Retropubic space is a potential avascular space located between the

pubic symphysis The pubic symphysis (: symphyses) 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 attache ...

and the

urinary bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the Kidney (vertebrates), kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the ...

. The retropubic space is a preperitoneal space, located behind the

transversalis fascia The transversalis fascia (or transverse fascia) is the fascial lining of the anterolateral abdominal wall situated between the inner surface of the transverse abdominal muscle, and the preperitoneal fascia. It is directly continuous with the ilia ...

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 mesotheli ...

. 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 to Anders Jahan Retzius and Ulrika Beata Prytz in ...

(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 The pubic symphysis (: symphyses) 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 ...

*Laterally: Pubic rami and obturator internus muscles *Posteriorly:

Urinary bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the Kidney (vertebrates), kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the ...

*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 contain Organ (anatomy), organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roo ...

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, considered by multiple organizations to be a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when ...

patients. The pressure is strongly related to

body mass index Body mass index (BMI) is a value derived from the mass (Mass versus weight, weight) and height of a person. The BMI is defined as the human body weight, body mass divided by the square (algebra), square of the human height, body height, and is ...

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 American and British English spelling differences) is the area of medicine concerned with conditions affecting the female reproductive system. It is often paired with the field of obstetrics, which focuses on pre ...

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 system and the reproductive organs. Orga ...

procedures. Access to the space is achieved by separating the

rectus abdominis muscle The rectus abdominis muscle, () also known as the "abdominal muscle" or simply better known as the "abs", is a pair of segmented skeletal muscle on the ventral aspect of a person's abdomen. The paired muscle is separated at the midline by a ba ...

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 Stress incontinence i ...

Artificial urinary sphincter An artificial urinary sphincter (AUS) is an implanted device to treat moderate to severe stress urinary incontinence, most commonly in men. The AUS is designed to supplement the function of the natural urinary sphincter that restricts urine fl ...

s 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 ...

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 significant effect on quality of life. Urinary incontinence is common in older women ...

in women

References

{{Authority control Abdomen

Structure

Function

Compartmental pressure

Clinical significance

See also

References