Anatomy of Denonvilliers' Fascia and Its Relationship with Pelvic Autonomic Nerves
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v6i3.4424
Abstract
Objective: This study investigated the anatomy of Denonvilliers' fascia and its relationship with pelvic autonomic nerves. Methods: Eight pelvic specimens (three male and five female specimens) provided by the Department of Anatomy of Guangdong Pharmaceutical University and Sun Yat-sen University were dissected to observe the morphological structure, craniocaudal attachments, and lateral extension of Denonvilliers' fascia, as well as its associations with pelvic autonomic nerves and perirectal fascia. The histological staining was performed to analyze the tissue composition of Denonvilliers' fascia. Additionally, 102 laparoscopic surgical videos of mid-low rectal cancer from the Department of Gastrointestinal Surgery, the Third Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed to verify the anatomical findings. Results: Denonvilliers' fascia was identified in all specimens. In males, it located between the prostate, seminal vesicles, and rectal proper fascia, which located between the posterior vaginal wall and rectal proper fascia in females. It was single-layer membranous structure originating cranially from the lowest peritoneal reflection and terminating caudally at the perineal body. At the anterolateral pelvic wall (approximately 2 o'clock and 10 o'clock positions), it connects with the pelvic fascia to form a complete cylindrical structure. Neurovascular bundles of pelvic autonomic nerves passed through Denonvilliers' fascia and ran in the anterior space, innervating genitourinary functions. Histologically, Denonvilliers' fascia is primarily composed of elastic fibers, collagen fibers, and abundant neurovascular tissues. Conclusion: Denonvilliers' fascia located between the prostate, seminal vesicles or posterior vaginal wall and rectal proper fascia, with cranial attachment to the lowest peritoneal reflection, caudal termination at the perineal body, and laterally attached the pelvic fascia. Neurovascular bundles pass through its anterolateral aspect. Preserving Denonvilliers' fascia during radical rectal cancer surgery is conducive to protecting neurovascular bundles.
Keywords
Denonvilliers' fascia; Pelvic autonomic nerve; Neurovascular bundle; Rectal cancer
Full Text
PDF - Viewed/Downloaded: 1 TimesReferences
[1] Denonvilliers C. Anatomie du perinee. Bull Soc Anat Paris 1836,10:105–7.
[2] Zhu XM et al. Review of Denonvilliers fascia: the controversies and consensuses. Gastroenterology Report, 8(5), 2020, 343–348.
[3] Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
[4] Chew MH, Yeh YT, Lim E, et al. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf). 2016 Aug;4(3):173-85.
[5] Wang Y, Liang X. The further understanding of Denonvilliers fascia based on "Fascial Surgery". Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Oct 25;19(10):1092-1096.
[6] Smith GE. Studies in the Anatomy of the Pelvis, with Special Reference to the Fasciae and Visceral Supports: Part I[J]. J Anat Physiol, 1908,42(Pt 2):198-218.
[7] Miley B, Wesson. The Development and Surgical Importance of the Rectourethralis Muscle and Denonvilliers' Fascia[J].The Journal of Urology,1922,8(4):339-359.
[8] Tobin CE, Benjamin JA. Anatomical and surgical restudy of Denonvilliers' fascia[J]. Surg Gynec Obst, 1945(80):373.
[9] Kourambas J, Angus DG, Hosking P, et al. A histological study of Denonvilliers' fascia and its relationship to the neurovascular bundle[J]. Br J Urol, 1998,82(3):408-10.
[10] Lindsey I, Guy RJ, Warren BF, et al. Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon[J]. Br J Surg, 2000,87(10):1288-99.
[11] Ludwikowski B, Hayward IO, Fritsch H. Rectovaginal fascia: An important structure in pelvic visceral surgery? About its development, structure, and function[J]. J Pediatr Surg, 2002,37(4):634-8.
[12] Wei HB, Fang JF. Total mesorectal excision with preservation of Denonvilliers' fascia (iTME) based on membrane anatomy. Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Jul 25;23(7):666-669.
[13] Bertrand MM, Alsaid B, Droupy S, et al, Prudhomme M. Biomechanical origin of the Denonvilliers' fascia[J]. Surg Radiol Anat, 2014,36(1):71-8.
[14] KINUGASA Y, MURAKAMI G, SUZUKI D, et al. Histological identification of fascial structures posterolateral to the rectum[J]. Br J Surg, 2007, 94(5): 620-626.
[15] STELZNER S, HEINZE T, NIKOLOUZAKIS T K, et al. Perirectal fascial anatomy: new insights into an old problem[J]. Dis Colon Rectum, 2021, 64(1): 91-102.
[16] Xie LF, Li XY. Understanding and protection of the membranous anatomical basis of TME and the mechanism of autonomic nerve injury. Journal of Colorectal & Anal Surgery, 2023, 29(01):6-13. (In Chinese)
[17] WALSH P C, LEPOR H, EGGLESTON J C. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations[J]. Prostate, 1983, 4(5): 473-485.
