Perineum 2014
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Transcript of Perineum 2014
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PERINEUM
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Berada pada outlet pelvis dan dipisahkan dari
capvitas pelvis oleh diafragma pelvis(Levator
ani and coccygeus muscles)
Dibatasi oleh simphysis pubis pada anterior Anterolateral; inferior pubic rami and ischial rami
Lateral: ischial tuberosity
posterolateral: sacrotuberous ligamentinferior sacrum and coccyx
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Perineum
2 Triangles
Anal triangle (posterior) contains the anus
Urogenital triangle (anterior) contains the root of thescrotum and penis in males or the external genitalia infemales
Membran perineal membentang antara dua sisiarkus pubis dan meliputi bagian anterior outlet
perineal body : mass fibromuscular irregularberlokasi antara anal canal dan perinealmembrane
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Perineum pria dan wanita
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The subcutaneous tissue of the urogenital triangle includes a
superficial fatty layer and a deeper membranous layer, theperineal fascia (Colles fascia), which are continuous withcorresponding layers of the inferior anterior abdominal wall. ♦
In females, the fatty layer is thick within the mons pubis andlabia majora, but in males it is replaced by smooth dartosmuscle in the penis and scrotum. ♦
The perineal fascia is limited to the UG triangle, fusing withthe deep fascia at the posterior border (base) of the triangle.♦
In males, this layer extends into the penis and scrotum,where it is closely associated with the loose, mobile skin ofthose structures.
UG TRIANGLE
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The planar perineal membrane divides the
urogenital triangle of the perineum into
superficial and deep perineal pouches.
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Superficial perineal pouch
between the membranous layer of
subcutaneous tissue of the perineum and the
perineal membrane
bounded laterally by the ischiopubic rami
contains the erectile bodies of the external
genitalia and associated muscles, the
superficial transverse perineal muscle, deepperineal nerves and vessels, and in females
the greater vestibular glands
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Perineal Membrane
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Perineum
Muscles
Bulbospongiosus –
F O: tendon central perineum,
M O: tendon central dan bulb of penis;
F I: dorsum clitoris, diaphragma urogenital, M I: akar penis;
A: kompressi orifisium vagina atau kompressi urethra,
N: perineal nerve, pudenal nerve
IschiocavernosusO: ramus ischium,
I: dekat symphysis pubic, menjaga ereksi penis atauklitoris
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Muscles – Male
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Perineal Body
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Superficial Transverse Perineal
O: Ischial tuberosity
I: Perineal body
A: Support perineal body
N: Pudenal nerve
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External Urethral Sphincter
O: Ischial tuberosity
I: surround urethra
A: compress urethra to maintain urine
continence
N: Pudenal (S2-S4)
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Superficial Transverse Perineal
Female
S fi i l T
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Superficial Transverse
Perineal M
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Deep Transverse Perineal
O:aspek medial ramus ischium
I: Pineal Body
A: stabilisasi posisi perineal body
N: Pudenal N (S2-S4)
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Deep Transverse Perineal - F
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Deep Transverse Perineal -M
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Deep perineal pouch
is between the perineal membrane and the inferior
fascia of the pelvic diaphragm
is bounded laterally by the obturator fascia
includes the fat-filled anterior recesses of theischioanal fossae (laterally), the deep perineal
muscle and inferiormost part of the external
urethral sphincter, the part of the urethra
traversing the perineal membrane andinferiormost external urethral sphincter (the
intermediate urethra of males), the dorsal nerves
of the penis/clitoris, and in males the bulbourethral
glands.
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Anal Triangle
The ischioanal fossae are fascia-lined, wedge-
shaped spaces occupied by ischioanal fat
bodies.
The fat bodies provide supportive packing thatcan be compressed or pushed aside to permit
the temporary descent and expansion of the
anal canal or vagina for passage of feces or a
fetus. ♦
The fat bodies are traversed by inferior
anal/rectal neurovasculature. ♦
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Canalis Alcock
The pudendal canal is an important
passageway in the lateral wall of the fossa,between layers of the obturator fascia, forneurovasculature passing to and from theUG triangle
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Branches
Superior gluteal Inferior gluteal
Pudendal
Posterior femoral
cutaneou
Sciatic Common
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Pudendal nerve block
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