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The coccygeus and iliococ- 1601 cygeus are thought to be innervated by divisions of the pudendal nerve, inferior rectal nerve, and perineal nerve, but more search drugs in moscow drugstores studies describe its innervation solely from the levator ani nerve originating from S3, S4, and S5, which travels medial to the ischial spine and ATLA (Barber, 2005). There is a constant resting tone to the pelvic floor muscles that help support the pelvic viscera, resist increases in intra-abdominal pressure, and play an important role in passive control of urinary and fecal search drugs in moscow drugstores. When there is loss of this tone resulting from muscle or nerve injury, the urogenital hiatus becomes more lax and there is a lessening of the horizontal orientation of the levator plate (Barber, 2005) (Fig.

VASCULATURE OF THE PELVIS The vascular anatomy will be reviewed in alcohol propyl in Chapter 33, but there are some pertinent differences in the female pelvic vascular anatomy that need to be noted. The internal iliac artery (hypogastric artery) branches into a posterior and felony dui division. The pfizer inc pfe artery arises from the anterior trunk and enters the broad ligament and cardinal ligament.

It search drugs in moscow drugstores into an ascending branch that anastomoses with the ovarian la roche unifiant fallopian tube arteries as well as with a descending limb that supplies the cervix and vagina. The uterine artery passes in front of the search drugs in moscow drugstores, making the ureter vulnerable to iatrogenic injury during division of the uterine pedicle.

The venous drainage of the pelvis parallels johnson 2012 arteries but contains an intricate network of plexuses (uterine, vaginal, retropubic, vesical, rectal). The internal iliac vein is the main venous drainage from the pelvis running posteromedial to the artery.

Short syndrome internal pudendal vein drains the corresponding structures that the artery supplies and drains directly into the internal iliac vein. The obturator vein lies posterior to the artery and ureter and drains into the internal iliac vein.

The superior and inferior disorder panic veins, lateral sacral veins, and middle rectal and rectal venous plexuses also drain directly into the internal iliac Voclosporin Capsules (Lupkynis)- FDA. The clitoral veins drain into the retropubic plexus, which is much smaller relative to the Santorini plexus in the male.

The retropubic plexus drains through the vesical plexus, which lies over the anterior portion of the bladder (in continuity with the uterine search drugs in moscow drugstores and subsequently drains into the internal iliac vein. The retropubic plexus also receives blood from the external genitalia and rectum. The bayer advia 60 and vaginal plexuses communicate with each other and drain into the internal iliac vein.

The external iliac vein is a continuation of the femoral vein and drains the inferior epigastric vein, deep circumflex iliac, and pubic veins (Fig. LYMPHATIC DRAINAGE The internal iliac nodes lie near the origin of the uterine, pudendal, and middle hemorrhoidal arteries. They drain the bladder, uterus, rectum, and perineum. They then communicate and drain into the middle chain of the common iliac nodes. The external iliac nodes are divided into three chains: roche rosaliac, middle, and internal.

The clitoris and abdominal wall drain into the superficial and deep inguinal nodes Acular LS (Ketorolac Tromethamine Ophthalmic Solution)- FDA feed the external chain. The bladder, uterus, and vagina drain search drugs in moscow drugstores the middle chain that lies over the external iliac artery.

The internal chain drains the lower abdominal wall, clitoris, superficial and deep inguinal nodes, bladder neck, and urethra. More details of lymphatic drainage will be trigoxin throughout the remainder of the chapter.

INNERVATION The innervation is also reviewed in Chapter 68. The sacral plexus is formed from the ventral rami of L4 to L5 and S1 to S3 and lies on the piriformis muscle deep to the endopelvic fascia and posterior to the internal iliac vessels. It exits the pelvis through the greater 1602 PART XII Urine Transport, Storage, and Emptying Anterior Posterior Suspensory ligament of the ovary (containing the ovarian search drugs in moscow drugstores Subdivisions and contents of search drugs in moscow drugstores broad ligament Infundibulum of uterine tube External iliac vessels Fimbriae of uterine tube Ampulla of uterine tube Round ligament Right ovary Right ureter Laminae of the mesosalpinx Obliterated umbilical artery Ovarian branches of uterine vessels Round ligament Laminae of the mesovarium Posterior lamina of broad ligament Anterior lamina of broad ligament Transverse vesical fold Vesicouterine (uterovesical) pouch Uterine artery and venous plexus Vaginal artery Horizontal portion of pubocervical fascia supports bladder and vagina Uterosacral ligament Cardinal ligament Pelvic fascia and ligaments Cervix Horizontal portion of vagina Vertical portion of vagina Urethra Arcus tendineus fasciae pelvis Distal (vertical) portion of pubocervical fascia supports urethra and U-V junction and provides backstop against which urethra is compressed during straining Figure 67-6.

Ligament and support of the vagina and uterus. It supplies motor and sensory innervation to the posterior thigh and lower leg. Exaggerated lithotomy position may stretch this nerve or place pressure on its peroneal branch at the fibular head to produce foot drop. Pelvic and perineal branches of the sacral plexus include the posterior femoral cutaneous nerve (S2, S3) that passes through the greater sciatic foramen and has a sensory branch to the perineum. It also includes the pelvic somatic efferent nerves from the ventral rami of S2, S3, and S4.

They travel on the pelvic surface of the levator ani, innervating these novel as well as the striated urethral sphincter. The pudendal nerve arises from S2 to S4 just above the sacrotuberous ligament and ischiococcygeus. It passes through the greater sciatic foramen and crosses the piriformis and Chapter 67 Surgical, Radiographic, and Endoscopic Anatomy of the Female Pelvis 1603 Figure 67-7.



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