[18] ZHAI L D, LIU J, LI Y S, et al. Denonvilliers' fascia in women and its relationship with the fascia propria of the rectum examined by successive slices of celloidin-embedded pelvic viscera[J]. Dis Colon Rectum, 2009, 52(9): 1564-1571.
[19] BERTRAND M M, ALSAID B, DROUPY S, et al. Optimal plane for nerve sparing total mesorectal excision, immunohistological study and 3D reconstruction: an embryological study[J]. Colorectal Dis, 2013, 15(12): 1521-1528.
[20] Cong JC, Zhang H. Mechanism and anatomy recognition of neurovascular bundle injury from different perspectives of transabdominal and transanal approach. Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Oct 25;22(10):943-948.
[21] Fang JF, Wei HB. Operation standard and application status of radical rectal cancer resection with preservation of Denonvilliers'fascia(iTME)navigated with Wei's Line. Chinese Journal of Bases and Clinics in General Surgery, 2024, 31(05):518-522. (In Chinese)
[2] Zhu XM et al. Review of Denonvilliers fascia: the controversies and consensuses. Gastroenterology Report, 8(5), 2020, 343–348.
[3] Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
[4] Chew MH, Yeh YT, Lim E, et al. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf). 2016 Aug;4(3):173-85.
[5] Wang Y, Liang X. The further understanding of Denonvilliers fascia based on "Fascial Surgery". Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Oct 25;19(10):1092-1096.
[6] Smith GE. Studies in the Anatomy of the Pelvis, with Special Reference to the Fasciae and Visceral Supports: Part I[J]. J Anat Physiol, 1908,42(Pt 2):198-218.
[7] Miley B, Wesson. The Development and Surgical Importance of the Rectourethralis Muscle and Denonvilliers' Fascia[J].The Journal of Urology,1922,8(4):339-359.
[8] Tobin CE, Benjamin JA. Anatomical and surgical restudy of Denonvilliers' fascia[J]. Surg Gynec Obst, 1945(80):373.
[9] Kourambas J, Angus DG, Hosking P, et al. A histological study of Denonvilliers' fascia and its relationship to the neurovascular bundle[J]. Br J Urol, 1998,82(3):408-10.
[10] Lindsey I, Guy RJ, Warren BF, et al. Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon[J]. Br J Surg, 2000,87(10):1288-99.
[11] Ludwikowski B, Hayward IO, Fritsch H. Rectovaginal fascia: An important structure in pelvic visceral surgery? About its development, structure, and function[J]. J Pediatr Surg, 2002,37(4):634-8.
[12] Wei HB, Fang JF. Total mesorectal excision with preservation of Denonvilliers' fascia (iTME) based on membrane anatomy. Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Jul 25;23(7):666-669.
[13] Bertrand MM, Alsaid B, Droupy S, et al, Prudhomme M. Biomechanical origin of the Denonvilliers' fascia[J]. Surg Radiol Anat, 2014,36(1):71-8.
[14] KINUGASA Y, MURAKAMI G, SUZUKI D, et al. Histological identification of fascial structures posterolateral to the rectum[J]. Br J Surg, 2007, 94(5): 620-626.
[15] STELZNER S, HEINZE T, NIKOLOUZAKIS T K, et al. Perirectal fascial anatomy: new insights into an old problem[J]. Dis Colon Rectum, 2021, 64(1): 91-102.
[16] Xie LF, Li XY. Understanding and protection of the membranous anatomical basis of TME and the mechanism of autonomic nerve injury. Journal of Colorectal & Anal Surgery, 2023, 29(01):6-13. (In Chinese)
[17] WALSH P C, LEPOR H, EGGLESTON J C. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations[J]. Prostate, 1983, 4(5): 473-485.
[18] ZHAI L D, LIU J, LI Y S, et al. Denonvilliers' fascia in women and its relationship with the fascia propria of the rectum examined by successive slices of celloidin-embedded pelvic viscera[J]. Dis Colon Rectum, 2009, 52(9): 1564-1571.
[19] BERTRAND M M, ALSAID B, DROUPY S, et al. Optimal plane for nerve sparing total mesorectal excision, immunohistological study and 3D reconstruction: an embryological study[J]. Colorectal Dis, 2013, 15(12): 1521-1528.
[20] Cong JC, Zhang H. Mechanism and anatomy recognition of neurovascular bundle injury from different perspectives of transabdominal and transanal approach. Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Oct 25;22(10):943-948.
[21] Fang JF, Wei HB. Operation standard and application status of radical rectal cancer resection with preservation of Denonvilliers'fascia(iTME)navigated with Wei's Line. Chinese Journal of Bases and Clinics in General Surgery, 2024, 31(05):518-522. (In Chinese)
Copyright © 2025 Xiangpeng Gu
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License