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Concepts of the rectovaginal septum: implications for function and surgery

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Abstract

Introduction

In the pelvis, the rectogenital septum (RGS) separates the urogenital compartment from the digestive compartment. In men, it corresponds to Denonvilliers’ rectoprostatic fascia or rectovesical septum (RVS). Its purpose—and, indeed, its existence—are controversial in women. The purpose of this review was to update knowledge about the RGS in women and, in particular, to clarify its relationship to pelvic nerves in order to deduce practical consequences of pelvic surgery and compare it to the RVS in men.

Methods

A review of the anatomical and surgical literature was undertaken. Evidence for embryological origin, composition, and surgical importance of the RGS in women and men is suggested.

Results

This manuscript presents evidence of the existence of the RGS in both women (rectovaginal septum, RVaS) and men (rectovesical septum, RVS). It originates from the genital structures and extends from the rectogenital pouch to the perineal body. It is composed of connective tissue associated with bundles of smooth muscle cells and has lateral expansions in close contact with neurovascular bundles originating from the inferior hypogastric plexus. During pelvic surgery for carcinoma, preservation of nerve fibers of erectile bodies is necessary if possible. The RGS is thus an important surgical landmark during urogenital sinus surgery, prolapse surgery, and proctectomy in women as well as during proctectomy and prostatectomy in men.

Conclusions

The RGS is present in women as well as in men, with great similarities between the two sexes. It represents an important surgical landmark during pelvic nerve-sparing surgery.

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Abbreviations

CN:

Cavernous nerve

IHP:

Inferior hypogastric plexus

DSDs:

Disorders of sex development

NVB:

Neurovascular bundle

PPF:

Pelvic parietal fascia

PSF:

Presacral fascia

RGS:

Rectogenital septum

RVF:

Rectal visceral fascia (fascia recti)

RVP:

Rectovaginal pouch (rectouterine pouch)

RVS:

Rectovesical septum (rectoprostatic fascia of Denonvilliers)

RVaS:

Rectovaginal septum

SN:

Spongious nerve

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Acknowledgments

The authors thank Dr. Mostaffa El Hajjam (Service de Radiologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France) for imaging pictures, Pr. Bruno Deval (Chirurgie gynécologique, Clinique Geoffroy Saint-Hilaire, Paris, France) and Pr. Georges Audry (Service de Chirurgie Viscérale pédiatrique et néonatale, Hôpital Trousseau, Paris, France) for surgical pictures.

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Authors and Affiliations

  1. Service de Chirurgie Digestive, Oncologique et Métabolique, Hôpital Ambroise-Paré, AP-HP, 92104, Boulogne-Billancourt, France

    Charles Dariane, David Moszkowicz & Frédérique Peschaud

  2. Université de Versailles St-Quentin-en-Yvelines, UFR des Sciences de la santé Simone-Veil, 78180, Montigny-Le-Bretonneux, France

    Charles Dariane, David Moszkowicz & Frédérique Peschaud

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  1. Charles Dariane
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  2. David Moszkowicz
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Correspondence to Frédérique Peschaud.

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Dariane, C., Moszkowicz, D. & Peschaud, F. Concepts of the rectovaginal septum: implications for function and surgery. Int Urogynecol J 27, 839–848 (2016). https://doi.org/10.1007/s00192-015-2878-3

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