Applied Anatomy of the Pelvis

General Part.- Structural and Functional Anatomy of the Pelvis.- I. General.- 1. Definition.- 2. Limits of the Pelvis.- 3. General Characteristics of the Pelvis.- II. External Appearance.- 1. Ventral Aspect.- 2. Dorsal Aspect.- 3. Lateral Aspect.- 4. Inferior Aspect.- 5. The Skin Covering of the Pelvis.- 6. Hair Distribution.- 7. Skin Mobility of the Pelvis.- III. Importance of the Pelvic Girdle.- IV. Pelvic Morphology in Relation to Constitution.- 1. Athletic Type.- 2. Pyknic Type.- 3. Leptosomatic Type.- V. Pelvic Girdle.- 1. Components of the Pelvic Girdle.- 2. Development of the Pelvic Girdle.- 3. Wedging of the Sacrum into the Pelvis.- 4. Pelvic Movements.- 5. Injuries of Pelvic Girdle Joints.- VI. Bony Pelvis.- 1. Sacrum.- 1.1 Promontory.- 1.2 Number of Vertebrae.- 2. Coccyx.- 3. Morphogenesis of Sacrum and Coccyx and its Relevance to Malformations.- 4. Malformations.- 4.1 Aplasia.- 4.2 Asymmetry.- 4.3 Deficient Regression of Sacral Vertebrae.- 4.4 Unphysiologic Curvature of the Sacrum.- 4.5 Sacral Cysts.- 4.6 Sacral Tumors.- 4.7 Ventral Meningocele of Sacrum.- 4.8 Lumbosacral Assimilation.- 5. Hip Bone.- 6. Ilium.- 7. Ischium.- 8. Pubis.- 9. Nonuniform Thickness of Acetabulum.- 10. Rim of Acetabulum.- 11. Development of the Acetabulum.- 12. Dimensions of the Acetabulum.- VII. Pelvic Ligaments.- VIII. Joints of the Pelvis.- 1. Sacroiliac Joint.- 1.1 Ligaments of the Sacroiliac Joint.- 1.2 Innervation of the Sacroiliac Joint.- 1.3 Topographic Relations of the Sacroiliac Joint.- 2. Symphysis Pubis.- 2.1 Topographic Relations of the Symphysis Pubis.- 2.2 Ligaments of the Symphysis Pubis.- 2.3 Tensile Strength.- IX. Statics and Mechanics of the Osteoligamentous Pelvis.- X. Female Bony Pelvis.- 1. Anthropoid Pelvis.- 2. Gynecoid Pelvis.- 3. Android Pelvis.- 4. Platypelloid Pelvis.- XI. Visible and Palpable Parts of the Pelvis.- XII. Pelvic Landmarks.- XIII. Development of the Pelvis; Malformations.- XIV. Growth of the Pelvis; Abnormalities.- XV. Varieties of Pelvic Architecture.- XVI. Ossification of the Pelvis.- XVII. Shaping of the Pelvis; Sex Differences.- XVIII. Pelvic Measurements.- 1. Plane of Least Pelvic Dimensions.- 2. Pelvic Planes.- 3. Pelvic Dimensions.- XIX. Pelvic Deformities.- 1. High Pelvis.- 2. Broad Pelvis.- 3. Contracted Pelvis.- 3.1 Symmetrically Contracted Pelvis.- 3.2 Asymmetrically Contracted Pelvis.- 4. Simple Flat Pelvis.- 4.1 Rachitic Flat Pelvis.- 5. Obliquely Contracted Pelvis.- 6. Coxalgic Pelvis.- 7. Scoliotic Pelvis.- 8. Ankylotic Pelvis (Naegele's Pelvis).- 9. Transversely Contracted Pelvis (Robert's Pelvis).- XX. Pelvic Injuries.- 1. Pelvic Ring Fractures.- 2. Main Types of Acetabular Fracture.- 2.1 Isolated Fracture of Rim of Acetabulum.- 2.2 Anterior Acetabular Roof Fracture.- 2.3 Single Column Fracture.- 2.4 Pure Transverse Fracture.- 2.5 Combinations of Fractures.- 2.6 Fracture of Both Columns.- XXI. Blood Vessels of Pelvic Bones.