••• Chapter 38^ Pelvic Organ Prolapse^377
❍ What conditions may mimic a urethrocele?
Urethral caruncle, urethral diverticulum or inflamed Skene’s gland.
❍ What forms the intermediate layer of the pelvic floor between the endopelvic fascia and the urogenital
diaphragm?
Levator ani.
❍ What structure is located on the pelvic sidewall approximately halfway between the pubic bones and
the sacrum?
Ischial spine.
❍ What two band of fibrous tissue are located on the pelvic wall between the spines and pubic bones?
Arcus tendineus fasciae pelvis and arcus tendineus muscularis levator ani.
❍ What muscle overlies the sacrospinous ligament?
Coccygeus muscle.
❍ Trunks of what nerve cross the surface of the piriformis muscle?
Sciatic nerve.
❍ The cardinal ligaments arise from what region?
Greater sciatic foramen.
❍ The uterosacral ligaments originate from what region?
Second, third, and fourth sacral vertebrae.
❍ What muscles support the pelvic viscera?
Pubococcygeus and iliococcygeus.
❍ What are three common apical attachment points used in pelvic organ prolapse repair?
The sacrum, uterosacral ligaments and sacrospinous ligaments.
❍ Vesical neck support is provided by what structure and its attachment to the fascial arch (arcus tendineus
musculi levatori ani)?
Pubovesical fascia.
❍ What are the most frequent symptoms of uterine prolapse?
Fullness of the vagina, sensation of something “falling out,” or a protrusion/bulge at the introitus. At times vaginal
bleeding maybe the first complaints if the bulge rubs against clothing.
❍ Marked degrees of uterine prolapse may compress the ureters resulting in what abnormality of the ureters?
Hydroureter.