PELVIS.

Moore, Keith. Clinically Oriented Anatomy. Seventh Edition. Lippincott

Williams & Wilkins. Baltimore. 2014.
INTRODUCTION TO PELVIS AND PERINEUM.
PELVIS GIRDLE.
• Ring of bones that conects
vertebral column to femurs.
• Primary function:
• Bear weight of upper body when
sitting and standing.
• Transfer weight from axial to lower
limbs for locomotion.
• Provide attachment for muscles to
locomotion.
• Is strong and rigid.
• Contain and protect pelvic viscera.
• Provide support during pregnant.
PELVIS GIRDLE.
JOINTS OF PELVIC
GIRDLE.
• Sacro-iliac joint.
• Anterior synovial joint.
• Posterior syndesmosis.
• Limited mobility.
• Pubic symphysis.
• Interpubis disc uniting pubis bones.
• Lumbosacral joints.
• L5/S1 joint.
• Sacrococcygeal joint.
• Apex to the sacrum to base of coccyx.
PELVIC CAVITY.
•The pelvic cavity is
continuos with the
abdominal cavity.

•Contains the terminal parts

of the ureters, the urinary
bladder, rectum, pelvic
genital organs, blood
vessels, lymphatics and
nerves.
PELVIC CAVITY.
• Abdominal cavity is continuos at
the pelvic inlet but angulated
posteriorly from it.

• Is limited inferiorly by the pelvic

diaphragm (pelvic floor).

• Is bounded posteriorly by the

coccyx and inferiormost sacrum.
The superior part of the sacrum
forming a roof over the posterior
half of the cavity.
PELVIC CAVITY.
•The bodies of the pubic
bones and the pubic
symphysis form an
antero-inferior wall that is
much shorter than
postero-superior wall.

•Axis of the pelvis is curved

and pivoting around the
pubic symphysis.
WALLS AND FLOOR OF PELVIC CAVITY.
• Antero-inferior wall: • Postero-lateral wall and roof:
• Is formed primarily by the bodies • Consist of a bony wall and roof in
and rami of the pubic bones and the midline (sacrum and coccyx).
the pubic symphysis. • Postero-lateral wall consist
• Lateral wall: musculoligamentous (ligaments of
sacro-iliac joint and piriform
• Lateral wall is formed by hip muscles)
bones, includes obturator foramen
and obturator membrane
(attachments of obturator • Pelvic floor:
internus muscle). • Pelvic diaphragm consist of the
• The medial surface covered by coccygeum and elevator ani
obturator fascia. • Puborectalis, pubococcygeus,
iliococcygeus.
WALLS AND FLOOR OF PELVIC CAVITY.
WALLS AND FLOOR OF PELVIC CAVITY.
VASCULAR STRUCTURES
OF PELVIS.
VASCULAR STRUCTURES
OF PELVIS.
• Internal iliac vein to cava vein.
• Vaginal.
• Prostatic.
• Uterine.
• Rectal.
• Vesical.
• Superior gluteal vein.
• Median sacral vein to common
iliac vein.
• Superior rectal to mesenteric
vein.
• Lateral sacral vein to sup or inf
cava vein.
NEUROVASCULAR STRUCTURES OF PELVIS.
NEUROVASCULAR STRUCTURES OF PELVIS.
• Obturator nerve.
• Anterior rami of L2-L4 (lumbar
plexus).
• Lumbosacral trunk.
• Descending part of L4 and anterior
ramus of L5. Passes inferiorly to
joint to sacral plexus.
• Sacral plexus (L4-S4).
• Sciatic nerve (S4-L3).
• Pudendal nerve (S2-S4).
• Superior gluteal nerve (L4-S1).
• Inferior gluteal nerve (L5-S2).
• Coccygeal plexus.
• Anterior rami of S4 and S5 and the
coccygeal nerves.
• Anococcygeal nerves.
• Pelvic autonomic nerves.
• Sacral sympathetic trunk (lower
limbs).
• Peri-arterial plexus (vasomotor to
sup rectal, ovarian, internal iliac art).
• Hypogastric plexus (sympahetic pelvic
viscera).
• Pelvic splanchic nerves
(parasympathetic innervation of
pelvic viscera and sigmoides.)
NEUROVASCULAR STRUCTURES OF PELVIS.
NEUROVASCULAR STRUCTURES OF PELVIS.
PELVIC VISCERA.
• URINARY ORGANS.
• Pelvic portion of ureters.
• Muscular tubes. 25-30 cm long.
• Pass obliquely muscular wall of
bladder in a inferomedial
direction.
• This oblique passage form
one-way flap valve (intramural
collapse).
• In males the only structure that
pass betwen peritoneum and
uteres is the ductus deferens
• In females passes medial to the
origin of the uretine artery.
PELVIC VISCERA.
• URINARY ORGANS.
• Blood supply and venous
drainage of pelvic portion of
ureters.
• Abdominal supply from renal
artery, gonadal artery, abdominal
aorta.
• Variable supply from common
iliac, internal iliac and ovarian
arteries.