- 1. Arteries of Pelvic Bones.- 2. Veins of Pelvic Bones.- XXII. Muscle Attachments on Pelvis.- XXIII. Anterior Abdominal Wall and Pelvis.- XXIV. Pelvic Floor Musculature.- 1. Striated Muscle and Fibrous Tissue System of Pelvic Floor.- 1.1. Levator Ani Muscle.- 1.2. Pubococcygeus.- 1.3. Levator Prostatae (Pubovaginalis).- 1.4. Puborectalis.- 1.5. Iliococcygeus.- 1.6. Coccygeus Muscle.- 1.7. Deep Transverse Perineal Muscle.- 1.8. Superficial Transverse Perineal Muscle.- 1.9. Ischiocavernosus Muscle.- 1.10. Bulbocavernosus Muscle.- 1.11. Sphincter Urethrae Muscle.- 2. The Nonstriated Musculoflbrous System of the Pelvic Floor.- Sagittal Components of the Nonstriated Musculoflbrous System.- 2.1. Puboprostatic and Pubovesical Ligaments.- 2.2. Recto-urethral Muscle.- 2.3. Rectococcygeus Muscle (of Treitz).- 2.4. The Nonstriated Muscle Center of the Perineum.- 2.5. Ischioprostatic Muscle.- 2.6. Cardinal Ligament of the Uterus.- Coronal Components of the Nonstriated Musculoflbrous System.- 2.7. Broad Ligament of Uterus.- Vascular, Nervous and Lymphatic Systems.- XXV. Blood Vessels of the Pelvis.- 1. Arteries of the Pelvis.- 1.1 Internal Iliac Artery.- 1.2 Iliolumbar Artery.- 1.3 Lateral Sacral Artery.- 1.4 Superior Gluteal Artery.- 1.5 Inferior Gluteal Artery.- 1.6 Umbilical Artery.- 1.7 Superior Vesical Artery.- 1.8 Inferior Vesical Artery.- 1.9 Middle Rectal Artery.- 1.10 Uterine Artery.- 1.11 Obturator Artery.- 1.12 Internal Pudendal Artery.- 1.13 Inferior Rectal Artery.- 1.14 Perineal Artery.- 1.15 Artery of Bulb of Penis.- 1.16 Urethral Artery.- 1.17 Deep Artery of Penis.- 1.18 Dorsal Artery of Penis.- 2. Veins of the Pelvis.- 2.1 Inferior Vena Cava.- 2.2 Renal Vein.- 2.3 Common Iliac Vein.- 2.4 External Iliac Vein.- 2.5 Pubic Vein.- 2.6 Inferior Epigastric Vein.- 2.7 Deep Circumflex Iliac Vein.- 2.8. Internal Iliac Vein.- 2.9 Obturator Vein.- 2.10 Lateral Sacral Vein.- 2.11 Middle Rectal Vein.- 2.12 Vesical Venous Plexus.- 2.13 Prostatic Venous Plexus.- 2.14 Deep Dorsal Vein of Penis.- 2.15 Superficial Dorsal Vein of Penis.- 2.16 Uterine Venous Plexus.- 2.17 Internal Pudendal Vein.- 3. Venous Collateral Circulation of the Pelvis.- 3.1 Transverse Collateral Veins.- 3.2 Vertical Collateral Veins.- XXVI. Nerves in the Pelvis.- Somatic Motor Innervation.- 1. Lumbar Plexus.- 1.1 Iliohypogastric Nerve.- 1.2 Ilio-inguinal Nerve.- 1.3 Genitofemoral Nerve.- 1.4 Lateral Cutaneous Nerve of Thigh.- 1.5 Femoral Nerve.- 1.6 Obturator Nerve.- 2. Sacral Plexus.- 2.1 Sciatic Nerve.- 2.2 Superior Gluteal Nerve.- 2.3 Inferior Gluteal Nerve.- 2.4 Gluteal Branches of Posterior Cutaneous Nerve.- 2.5 Posterior Cutaneous Nerve of Thigh.- 2.6 Pudendal Plexus.- 2.7 Pudendal Nerve.- 2.8 Inferior Rectal Nerves.- 2.9 Perineal Nerves.- 2.10 Dorsal Nerve of Penis.- 2.11 Branches of Coccygeal Plexus.- Spinal Cord Segments and the Muscles Supplied.- Somatic Sensibility (Pain).- 1. First Neuron.- 2. Second Neuron.- Supraspinal, Ascending Conduction.- 1. Rhombencephalon.