Surgical and Radiologic Anatomy

, Volume 36, Issue 1, pp 71–78 | Cite as

Biomechanical origin of the Denonvilliers’ fascia

  • M. M. Bertrand
  • B. Alsaid
  • S. Droupy
  • G. Benoit
  • M. Prudhomme
Original Article



Since 1836 and the first description of the recto-genital fascia by Charles Denonvilliers, many anatomists have shown interest in this subject. Recently, pelvic surgeons have in turn shown similar interest, for they consider that perfect knowledge of this anatomical domain is crucial for optimal nerve conservation during surgery. Thanks to new anatomical description techniques, fascia location and relationships with pelvic nerves now appear clearer.


To describe and represent Denonvilliers’ fascia and its relationships in the female foetus at different stages of gestation and in three-dimensional space (3D).

Materiel/patients and methods

Computer-assisted anatomical dissection technique was used. Serial histological sections were made from four human female foetuses. Sections were treated with conventional staining, as well as with nerve and smooth muscle immunostaining. Finally, the sections were digitalized and reconstructed in 3D.


Denonvilliers’ fascia was clearly located and visualized in three dimensions. It was present in the female foetus, being distinct from the fascia propria of the rectum. It appeared to be composed of multiple parallel layers situated between the vagina and the rectum. From a lateral view, it had an asymmetrical “Y-shaped” aspect that seemed to play the role of a protective sheet for the neurovascular bundles.


This study betters our comprehension of the Denonvilliers’ fascia in the female foetus and of its connections with pelvic nerves. It also provides a better understanding of safe planes during pelvic dissection. These findings also suggest a biomechanical theory for embryological origin of the Denonvilliers’ fascia.


