Denonvilliers' fascia as a potential nerve-course marker for the female urinary bladder

This study investigated the relationship between Denonvilliers' fascia (DF) and the pelvic plexus branches in women and explored the possibility of using the DF as a positional marker in nerve-sparing radical hysterectomy (RH). This study included eight female cadavers. The DF, its lateral border, and the pelvic autonomic nerves running lateral to the DF were dissected and examined. The pelvis was cut into two along the mid-sagittal line. The uterine artery, deep uterine veins, vesical veins, and nerve branches to the pelvic organs were carefully dissected. The nerves ran sagitally, while the DF ran perpendicularly to them. The rectovaginal ligament was continuous with the DF, forming a single structure. The DF attached perpendicularly and seamlessly to the pelvic plexus. The pelvic plexus branches were classified into a ventral part branching to the bladder, uterus, and upper vagina and a dorsal part branching to the lower vagina and rectum as well as into four courses. Nerves were attached to the rectovaginal ligament and ran on its surface to the bladder ventral to the DF. The uterine branches split from the common trunk of these nerves. The most dorsal branch to the bladder primarily had a common trunk with the uterine branch, which is the most important and should be preserved in nerve-sparing Okabayashi RH. The DF can be used as a marker for nerve course, particularly in one of the bladder branches running directly superior to the DF, which can be preserved in nerve-sparing Okabayashi RH. [Display omitted] •The rectovaginal ligament was a continuous structure with the Denonvilliers' fascia (DF) and lined the pelvic plexus.•Pelvic plexus branches were classified by lateral attached part of DF to the pelvic plexus into ventral and dorsal parts.•The branches originating from the pelvic plexus were classified into four courses.•Nerves were attached to the rectovaginal ligament and ran on its surface to the bladder, ventral to the DF.•The most dorsal branch from bladder is important and should be preserved in nerve-sparing Okabayashi radical hysterectomy.