- 2. Diencephalon.- 3. Telencephalon.- The Autonomic Nervous System in the Pelvis.- 1. Sympathetic Nervous System in the Pelvis.- 1.1 First Neuron.- 1.2 Prevertebral Plexus.- 1.3 Transmitter Substances.- 2. Parasympathetic Nervous System in the Pelvis.- XXVII. Pelvic Connective Tissue.- 1. Dense Connective Tissue.- 1.1 Ligaments.- 1.2 Boundary Lamellae.- 1.3 Fasciae.- 1.4 Neurovascular Bundles.- 2. Loose Connective Tissue.- 2.1 Spaces.- XXVIII. The Lymphatic System in the Pelvis.- 1 Lymphatic System and Connective Tissue.- 2. Regional Lymph Nodes in the Pelvis.- 2.1 Lumbar Lymph Nodes.- 2.2 Common Iliac Lymph Nodes.- 2.3 External Iliac Lymph Nodes.- 2.3 Internal Iliac Lymph Nodes.- 2.4 TNM Classification of Lymph Nodes in the Pelvis.- Special Part.- I. The Kidneys (Renes).- 1. Size and Weight of the Kidneys.- 2. Age Differences of the Kidneys.- 3. Dimensions of the Kidneys.- 3.1 Measurements of Fixed Kidneys.- 3.2 Roentgenological Measurements.- 4. Anatomical Features of the Kidneys.- 5. Position of the Kidneys.- 6. Topographical Features of the Kidneys.- 7. Renal Bed and Renal Fasciae.- 8. The Fastenings of the Kidney.- 8.1 Posterior Renal Fascia.- 8.2 Anterior Renal Fascia.- 8.3 Adipose Renal Capsule, Perirenal Fat.- 8.4 Fibrous Renal Capsule.- 9. Surgical Approaches to the Kidney.- 9.1 Retroperitoneal Approach to the Kidney.- 10. Arteries of the Kidneys Ill.- 10.1 Renal Artery Ill.- 10.2 Primary Branches of the Renal Artery.- 10.3 Secondary Branches Ill.- 10.4 Procedures for Bypassing a Stenosed Renal Artery.- 10.5 Accessory Renal Arteries.- 10.6 Variations in the Sequence of Branching in the Primary and Secondary Branches of the Renal Artery.- 10.7 Variations in the Renal Segments.- 10.8 Intrarenal Arteries.- 11. The Veins of the Kidney.- 11.1 Renal Vein.- 11.2 The Veins of the Perirenal Space.- 11.3 Primary Embryonic Venous System.- 11.4 Secondary Embryonic Venous System.- 12. The Lymphatics of the Kidney and the Regional Lymph Nodes.- 13. Innervation of the Kidneys and Pain.- 14. The Embryological Development of the Kidney and the Interpretation of its Malformations.- 14.1 General.- 14.2 Stages in the Development of the Kidney.- 15. Malformations of the Kidney.- 15.1 Malformations of the Metanephrogenic Blastema.- 15.2 Anomalies of the Nephron and Collecting Tube System (Ureteric Bud).- 15.3 Anomalies of the Position of the Kidneys.- 15.4 Agenesis of the Kidney.- 15.5 Hypoplasia of the Kidney.- 15.6 Dysplasia (Ectopia) of the Kidney ..- 15.7 Polycystic Kidneys.- 15.8 Solitary Cysts of the Kidneys.- 15.9 Renal Dystopia.- 15.10 Abnormal Rotation of the Renal Pelvis.- 15.11 Injuries of the Kidney.- II. Renal Pelvis.- 1. Boundaries of the Renal Pelvis.- 2. Bioconstruction of the Renal Pelvis.- 3. Types of Renal Pelvis.- 4. Arteries of the Renal Pelvis.- 5. Function of the Renal Pelvis and Ureter.- III. Ureter.- 1. Length and Segments of the Ureter.- 2. Points at which the Ureter Narrows.