UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

FEMALE REPRODUCTIVE SYSTEM AND PELVIC ANATOMY

Figen Oktay Korucuoğlu

Trakya University, Faculty of Medicine, Department of Gynecology and Obstetrics, Edirne, Türkiye

Oktay Korucuoğlu F. Female Reproductive System and Pelvic Anatomy. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.15-27.

ABSTRACT

Pelvic anatomy has critical importance in terms of female reproductive and urinary tract health and surgery. Knowing both the muscular and vascular support status of the anterior abdominal wall is important in the achievement of safe surgical approaches while accessing the abdomen. The bones that constitute the pelvis (ilium, ischium, pubis, sacrum, and coccyx) not only protect but also support the pelvic organs. Among the types of pelvis shapes, the gynecoid type is the most suitable for vaginal labor. The levator ani and coccygeus muscles, which are pelvic floor muscles, ensure continence and keep the organs in their place, while a weakness in these structures is associated with prolapse and incontinence. The endopelvic fascia and, in particular, the Arcus Tendinous Fasciae Pelvis (ATFP) play the main role in the stability of the urethra and vagina. As the ureter enters the pelvis, it angles posteriorly and passes approximately 1 cm below the infundibulopelvic ligament, continues to the lateral cervix and passes under the uterine artery. To prevent complications during surgery, knowing these anatomical relationships is vital. The bladder has a subperitoneal position surrounded by the detrusor muscle, while the urethra is short and serves to provide continence along with the periurethral sphincter complexes. The pelvic organs are vascularized by the visceral branches of the Arteria iliaca interna, whereas sympathetic innervation is provided by the hypogastric nerve, and parasympathetic innervation is provided by the pelvic splanchnic nerves. The accurate functional and surgical understanding of these complex structures is indispensable for physicians, especially those working in the field of urogynecology, to make interventions successfully and safely.

Keywords: Ureter; Urinary bladder; Visceral prolapse; Anatomy; Pelvic floor; Perineum

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