Abstract
Denonvilliers’ fascia is an important landmark of the dissection layer during prostate or rectal surgeries. However, there are few reports on its lateral extension. This anatomical study aimed to define the lateral border of Denonvilliers’ fascia and use it as an anatomical landmark to identify the origin and distribution of the nerve branches of the pelvic plexus. We investigated the lateral extent and position of the lateral border of Denonvilliers’ fascia through macroscopic examination of 12 pelvic halves from eight cadavers and histological examination of two cadavers. The Denonvilliers’ fascia extended laterally to be attached to the pelvic plexus on the lateral border. The origins of nerve branches from the pelvic plexus to the pelvic organs, except the rectum, were located anterior or anterosuperior to the lateral border of Denonvilliers’ fascia. The origins of nerve branches to the prostate were mainly anterior to the lateral border of Denonvilliers’ fascia; however, in 3/12 pelvic halves, the nerve branches originated in the region posteroinferior to the lateral border of Denonvilliers’ fascia. The attachment point of Denonvilliers’ fascia to the prostate was more superior in these three pelvic halves (distance from the top point of the posterior surface of the prostate to the attachment point, 5.6 ± 1.9 mm) than that in the other nine pelvic halves (10.1 ± 3.6 mm). The lateral border of Denonvilliers’ fascia is closely related to the pelvic plexus, suggesting its usefulness as an anatomical landmark to identify the origin of nerve branches from the pelvic plexus.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig2_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig3_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig4_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig5_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig6_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig7_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12565-021-00629-4/MediaObjects/12565_2021_629_Fig8_HTML.png)
Similar content being viewed by others
References
Aigner F, Zbar AP, Ludwikowski B, Kreczy A, Kovacs P, Fritsch H (2004) The rectogenital septum: morphology, function, and clinical relevance. Dis Colon Rectum 47:131–140
Akita K, Sakamoto H, Sato T (2003) Origins and courses of the nervous branches to the male urethral sphincter. Surg Radiol Anat 25:387–392
Ali M, Johnson IP, Hobson J, Mohammadi B, Khan F (2004) Anatomy of the pelvic plexus and innervation of the prostate gland. Clin Anat 17:123–129
Baader B, Herrmann M (2003) Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat 16:119–130
Bertrand MM, Alsaid B, Droupy S, Benoit G, Prudhomme M (2014) Biomechanical origin of the Denonvilliers’ fascia. Surg Radiol Anat 36:71–78
Chapuis PH, Kaw A, Zhang M, Sinclair G, Bokey L (2016) Rectal mobilization: the place of Denonvilliers’ fascia and inconsistencies in the literature. Colorectal Dis 18:939–948
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 32:1768–1775
Costello AJ, Brooks M, Cole OJ (2004) Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int 94:1071–1076
Cunéo B, Veau V (1899) De la signification morphologique des aponévroses périvésicales. J Anat Physiol 35:235
Dalpiaz O, Anderhuber F (2017) The fascial suspension of the prostate: a cadaveric study. Neurourol Urodyn 36:1131–1135
Ghareeb WM, Wang X, Chi P, Wang W (2020) The “multilayer” theory of Denonvilliers’ fascia: anatomical dissection of cadavers with the aim to improve neurovascular bundle preservation during rectal mobilization. Colorectal Dis 22:195–202
Huang J, Liu J, Fang J et al (2020) Identification of the surgical indication line for the Denonvilliers’ fascia and its anatomy in patients with rectal cancer. Cancer Commun (lond) 40:25–31
Kim JH, Kinugasa Y, Hwang SE, Murakami G, Rodriguez-Vazquez JF, Cho BH (2015) Denonvilliers’ fascia revisited. Surg Radiol Anat 37:187–197
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 49:1024–1032
Kiyoshima K, Yokomizo A, Yoshida T et al (2004) Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34:463–468
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 82:408–410
Kraima AC, West NP, Treanor D et al (2015) Whole mount microscopic sections reveal that Denonvilliers’ fascia is one entity and adherent to the mesorectal fascia; implications for the anterior plane in total mesorectal excision? Eur J Surg Oncol 41:738–745
Lindsey I, Guy RJ, Warren BF, Mortensen NJ (2000) Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Lindsey, I 87:1288–1299
Liu J, Huang P, Liang Q, Yang X, Zheng Z, Wei H (2019) Preservation of Denonvilliers’ fascia for nerve-sparing laparoscopic total mesorectal excision: a neuro-histological study. Clin Anat 32:439–445
Mauroy B, Demondion X, Drizenko A et al (2003) The inferior hypogastric plexus (pelvic plexus): its importance in neural preservation techniques. Surg Radiol Anat 25:6–15
Muraoka K, Hinata N, Morizane S et al (2015) Site-dependent and interindividual variations in Denonvilliers’ fascia: a histological study using donated elderly male cadavers. BMC Urol 15:42
Nyangoh Timoh K, Moszkowicz D, Creze M, Zaitouna M, Felber M, Lebacle C, Diallo D et al (2021) The male external urethral sphincter is autonomically innervated. Clin Anat 34:263–271
Rothlisberger R, Aurore V, Boemke S et al (2018) The anatomy of the male inferior hypogastric plexus: What should we know for nerve sparing surgery. Clin Anat 31:788–796
Takenaka A, Murakami G, Soga H, Han SH, Arai Y, Fujisawa M (2004) Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy. J Urol 172:1032–1035
Tewari A, Takenaka A, Mtui E et al (2006) The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve-sparing prostatectomy. BJU Int 98:314–323
Van Ophoven A, Roth S (1997) The anatomy and embryological origins of the fascia of Denonvilliers: a medico-historical debate. J Urol 157:3–9
Villers A, Mcneal JE, Freiha FS, Boccon-Gibod L, Stamey TA (1993) Invasion of Denonvilliers’ fascia in radical prostatectomy specimens. J Urol 149:793–798
Walsh PC, Donker PJ (1982) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128:492–497
Walz J, Burnett AL, Costello AJ et al (2010) A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Walz, J 57:179–192
Walz J, Epstein JI, Ganzer R et al (2016) A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol 70:301–311
Xu Z, Chapuis PH, Bokey L, Zhang M (2018) Denonvilliers’ fascia in men: a sheet plastination and confocal microscopy study of the prerectal space and the presence of an optimal anterior plane when mobilizing the rectum for cancer. Colorectal Dis 20:236–242
Yamaguchi K, Kobayashi M, Kato T, Akita K (2011) Origins and distribution of nerves to the female urinary bladder: new anatomical findings in the sex differences. Clin Anat 24:880–885
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 52:1564–1571
Zhang C, Ding ZH, Li GX, Yu J, Wang YN, Hu YF (2010) Perirectal fascia and spaces: annular distribution pattern around the mesorectum. Dis Colon Rectum 53:1315–1322
Acknowledgements
We acknowledge and thank the anonymous individuals who generously donated their bodies to perform this study. We also thank Editage (www.editage.jp) for English language editing. This work was supported by JSPS KAKENHI (Grant Numbers JP19K23821) and Ishizu Shun Memorial Scholarship.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
He, M., Muro, S. & Akita, K. Positional relationship between the lateral border of Denonvilliers’ fascia and pelvic plexus. Anat Sci Int 97, 101–109 (2022). https://doi.org/10.1007/s12565-021-00629-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12565-021-00629-4