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.
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 contributes to anterior compartment prolapse and bladder neck descent. 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 ligament support. Anterior vaginal wall repair (anterior colporrhaphy) and paravaginal repair address pubovesical ligament complex defects. Bladder injury during cystoscopy-assisted sling procedures can occur if the pubovesical ligament anatomy is disrupted by prior surgery.
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.