Denonvilliers’ fascia Embryology Neurovascular bundles Anatomy 3D reconstruction 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Aigner F, Zbar AP, Ludwikowski B, Kreczy A, Kovacs P, Fritsch H (2004) The rectogenital septum: morphology, function, and clinical relevance. Dis Colon Rectum 47(2):131–140PubMedCrossRefGoogle Scholar
  2. 2.
    Alsaid B, Bessede T, Diallo D, Karam I, Uhl JF, Delmas V, Droupy S, Benoit G (2012) Computer-assisted anatomic dissection (CAAD): evolution, methodology and application in intra-pelvic innervation study. Surg Radiol Anat 34(8):721–729PubMedCrossRefGoogle Scholar
  3. 3.
    Alsaid B, Bessede T, Diallo D, Moszkowicz D, Karam I, Benoit G, Droupy S (2011) Division of autonomic nerves within the neurovascular bundles distally into corpora cavernosa and corpus spongiosum components: immunohistochemical confirmation with three-dimensional reconstruction. Eur Urol 59(6):902–909PubMedCrossRefGoogle Scholar
  4. 4.
    Alsaid B, Bessede T, Karam I, Abd-Alsamad I, Uhl JF, Benoit G, Droupy S, Delmas V (2009) Coexistence of adrenergic and cholinergic nerves in the inferior hypogastric plexus: anatomical and immunohistochemical study with 3D reconstruction in human male fetus. J Anat 214(5):645–654PubMedCrossRefGoogle Scholar
  5. 5.
    Arango-Toro O, Domenech-Mateu JM (1993) Development of the pelvic plexus in human embryos and fetuses and its relationship with the pelvic viscera. Eur J Morphol 31(3):193–208PubMedGoogle Scholar
  6. 6.
    Clausen N, Wolloscheck T, Konerding MA (2008) How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae. World J Surg 32(8):1768–1775PubMedCrossRefGoogle Scholar
  7. 7.
    Costello AJ, Brooks M, Cole OJ (2004) Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int 94(7):1071–1076PubMedCrossRefGoogle Scholar
  8. 8.
    Cuneo B, Veau V (1899) De la signification morphologique des aponevroses périvésicales. J Anat Paris 35:235–245Google Scholar
  9. 9.
    Elliot Smith G (1908) Studies in the anatomy of the pelvis, with special reference to the fasciae and visceral supports. Part I. J Anat Physiol 42:198–218Google Scholar
  10. 10.
    Elliot Smith G (1908) Studies in the anatomy of the pelvis, with special reference to the fasciae and visceral supports. Part II. J Anat Physiol 42:252–270PubMedCentralGoogle Scholar
  11. 11.
    Fritsch H (1990) Development of the rectal fascia. Anat Anz 170(3–4):273–280PubMedGoogle Scholar
  12. 12.
    Fritsch H (1993) Development and organization of the pelvic connective tissue in the human fetus. Ann Anat 175(6):531–539PubMedCrossRefGoogle Scholar
  13. 13.
    Heald RJ, Moran BJ (1998) Embryology and anatomy of the rectum. Semin Surg Oncol 15(2):66–71PubMedCrossRefGoogle Scholar
  14. 14.
    Ho KK, O’Sullivan AJ, Weissberger AJ, Kelly JJ (1996) Sex steroid regulation of growth hormone secretion and action. Horm Res 45(1–2):67–73PubMedCrossRefGoogle Scholar
  15. 15.
    Hounnou GM, Uhl JF, Plaisant O, Delmas V (2003) Morphometry by computerized three-dimensional reconstruction of the hypogastric plexus of a human fetus. Surg Radiol Anat 25(1):21–31PubMedCrossRefGoogle Scholar
  16. 16.
    Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K (2006) Operating behind Denonvilliers’ fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum 49(7):1024–1032PubMedCrossRefGoogle Scholar
  17. 17.
    Kiyoshima K, Yokomizo A, Yoshida T, Tomita K, Yonemasu H, Nakamura M, Oda Y, Naito S, Hasegawa Y (2004) Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34(8):463–468PubMedCrossRefGoogle Scholar
  18. 18.
    Kleeman SD, Westermann C, Karram MM (2005) Rectoceles and the anatomy of the posteriorvaginal wall: revisited. Am J Obstet Gynecol 193(6):2050–2055PubMedCrossRefGoogle Scholar
  19. 19.
    Kourambas J, Angus DG, Hosking P, Chou ST (1998) A histological study of Denonvilliers’ fascia and its relationship to the neurovascular bundle. Br J Urol 82(3):408–410PubMedCrossRefGoogle Scholar
  20. 20.
    Lindsey I, Guy RJ, Warren BF, Mortensen NJ (2000) Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 87(10):1288–1299PubMedCrossRefGoogle Scholar
  21. 21.
    Ludwikowski B, Hayward IO, Fritsch H (2002) Rectovaginal fascia: an important structure in pelvic visceral surgery? About its development, structure, and function. J Pediatr Surg 37(4):634–638 (pii:S0022346802707100)PubMedCrossRefGoogle Scholar
  22. 22.
    Newman SA, Forgacs G, Hinner B, Maier CW, Sackmann E (2004) Phase transformations in a model mesenchymal tissue. Phys Biol 1(1–2):100–109PubMedCrossRefGoogle Scholar
  23. 23.
    Ricci JV, Lisa JR et al (1947) The relationship of the vagina to adjacent organs in reconstructive surgery; a histologic study. Am J Surg 74(4):387–410PubMedCrossRefGoogle Scholar
  24. 24.
    Richardson AC (1993) The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol 36(4):976–983PubMedCrossRefGoogle Scholar
  25. 25.
    Taguchi K, Tsukamoto T, Murakami G (1999) Anatomical studies of the autonomic nervous system in the human pelvis by the whole-mount staining method: left-right communicating nerves between bilateral pelvic plexuses. J Urol 161(1):320–325PubMedCrossRefGoogle Scholar
  26. 26.
    Tobin C, Benjamin A (1945) Anatomical and surgical restudy of Denonvilliers’ fascia. Surg Gynecol Obstet 80:373–388Google Scholar
  27. 27.
    Uhlenhuth E, Nolley GW (1957) Vaginal fascia, a myth. Obstet Gynecol 10(4):349–358PubMedGoogle Scholar
  28. 28.
    van Ophoven A, Roth S (1997) The anatomy and embryological origins of the fascia of Denonvilliers: a medico-historical debate. J Urol 157(1):3–9PubMedCrossRefGoogle Scholar
  29. 29.
    Wesson M (1922) The development and surgical importance of the recto-urethralis muscle and Denonvilliers’ fascia. J Urol 8:339–359Google Scholar
  30. 30.
    Zhai LD, Liu J, Li YS, Yuan W, He L (2009) Denonvilliers’ fascia in women and its relationship with the fascia propria of the rectum examined by successive slices of celloidin-embedded pelvic viscera. Dis Colon Rectum 52(9):1564–1571PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • M. M. Bertrand
    • 1
  • B. Alsaid
    • 2
  • S. Droupy
    • 3
  • G. Benoit
    • 4
  • M. Prudhomme
    • 1
    • 5
  1. 1.Laboratory of Experimental Anatomy, Faculty of Medicine Montpellier-NîmesUniversity Montpellier IMontpellierFrance
  2. 2.Laboratory of Anatomy, Faculty of MedicineUniversity of DamascusDamascusSyria
  3. 3.Urology-Andrology DepartmentCHU de Nimes, University Montpellier 1NimesFrance
  4. 4.Laboratory of Experimental Surgery, EA 4122, Faculty of MedicineBicêtre-Paris 11 UniversityLe Kremlin-BicêtreFrance
  5. 5.Digestive surgery DepartmentCHU de Nîmes, University Montpellier 1NimesFrance

Personalised recommendations