- 3. Relations of the Ureter.- 3.1 Abdominal (Lumbar) Part of the Ureter.- 3.2 Curves of the Ureter.- 3.3 Pelvic Part of Ureter.- 3.4 Intramural Part of Ureter.- 4. Arteries of the Ureter in the Lumbar and Pelvic Regions.- 5. Lymphatics and Regional Lymph Nodes of the Ureter.- 6. Innervation of the Ureter and Pain.- 7. Bioconstruction of the Ureter and its Intramural Part (Trigone of the Bladder).- 8. Vesicoureteric Reflux.- 9. Shape and Appearance of the Ureteric Orifice.- 10. Surgical Approaches to the Ureter.- 11. Malformations of the Ureter.- 11.1 Reduplication of the Ureter.- 11.2 Retrocaval Ureter.- 11.3 Ectopia of the Ureters.- 11.4. Ureteroceles.- IV. Urinary Bladder.- 1. Situation and Shape.- 2. Internal Features.- 3. Topographical Relations of the Bladder to Adjacent Organs.- 4. Relation of the Bladder to the Peritoneum.- 5. Supporting Connective Tissue of the Bladder.- 5.1. Puboprostatic Ligament.- 5.2 Pubovesical Ligament.- 6. Neurovascular Bundle.- 6.1. Paravesical Connective Tissue in the Male.- 6.2. Paravesical Connective Tissue in the Female.- 7. Spaces Related to the Bladder.- 8. Fasciae of the Bladder.- 9. Urachus.- 10. Median Umbilical Fold.- 11. Bioconstruction of the Bladder Wall.- 12. Bioconstruction of the Bladder Outlet.- 13. Dimensions of the Ureter and Bladder.- 14. Arteries of the Bladder.- 15. Veins of the Bladder.- 16. Lymphatics of the Bladder and Regional Lymph Nodes.- 17. Innervation of the Bladder.- 18. Regulation of Bladder Function.- 19. Control of Bladder Function.- 20. Neurogenic Disorders of Bladder Function.- 21. Head's Zones.- 22. Development of the Bladder.- 23. Persistent Urachus.- V. Prostate.- 1. Shape of the Prostate.- 2. Lobes of the Prostate.- 3. Dimensions of the Prostate.- 4. Systematic Divisions of the Prostate.- 5. Clinical Divisions of the Prostate.- 6. Topographical Relations of the Prostate to Other Organs.- 7. Periprostatic Fibrous Tissue.- 8. Anchorages of the Prostate.- 9. Musculature of the Prostate.- 10. Prostatic Part of Urethra.- 11. Prostatic Utricle.- 12. Prostatic Secretion.- 13. Arteries of the Prostate.- 14. The Veins of the Prostate.- 15. Lymphatics and Regional Lymph Nodes of the Prostate.- 16. Innervation of the Prostate.- 17. Surgical Approaches to the Prostate.- 18. Development of the Prostate.- VI. Seminal Vesicle.- 1. Shape and Size of the Seminal Vesicles.- 2. Topography of the Seminal Vesicles.- 3. Excretory Ducts of the Seminal Vesicles.- 4. Arteries of the Seminal Vesicles.- 5. Veins of the Seminal Vesicles.- 6. Regional Lymph Nodes of the Seminal Vesicles.- 7. Innervation of the Seminal Vesicles.- VII. Male Urethra.- 1. Parts of the Male Urethra.- 2. Diameter of Lumen of the Male Urethra.- 3. Intrapelvic Segments of the Urethra.- 3.1. Prostatic Part of the Urethra.- 3.2. Membranous Part of the Urethra.- 4. External Meatus of the Urethra.- 5. Curves of the Urethra.- 6. Rupture of the Urethra.- 7. Surgical Access to the Urethra.- 8. Malformations of the Urethra.