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In most common handbooks male perineum ligaments  are still described  through    "theories".   The female perineum is rather more badly depicted.  For many surgeons  the female urethra remains as a no subject.  Operating on the female urethra  is merely unthinkable since any touch to a diseased tube is likely to turn into fistula.



After a 40 years experience of discrepancy between theory and practice here are my observations :


a)  Halban fascia does not disappear into  neighbouring  tissues. Its anatomical entity  continues into sub-urethral fascia

In fact, base of bladder and urethra down to its first third  are closely surrounded by a fibrous layer.

Female terminal urethra, as its male homologue,   is "membranous"  i.e. devoid of continence muscles but with a rich blood supply thanks to its spongious tissue.




b)   This intermediate fibrous envelope can be dissected.  When repairing a urinary fistula  the three layers must be sutured separately


c)  Similar to male, female urethra has three layers.  Although very thin and not depicted in treatises, the  albuginea  is a quite visible layer.   It could often  be sutured  with fine material.


Yet noticeable to any perineal surgeon  the sub-urethral fold  remains, to my knowledge, undescribed


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