The bladder , urethra and the musculature of the pelvic floor form the functional unit responsible for urinary continence. The anatomical structures of the pelvis are divided in passive and active¹. The passive ones are formed by the pelvic bones (coxae and sacrum), visceralis and parietalis fasciae (endopelvic fascia) associated to smooth muscular fibres form ligaments and muscles that will support the bladder and urethra^2,3,4. The porcion of the fascia that adheres to the uterus is called parametrium, and the one adhered to the vagina, paracolpium, having as amin components the uterosacral and cardianl ligaments.
The active anatomical structures comprise the neuromuscular components, responsible for the maintenance of the muscular contraction in answer to the sudden increase of the abdominal pressure. In the lateral regions of the pelvic floor we identify two strutures denominated tndinous arcus of the anus elevator and thepelvic fascia., formed by conjective tissues, important in the support of the anus elevator muscle, anterolateral vaginal wall and urethra³. The urethra’s support is frequently denominated pubourethral ligament, including fasciae and muscular ligaments of the tendinous arcus of the pelvis fascia. These structures are present in a third distal of the urethra, only portion of the urethra fixed to the pubis⁵.
DeLancey et al⁶ , in 1992, introduced the concept that conjuctive tessue support the pelvis in three levels: level I is formed by uterocacral and cardinal ligaments; level II, by middle ligaments of the vagina with structures that envolve the urethra, anus elevater, perineal muscles and body of the perineo.