TY - JOUR
T1 - Interactive three-dimensional teaching models of the female and male pelvic floor
AU - Wu, Yi
AU - Hikspoors, Jill P. J. M.
AU - Mommen, Greet
AU - Dabhoiwala, Noshir F.
AU - Hu, Xin
AU - Tan, Li-Wen
AU - Zhang, Shao-Xiang
AU - Lamers, Wouter H.
N1 - Funding Information: This study was funded by the John L. Emmett Foundation for Urology, National Natural Science Foundation of China (31771324), Graduate Education and Teaching Reform Research Project of Chongqing (yjg183144), and National Natural Science Foundation of China (cstc2018jcyjAX0537). Funding Information: This study was funded by the John L. Emmett Foundation for Urology, National Natural Science Foundation of China (31771324), Graduate Education and Teaching Reform Research Project of Chongqing (yjg183144), and National Natural Science Foundation of China (cstc2018jcyjAX0537). Publisher Copyright: © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Controversies regarding structure and function of the pelvic floor persist because of its poor accessibility and complex anatomical architecture. Most data are based on dissection. This “surgical” approach requires profound prior knowledge, because applying the scalpel precludes a “second look.” The “sectional” approach does not entail these limitations, but requires segmentation of structures and three-dimensional reconstruction. This approach has produced several “Visible Human Projects.” We dealt with limited spatial resolution and difficult-to-segment structures by proceeding from clear-cut to more fuzzy boundaries and comparing segmentation between investigators. We observed that the bicipital levator ani muscle consisted of pubovisceral and puborectal portions; that the pubovisceral muscle formed, together with rectococcygeal and rectoperineal muscles, a rectal diaphragm; that the external anal sphincter consisted of its subcutaneous portion and the puborectal muscle only; that the striated urethral sphincter had three parts, of which the middle (urethral compressor) was best developed in females and the circular lower (“membranous”) best in males; that the rectourethral muscle, an anterior extension of the rectal longitudinal smooth muscle, developed a fibrous node in its center (perineal body); that the perineal body was much better developed in females than males, so that the rectourethral subdivision into posterior rectoperineal and anterior deep perineal muscles was more obvious in females; that the superficial transverse perineal muscle attached to the fibrous septa of the ischioanal fat; and that the uterosacral ligaments and mesorectal fascia colocalized. To facilitate comprehension of the modified topography we provide interactive 3D-PDFs that are freely available for teaching purposes. Clin. Anat. 33:275–285, 2020.
AB - Controversies regarding structure and function of the pelvic floor persist because of its poor accessibility and complex anatomical architecture. Most data are based on dissection. This “surgical” approach requires profound prior knowledge, because applying the scalpel precludes a “second look.” The “sectional” approach does not entail these limitations, but requires segmentation of structures and three-dimensional reconstruction. This approach has produced several “Visible Human Projects.” We dealt with limited spatial resolution and difficult-to-segment structures by proceeding from clear-cut to more fuzzy boundaries and comparing segmentation between investigators. We observed that the bicipital levator ani muscle consisted of pubovisceral and puborectal portions; that the pubovisceral muscle formed, together with rectococcygeal and rectoperineal muscles, a rectal diaphragm; that the external anal sphincter consisted of its subcutaneous portion and the puborectal muscle only; that the striated urethral sphincter had three parts, of which the middle (urethral compressor) was best developed in females and the circular lower (“membranous”) best in males; that the rectourethral muscle, an anterior extension of the rectal longitudinal smooth muscle, developed a fibrous node in its center (perineal body); that the perineal body was much better developed in females than males, so that the rectourethral subdivision into posterior rectoperineal and anterior deep perineal muscles was more obvious in females; that the superficial transverse perineal muscle attached to the fibrous septa of the ischioanal fat; and that the uterosacral ligaments and mesorectal fascia colocalized. To facilitate comprehension of the modified topography we provide interactive 3D-PDFs that are freely available for teaching purposes. Clin. Anat. 33:275–285, 2020.
KW - adiposity
KW - anal sphincter
KW - levator ani muscle
KW - perineal body
KW - rectourethral muscle
KW - sexual dimorphism
KW - urethral sphincter
KW - vaginal support
UR - http://www.scopus.com/inward/record.url?scp=85075322465&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ca.23508
DO - https://doi.org/10.1002/ca.23508
M3 - Article
C2 - 31639237
SN - 0897-3806
VL - 33
SP - 275
EP - 285
JO - Clinical anatomy (New York, N.Y.)
JF - Clinical anatomy (New York, N.Y.)
IS - 2
ER -