Retropubic space

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

Function

The retropubic space is a potential space.

Compartmental pressure

The retropubic space is directly adjacent to the abdominal cavity 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 patients. The pressure is strongly related to body mass index 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 and urological procedures. Access to the space is achieved by separating the rectus abdominis muscle at the mid line, and bluntly dissecting the tissue in the direction of the symphysis pubis, until reaching the peritoneum.

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
• Artificial urinary sphincters are considered first line surgical treatment for certain types of incontinence in men
• Burch colposuspension is a retropubic procedure used in treatment of urinary incontinence in women

References

References

1. "Volume 1, Chapter 86. Abdominal Operations for Urinary Stress Incontinence".
2. Cundiff, Geoffrey W. (2004). "The Pathophysiology of Stress Urinary Incontinence: A Historical Perspective". Reviews in Urology.
3. (March 2001). "What is normal intra-abdominal pressure?". The American Surgeon.
4. (July 2010). "Intra-abdominal pressure and the morbidly obese patients: the effect of body mass index". The Journal of Trauma.
5. F.C. Burkhard, J.L.H.R. Bosch, F. Cruz, G.E. Lemack, A.K. Nambiar, N. Thiruchelvam, A. Tubaro Guidelines Associates: D. Ambühl, D.A. Bedretdinova, F. Farag, R. Lombardo, M.P. Schneider. "EAU Guidelines on Urinary Incontinence in Adults". European Association of Urology.