ANATOMY FEMALE PERINEUM LIGAMENTS
In most common handbooks male perineum ligaments are still described through "theories". The female perineum is rather more badly depicted. For many surgeons the female urethra remains as a no subject. Operating on the female urethra is merely unthinkable since any touch to a diseased tube is likely to turn into fistula.
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MY PERSONAL CONTRIBUTION |
After a 40 years experience of discrepancy
between theory and practice here are my observations :
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a) Halban fascia does not disappear into neighbouring tissues. Its anatomical entity continues into sub-urethral fascia In fact, base of bladder and urethra down to its first third are closely surrounded by a fibrous layer. Female terminal urethra, as its male homologue, is "membranous" i.e. devoid of continence muscles but with a rich blood supply thanks to its spongious tissue. |
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b) This intermediate fibrous envelope can be dissected. When repairing a urinary fistula the three layers must be sutured separately |
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c) Similar to male, female urethra has three layers. Although very thin and not depicted in treatises, the albuginea is a quite visible layer. It could often be sutured with fine material.
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Yet noticeable to any perineal surgeon the sub-urethral fold remains, to my knowledge, undescribed |
