The pubovesical ligaments are the female equivalents of the puboprostatic ligaments in males, connecting the anterior bladder wall and bladder neck to the posterior surface of the pubic symphysis. They are thickenings of the anterior pelvic fascia and are continuous with the pubourethral ligaments inferiorly and the bladder pillars laterally. They anchor the bladder neck in its retropubic position.
| Origin | Posterior surface of the pubic bones |
|---|---|
| Insertion | Neck of the bladder |
Support the bladder neck in its correct retropubic position, contributing to bladder neck closure during stress and maintaining the posterior urethrovesical angle that is important for stress continence mechanisms.
Pubovesical ligament attenuation after vaginal delivery and with menopausal oestrogen loss contributes to anterior compartment prolapse, bladder neck descent and stress urinary incontinence. The retropubic approach to bladder neck suspension (Burch colposuspension) elevates the paravaginal fascia and bladder neck by suturing it to the Cooper pectineal ligament, effectively restoring pubovesical support. The mid-urethral sling (tension-free vaginal tape) supports the mid-urethra as a backboard during straining. Anterior vaginal wall repair (anterior colporrhaphy) and paravaginal repair address pubovesical ligament complex defects.
Attenuation of the pubovesical ligaments and anterior pelvic support allows the bladder to prolapse into the anterior vaginal wall, producing an anterior vaginal bulge with bladder symptoms including incomplete emptying and stress incontinence, managed with pessaries or surgical repair.
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