- 9. Lymphatics and Regional Lymph Nodes of the Urethra.- 10. Innervation of the Urethra.- VIII. Penis.- 1. Parts of the Penis.- 2. Corpus Spongiosum of the Penis.- 3. Tunica Albuginea of the Penis.- 4. Corpora Cavernosa of the Penis.- 5. Glans Penis.- 6. Arteries of the Penis.- 7. Veins of the Erectile Tissue of the Penis.- 8. Lymphatics of the Penis.- 9. Innervation of the Penis.- 10. The Skin of the Penis.- 11. Fasciae of the Penis.- 12. Muscles of the Penis.- IX. Scrotum.- 1. Skin of the Scrotum.- 2. Fasciae of the Scrotum.- 3. Arteries of the Scrotum.- X. Testis.- 1. Shape of the Testis.- 2. Coverings of the Testis.- 3. Tunica Albuginea of the Testis.- 4. Semen Formation and Conduction.- 4.1. Spermatocytogenesis.- 4.2. Spermatozoa.- 4.3. Seminal Fluid.- 5. Hormonal Regulation of Spermiogenesis.- 6. Interstitial Structures of the Testis.- 7. Varicocele.- 8. Regional Lymphatics and Lymph Nodes of the Testis.- 9. Innervation of the Testis.- 10. Summary of the Development of the Testis.- 11. Anomalies in the Position of the Testis.- 12. Testicular Appendages.- 13. Approaches to and Operations on the Testis.- 14. Torsion of the Testis.- 15. Abnormalities of the Coverings of the Testis.- XI. Bowel Segments in the Pelvis.- 1. Development of the Bowel.- 2. Developmental Malpositions of the Bowel.- 2.1. Nonrotation of the Umbilical Loop.- 2.2. Nonrotation (without Volvulus of the Bowel).- 2.3. Nonrotation (with Volvulus of the Intestine).- 2.4. Malrotation I (Caecum Altum Congenitum).- 2.5. Malrotation II.- 2.6. Retroposition of the Transverse Colon with Volvulus of Small and Large Bowel and Mobile Caecum.- 2.7. Retroposition of Transverse Colon.- 2.8. Common Mesentery.- XII. The Cecum.- 1. Situation of the Cecum.- 2. Peritoneal Relationships of the Cecum.- 3. Mobile Cecum.- 4. Cecal Membranes.- 5. Arteries of the Cecum.- 6. Veins of the Cecum.- 7. Lymphatics and Regional Lymph Nodes of the Cecum.- 8. Nerve Supply of the Cecum and Pain.- 9. The Ileocecal Junction.- 10. Colonic Sphincters.- 11. Vermiform Appendix.- 11.1 Position of the Vermiform Append.- 11.2 Bioconstruction of the Vermiform Appendix.- 11.3 Arteries of the Vermiform Append.- 11.4 Clinical considerations.- XIII. The Rectum.- 1. Boundaries of the Rectum and Nomenclature.- 2. Transition from the Sigmoid Colon into the Rectum.- 3. Subdivisions of the Rectum.- 4. Shape of the Rectum.- 5. Internal Contours of the Rectum.- 6. Valves of the Rectum.- 7. Internal Features of the Anal Canal.- 8. Peritoneal Relations of the Rectum.- 9. Fasciae of the Rectum.- 10. Perirectal Spaces.- 11. Relations of the Anal Canal.- 12. Bioconstruction of the Rectal Wall.- 13. Bioconstruction of the Wall of the Anal Canal.- 14. Sex Differences in the Sphincter Ani Externus Muscle.- 15. Aganglionosis of the Anal Canal.- 16. Proctodeal Glands.- 17. Vessels of the Anal Canal.- 18. Nerve Supply of the Anal Canal.- 19. Continence of Faeces.- 20. Control of the Continence Mechanisms.