Retropubic space is a potential avascular space located between the

pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic ...

and the

urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

. The retropubic space is a

preperitoneal space The extraperitoneal space is the portion of the abdomen and pelvis which does not lie within the peritoneum. It includes: * Retroperitoneal space, situated posteriorly to the peritoneum * ''Preperitoneal space'', situated anteriorly to the periton ...

, located behind the

transversalis fascia The transversalis fascia (or transverse fascia) is a thin aponeurotic membrane of the abdomen. It lies between the inner surface of the transverse abdominal muscle and the parietal peritoneum. It forms part of the general layer of fascia lining ...

and in front of

peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesoth ...

. Other names for the retropubic space are "Cave of Retzius" or "Retzius' space", named after the Swedish anatomist

Anders Retzius Anders Adolph Retzius (13 October 1796 – 18 April 1860), was a Swedish professor of anatomy and a supervisor at the Karolinska Institute in Stockholm. Biography Retzius was born in Lund, Sweden, in 1796. He enrolled at Lund University in 18 ...

(1796-1860). The space is a useful landmark in different gynecological and urological surgeries.

Structure

The space is located in the pelvic region and is bounded by the following structures: *Anteriorly: Symphysis pubis *Laterally: Pubic rami and obturator internus muscles *Posteriorly:

Urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

*Floor: Anterior vagina (in women) and proximal urethra

Function

The retropubic space is a

potential space In anatomy, a potential space is a space between two adjacent structures that are normally pressed together (directly apposed). Many anatomic spaces are potential spaces, which means that they are potential rather than realized (with their realiz ...

Compartmental Pressure

The retropubic space is directly adjacent to the

abdominal cavity The abdominal cavity is a large body cavity in humans and many other animals that contains many organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the th ...

and is hence affected with change in intra-abdominal pressure, which in turn affects the physiology of urination and continence. Normally, intra-abdominal pressure is between 5 and 7 mmHg, and can reach 10 to 15 mmHg chronically in certain cases, such as in pregnant or

obese Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

patients. The pressure is strongly related to

body mass index Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...

and a history of previous surgical procedures. This highly elevated pressure in obese and pregnant patients is sometimes referred to as chronic intra-abdominal hypertension. This pressure is relayed to the adjacent retropubic compartment and can affect the structures within.

Clinical significance

The retropubic space is a surgical landmark that has surgical significance in several

gynecological Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined area ...

and

urological Urology (from Greek οὖρον ''ouron'' "urine" and ''-logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organ ...

procedures. Access to the space is achieved by separating the

rectus abdominis muscle The rectus abdominis muscle, ( la, straight abdominal) also known as the "abdominal muscle" or simply the "abs", is a paired straight muscle. It is a paired muscle, separated by a midline band of connective tissue called the linea alba. It exte ...

at the mid line, and bluntly dissecting the tissue in the direction of the symphysis pubis, until reaching the

. Examples of surgeries involving the retropubic space include: * The Sling procedure. Slings are or considered the first line surgical treatment for women with

stress incontinence Stress incontinence, also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the bladder outlet by the urethral sphincter. Pathophysiology It is the loss of sma ...

* Artificial Urinary Sphincters are considered first line surgical treatment for certain types of incontinence in men *

Burch Colposuspension The Burch colposuspension is a procedure to treat urinary incontinence due to pelvic floor relaxation. The paravaginal fascia is attached to Cooper's ligament. The purpose is to suspend the prolapsed urethra so that the urethrovesical junction an ...

is a retropubic procedure used in treatment of

urinary incontinence Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geria ...

in women

References

External links