and urogenital diaphragm.pptx

Perineum is a diamond-shaped region below the pelvic diaphragm...

1. PERINEUM & UROGENINTAL DIAPHRAGM

2. Perineum It is a diamond-shaped region below the pelvic diaphragm. Boundaries of the perineum are those of the pelvic outlet Lower border of symphysis pubis Rami of pubis and ischium Ischial tuberosity Sacrotuberous ligament Tip of coccyx Wednesday, 28 June 2023 2

3. Perineum Two triangles The perineum is divided into anterior and posterior triangles by joining the ischial tuberosities with an imaginary line Urogenital region/ urogenital triangle (anterior) － differs in male and female Anal region/ anal triangle (posterior) － similar in both sexes Wednesday, 28 June 2023 3

4. Anal triangle The anal triangle contains the anus its sphincters and also the ischioanal fossa on either side in both males and females . Wednesday, 28 June 2023 4

5. Contents of the anal triangle Wednesday, 28 June 2023 5

6. Urogenital region Superficial fascia The fatty layer The membranous layer － superficial fascia of perineum or Colles ’ fascia Attached posteriorly to the posterior border of the urogenital diaphragm Laterally to the margins of pubic arch and ischial tuberosity Anteriorly it is continuous with: Dartos of the scrotum Fascia of the penis Scarpa’s fascia Wednesday, 28 June 2023 6

7. Camper’s fascia Position of penis Scarpa’s fascia Fascia later Line of fusion Position of scrotum superficial fascia of perineum Wednesday, 28 June 2023 7

8. Urogenital region Deep fascia Superior fascia of urogenital diaphragm Inferior fascia of urogenital diaphragm Attached p osteriorly to the posterior border of the urogenital diaphragm Laterally to pubic arch In front they fuse together forming the so-called: transverse perineal ligament Wednesday, 28 June 2023 8

9. Urogenital region Two spaces Deep perineal space Superficial perineal space Wednesday, 28 June 2023 9

10. Superior fascia of urogenital diaphragm Inferior fascia of urogenital diaphragm Superficial fascia of perineum (Colles’ fascia) Deep perineal space Superficial perineal space Fascia of the penis Scarpa’s fascia Dartos of the scrotum Urogenital region Wednesday, 28 June 2023 10

11. Urogenital region Superficial perineal space Lies between inferior fascia of urogenital diaphragm and superficial fascia of perineum . It is closed behind and laterally . Wednesday, 28 June 2023 11

12. Urogenital region Superficial perineal space Anteriorly, the space communicates with the potential space lying between the Scarpa’s fascia and the anterior abdominal muscles. In rupture of cavernous part of urethra, urine can extravasate from scrotum upward in front of symphysis pubis into anterior abdominal wall deep to Scarpa’s fascia Wednesday, 28 June 2023 12

13. Urogenital region Superficial perineal space Wednesday, 28 June 2023 13

14. Urogenital region Superficial perineal space Contents Posterior part － superficial transverse muscle of perineum Lateral part － crus penis (male), crus of clitoris (female) and ischiocavernousus covering them Central part － bulb of urethra (male), bulb of vestibule (female) and bulbocavernousus covering them Branches of pudendal nerves and internal pudendal vessels Wednesday, 28 June 2023 14

15. Clitoris Crus of clitoris Bulb of vestibule Great vestibular gland Superficial transverse m. of perineal Ischiocavernousus Wednesday, 28 June 2023 15

16. Urogenital region Superficial perineal space Contents Posterior part － superficial transverse muscle of perineum Lateral part － crus penis (male), crus of clitoris (female) and ischiocavernousus covering them Central part － bulb of urethra (male), bulb of vestibule (female) and bulbocavernousus covering them Branches of pudendal nerves and internal pudendal vessels Wednesday, 28 June 2023 16

17. Urogenital region Deep perineal space The closed space that is contained between superior and inferior fascia of urogenital diaphragm Contents Deep transverse muscle of perineum Bulbourethral gland (male) Sphincter of urethra Arteries, veins and nerves Wednesday, 28 June 2023 17

18. Urogenital region Urogenital diaphragm Triangular in shape Formed by sphincter of urethra, deep transverse perineal muscle, superior and inferior fascia of urogenital diaphragm Wednesday, 28 June 2023 18

19. Perineal central tendon 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 fine support to the posterior wall of the vagina Wednesday, 28 June 2023 19

20. Perineal central tendon Sphincter ani externus Levator ani Superficial transverse muscle of perineum Deep transverse muscles of perineum Bulbocavernousus Sphincter of urethra (male) or urethrovaginal sphincter (female) Wednesday, 28 June 2023 20

21. Sphincter ani externus Levator ani Superficial transverse muscle of perineum Bulbocavernousus Deep transverse muscles of perineum Sphincter of urethra (male) or urethrovaginal sphincter (female) Perineal central tendon Wednesday, 28 June 2023 21

22. Episiotomy Tear of perineum Wednesday, 28 June 2023 22

23. THANK YOU FOR YOUR ATTENTION