Pelvic anatomy Flashcards
Which nerve can be inadvertently injured during suprapubic TVT (tension-free vaginal tape)?
Ilioinguinal
When do you do a resection with primary repair for ureteral injury?
small injured segment of ureter of the upper or middle third of the ureter. I.e. thermal injury.
What is a ureteroureterostomy and when do you do it?
Injury to Upper or middle ⅓: End-to-end procedure where ends of the ureters are trimmed and spatulated before suture is used to reapproximate the ends. The anastomosis is done over a ureteral stent.
What is a ureteroneocystotomy and when do you do it?
Injury to Distal ⅓ (aka by uterine artery): bc concern that vascularity interrupted. he distal portion of the ureter is tied off and the proximal segment is anastomosed to the bladder through a cystotomy. If needed for bladder mobilization, psoas hitch may be created to elongate the bladder to the ureter and allow for a tension-free repair
What nerve can be injured with sacrospinous ligament suspension?
Sciatic nerve: L4-S4, motor innervation to hamstrings, sensation to posterior thigh. Injury w/ hyperflexion of thigh in stirrupts. injury=pain down posterior thigh, decreased hamstring strength, absent achilles reflex
What is a post op complication of sacrospinous ligament suspension?
Sacral nerve entrapment: severe gluteal pain
What are post-op risks with sacrosapinous ligament suspension?
dyspareunia, recurrent prolapse (especially anterior vaginal wall), bleeding (internal pudendal and inferior gluteal), pudendal/sacral nerve injury
What do internal and external iliac supply?
Internal iliac: supplies pelvic organs
External iliac: supplies gluteal muscles and lower extremities
What are branches of internal iliac?
ANTERIOR: uterine, umbilical, superior vesicle, obturator, internal pudendal, inferior gluteal, middle rectal, vaginal
POSTERIOR: she likes it (in the butt): superior gluteal, lateral sacral, iliolumbar
I Love Going Places In My Very Own Underwear! Iliolumbar, lateral sacral, gluteal (superior and inferior), pudendal, inferior vesicle (vaginal), superior vesicle, middle rectal, vaginal, obturator, umbilical and uterine
What is the urogenital complex?
- consists of external urethral sphincter proper (circular muscle fibers)
- the compressor urethrae muscle (bilateral extension from the innermost part)
- urethrovaginal sphincter.
What muscle overlies the sacrospinous ligament?
Coccygeus
What are the pelvic floor muscles?
Levator Ani (Puborectalis, Pubo-coccygeus, Iliococcygeus) + Coccygeus
- puborectalis comprises part of internal anal sphincter and is muscle used in levator plication
What are vaginal lymphatics?
Upper 1/3: Iliac
Middle 1/3: Hypogastric
Lower 1/3: Inguinal
What is vaginal arterial supply?
All branches of anterior division of internal iliac.
Upper: cervical branch of uterine (cuff bleeding)
Middle: inferior vesicle
Lower: internal pudendal and middle hemorrhoidal
What are nerves to uterus?
Hypogastric plexus/sympathetics/Frankenhauser’s Plexus
-T11-T12=pain to cervix/upper vagina
- S2, S3, S4 (pudendal)=perineum