- 21. Arteries of the Rectum and Anal Canal.- 22. The Veins of the Rectum and Anal Canal.- 23. Lymphatics, Regional Lymph Nodes, Arteries and Surgical Access.- 24. Lymphatics of the Rectum and Anal Canal of the Rectum.- 25. Resection of the Rectum.- 26. Innervation of the Rectum.- 27. Anorectal Fistulae.- 28. Anorectal Abscess.- 29. Malformations of the Rectum and Anal Region.- 30. Surgical Access in Cases of Rectal Trauma.- 31. Relations of the Rectum to Adjacent Organs.- 32. Relations of the Anal Canal.- 33. Age Changes in the Rectum.- 34. Surgical Approaches to the Rectum.- XIV. The Perineal Region in the Male.- XV. Anal Region.- XVI. Urogenital Region.- 1. Superficial Perineal Space.- 2. Central Tendon of the Perineum.- 3. Levator Prostatae Muscle.- 4. Rectourethralis Superior Muscle.- 5. Rectourethralis Inferior Muscle.- 6. Muscle of Treitz.- 7. Anobulbar Space.- 8. Sagittal Bracing of the Central Tendon of the Perineum.- 9. Transverse Bracing.- XVII. Ovary.- 1. Position and Shape of the Ovaries.- 2. Size of the Ovary.- 3. Position of the Ovary during Development.- 4. Peritoneal Relations of the Ovary.- 5. Anatomic Relations of the Ovary.- 6. Arterial Supply of the Ovary.- 7. Venous Drainage of the Ovary.- 8. Lymphatic Drainage of the Ovary.- 9. Innervation of the Ovary.- 10. Microscopic Structure of the Ovary.- 11. Control of Structural Changes within the Ovary.- 12. Malformations of the Ovary.- XVII. Uterine Tube.- 1. Divisions of the Uterine Tubes.- 2. Structure of the Uterine Tube.- 3. Tubal Pregnancy.- 4. Tubal Dimensions.- 5. Mesosalpinx.- XIX. Vagina.- 1. Form and Parts of the Vagina.- 2. Fasciae and Perivaginal Spaces.- 3. Neurovascular Conduit of the Vagina.- 4. Bioconstruction of the Vagina.- 5. Arteries of the Vagina.- 6. Veins of the Vagina.- 7. Lymphatics and Regional Lymph Nodes of the Vagina.- 8. Innervation of the Vagina.- XX. The Uterus.- 1. Parts of the Uterus.- 2. Uterine Dimensions.- 3. Age Changes and Topography of the Uterus.- 4. Position of the Uterus.- 5. Peritoneal Relationships of the Uterus and its Suspensory Apparatus.- 6. Peritoneum and Subperitoneal Fibrous Tissue on the Uterus and Vagina.- 7. Structure of the Endometrium.- 8. Bioconstruction of the Myometrium and the Cervix.- 9. Course of the Ureter in the Female Pelvis.- 10. Arteries of the Uterus.- 11. Veins of the Uterus.- 12. Lymphatics and Regional Lymph Nodes of the Uterus.- 13. Innervation of the Uterus.- 14. Malformations of the Uterus.- 14.1. Outline of Normal Development in Relation to Malformations.- 14.2. Developmental Stages and Malformations of the Uterus.- 14.3. Varieties of Congenital Atresia of the Female Genital Organs.- XXI. The Vulva.- 1. Labia Majora.- 2. Labia Minora.- 3. Vestibule of Vagina.- 4. Clitoris.- 5. Arteries of the Vulva.- 6. Veins of the Vulva.- 7. Lymphatics of the Female Perineum.- 8. Innervation of the Female Perineum.- 9. Episiotomy.- XXII. Forms of Intersexuality.- References.