• Venous drainage of pelvic

portion of ureters.
• Generally parallels the arterial
supply draining to veins
corresponding names.
PELVIC VISCERA.
• URINARY ORGANS.
• Urinary bladder is a temporary reservoir for urine charactized by its distensibility. It
has a strong muscular wall. Varies in size, position and relationships.
PELVIC VISCERA.
• URINARY ORGANS.
• Urinary bladder.
• Apex.
• Fundus.
• Body.
• Neck.
• Detrusore muscle (walls of the bladder.)
• Internal urethral sphinter.
• Trigone of the bladder. (uvula)
• Internal urethral orifice.
• Ureteric orifices.
• Blood supply: branches of internal iliac
arteries (sup vesical art to anterosuperior
part and inf vesical art to fundus and neck)
PELVIC VISCERA.
Female urethra.
• 4 cm long and 6 mm diameter.
• Passes antero-inferiorly from internal
urethral orifice, posterior and inferior
to pubic symphysis.
• Hasn´t internal sphincter.
• External orifice of the urethra is
located in vestibule of vagina,
between labia minora, anteriorly to
vagina orifice.
• Paraurethral gland (homologs to
prostate)
• Blood supply and drainage by
internal pudendal and vaginal
arteries.
PELVIC VISCERA.
Proximal male urethra.
• Muscular tuve 18-22 cm
long.
• Preprostatic part.
• Prostatic part.
• Urethral crest
• Orifice of prostatic utricle.
• Ejaculatory duct.
• Prostatic sinuses.
• Intermediate part.
• Spongy part.
PELVIC VISCERA.
• Rectum.
PELVIC VISCERA.
• Rectum.
PELVIC VISCERA.
• Rectum.
PELVIC VISCERA.
Male internal genital
organs.
•Ductus deferens.
•Seminal gland.
•Ejaculatory ducts.
•Prostate.
• Isthmus.
• Right and left lobes.
• Prostatic duct.
•Bulbo-urethral glands.
PELVIC VISCERA.
Male internal genital organs.
PELVIC VISCERA.
Artery supply of Male internal Innervation of Male internal
genital organs. genital organs.
• Artery of the ductus deferens • Presynaptic sympathetic
arise from sup or inf vesical fibers from T12-L2 or L3.
artery. • Orgasm contraction of internal
urethral sphynter.
• Ejaculatory ductus by artery • Contraction of ductus deferens,
of the duct deferens. seminal gland and prostate.
• Prostate by internal iliac • Presynaptic parasympathetic
artery especially inf vesical fibers from S2-S3.
artery. • Stimulates erectile bodies of the
penis and producing penile erection.
PELVIC VISCERA.
Female internal genital organs. • Uterus.
• Ovaries. • Body.
• Suspended for mesovarium and • Fundus.
suspensory ligament. • Isthmus.
• Uterines tubes. • Cervix.
• 10 cm long, open into peritoneal • Supravaginal part
cavity near the ovaries. • Vaginal part.
• Mesosalpinx. • Perimetrium.
• Infundibulum (abdominal ostium • Myometrium.
and fimbriae).
• Endometrium.
• Ampulla.
• Isthmus.
• Vagina.
• Uterine part.
PELVIC VISCERA.
PELVIC VISCERA.
PELVIC VISCERA.
PERINEUM.
PERINEUM.
PERINEUM.
• Pelvic floor.

• Pelvic diaphragm.
PERINEUM.
• Male and
female
urethral
sphyncter.
PERINEUM.
PERINEUM.
PERINEUM.
PERINEUM.
PERINEUM.
PERINEUM.