Denonvilliers fascia (rectoprostatic fascia in males, rectovaginal fascia in females) is a condensed layer of connective tissue between the posterior wall of the prostate/upper vagina and the anterior wall of the rectum, representing the fused peritoneal leaves of the rectovesical (Pouch of Douglas) pouch. It is approximately 3-5 mm thick and provides the plane for total mesorectal excision (TME) anterior dissection.
Creates a fibrous barrier between the posterior urogenital structures and the anterior rectum, protecting the rectum from prostate or vaginal pathology, and defining the surgical plane for anterior rectal dissection.
Denonvilliers fascia is the critical surgical plane landmark in radical prostatectomy, total mesorectal excision for rectal cancer, and repair of rectovaginal fistula. In TME, the anterior dissection plane on the posterior surface of Denonvilliers fascia protects the cavernous nerves of Walsh (neurovascular bundle) that lie immediately posterolateral. In prostatectomy, the choice of whether to incise anterior or posterior to the fascia determines whether the neurovascular bundle is preserved for erectile function.
The cavernous nerves for erection run posterolateral to the prostate along Denonvilliers fascia; nerve-sparing prostatectomy incises the fascia on the prostatic side, leaving the neurovascular bundle on the rectal side, while non-nerve-sparing surgery removes the fascia with the specimen to clear positive margins.
