ArticlePloS one2015
3D Topography of the Young Adult Anal Sphincter Complex Reconstructed from Undeformed Serial Anatomical Sections.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed, 48 citations in OpenAlex.
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- Contrast-enhanced Micro-CT imaging of a foetal female pelvic floor reveals anatomical details.PloS one · 2025Article
- Skeletal Muscle Complex Between the Vagina and Anal Canal: Implications for Perineal Laceration.International urogynecology journal · 2024Observational
- Towards a Terminologia Anatomica Humana.Anatomical science international · 2024Article
- Pain in the enthesis of levator ani muscle: A novel source of chronic pelvic pain.Journal of the Chinese Medical Association : JCMA · 2024Article
- Twisted orientation of the muscle bundles in the levator ani functional parts in women: Implications for pelvic floor support mechanism.Journal of anatomy · 2024Article
- Functional Anatomy of Urogenital Hiatus Closure: the Perineal Complex Triad Hypothesis.International urogynecology journal · 2024Article
- Automatic segmentation of the female pelvic floor muscles on MRI for pelvic floor function assessment.Quantitative imaging in medicine and surgery · 2023Article
- Pelvic floor and perineal muscles: a dynamic coordination between skeletal and smooth muscles on pelvic floor stabilization.Anatomical science international · 2023Review
- Study of female pelvic floor muscle in overactive bladder based on MRI 3D reconstruction.BMC urology · 2022Article
- Attachment of the levator ani muscle extends to the superior ramus of the pubic bone through electrophysiological and anatomical examinations.Scientific reports · 2021Article
- The series of smooth muscle structures in the pelvic floors of men: Dynamic coordination of smooth and skeletal muscles.Clinical anatomy (New York, N.Y.) · 2021Article
- Various significant connections of the male pelvic floor muscles with special reference to the anal and urethral sphincter muscles.Anatomical science international · 2020Article
- Interactive three-dimensional teaching models of the female and male pelvic floor.Clinical anatomy (New York, N.Y.) · 2020Article
- Three muscle slings of the pelvic floor in women: an anatomic study.Anatomical science international · 2020Article
- Application of three-dimensional reconstruction and printing as an elective course for undergraduate medical students: an exploratory trial.Surgical and radiologic anatomy : SRA · 2019Article
- Etiology and management of low anterior resection syndrome based on the normal defecation mechanism.Surgery today · 2019Review
- Anatomy of the smooth muscle structure in the female anorectal anterior wall: convergence and anterior extension of the internal anal sphincter and longitudinal muscle.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2019Article
- Architecture of structures in the urogenital triangle of young adult males; comparison with females.Journal of anatomy · 2018Article
- Three-Dimensional Portable Document Format (3D PDF) in Clinical Communication and Biomedical Sciences: Systematic Review of Applications, Tools, and Protocols.JMIR medical informatics · 2018Review
Corrections and comments
- Erratum issued
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPelvic-floor anatomy is usually studied by artifact-prone dissection or imaging, which requires prior anatomical knowledge. We used the serial-section approach to settle contentious issues and an interactive 3D-pdf to make the results widely accessible.
method3D reconstructions of undeformed thin serial anatomical sections of 4 females and 2 males (21-35y) of the Chinese Visible Human database.
findingsBased on tendinous septa and muscle-fiber orientation as segmentation guides, the anal-sphincter complex (ASC) comprised the subcutaneous external anal sphincter (EAS) and the U-shaped puborectal muscle, a part of the levator ani muscle (LAM). The anococcygeal ligament fixed the EAS to the coccygeal bone. The puborectal-muscle loops, which define the levator hiatus, passed around the anorectal junction and inserted anteriorly on the perineal body and pubic bone. The LAM had a common anterior attachment to the pubic bone, but separated posteriorly into puborectal and "pubovisceral" muscles. This pubovisceral muscle was bilayered: its internal layer attached to the conjoint longitudinal muscle of the rectum and the rectococcygeal fascia, while its outer, patchy layer reinforced the inner layer. ASC contraction makes the ano-rectal bend more acute and lifts the pelvic floor. Extensions of the rectal longitudinal smooth muscle to the coccygeal bone (rectococcygeal muscle), perineal body (rectoperineal muscle), and endopelvic fascia (conjoint longitudinal and pubovisceral muscles) formed a "diaphragm" at the inferior boundary of the mesorectum that suspended the anorectal junction. Its contraction should straighten the anorectal bend.
conclusionThe serial-section approach settled contentious topographic issues of the pelvic floor. We propose that the ASC is involved in continence and the rectal diaphragm in defecation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.