The pubovesical ligament connects the anterior surface of the bladder neck to the posterior surface of the pubic symphysis, suspending the bladder neck from the pubic bone. In females it is well-developed; in males the equivalent puboprostatic ligament connects the prostate to the pubis. The pubovesical ligament represents the anterior condensation of the pelvic fascia and contributes to bladder neck support for urinary continence.
Anchors the bladder neck and anterior vaginal wall to the posterior pubis, maintaining bladder neck position during increases in intraabdominal pressure, and contributes to the continence mechanism by preserving the posterior urethrovesical angle.
The pubovesical ligament is central to the anatomy of stress urinary incontinence (SUI) surgery. The Burch colposuspension elevates the anterior vaginal wall at the bladder neck and proximal urethra by suturing paravaginal fascia to Cooper's ligament (pectineal line), effectively augmenting the pubovesical ligament function. The tension-free vaginal tape (TVT) procedure places a mesh sling at the mid-urethra beneath the pubovesical ligament level to provide a backstop during stress. Pubovesical ligament attenuation from childbirth allows posterior urethrovesical angle loss and SUI.
Attenuation of the pubovesical ligament after vaginal delivery and with oestrogen loss in the menopause allows the bladder neck and proximal urethra to rotate posteriorly during coughing and exercise, breaking the continence mechanism; Burch colposuspension repairs the anatomical deficiency by restoring anterior vaginal wall-pubic symphysis support.
