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Retropubic space

The retropubic space, also called the space of Retzius or prevesical space, is an extraperitoneal potential space located between the pubic symphysis and urinary bladder. It contains loose connective tissue, fat, and venous plexuses. The space provides a surgical corridor to access the bladder, prostate, and urethra without entering the peritoneal cavity. It is clinically relevant in urology, gynecology, trauma, and radiology because it may harbor hematomas, abscesses, or tumor extension.

Synonyms

  • Space of Retzius

  • Prevesical space

  • Retropubic space of Retzius

Location and Boundaries

  • Anteriorly: Pubic symphysis and pubic bones

  • Posteriorly: Anterior wall of urinary bladder

  • Superiorly: Anterior abdominal wall and peritoneal reflection

  • Inferiorly: Pelvic diaphragm and urogenital diaphragm

  • Laterally: Obturator internus muscles and arcus tendineus fascia

Relations

  • Contains retropubic fat, loose connective tissue, and venous plexuses (dorsal venous complex of the penis/clitoris)

  • Lies anterior to the bladder and prostate (in males) or bladder and anterior vaginal wall (in females)

  • Provides surgical access to bladder and prostate (e.g., prostatectomy, bladder suspension procedures)

Function

  • Acts as a potential space allowing bladder expansion

  • Provides a cushion of fat and connective tissue between bladder and pubic symphysis

  • Serves as a surgical pathway to access bladder, urethra, and prostate

  • Acts as a reservoir for collections such as hematomas, abscesses, or extravasated urine

Clinical Significance

  • Site of hematomas following pelvic trauma or surgery

  • May collect urine in bladder rupture (extraperitoneal type)

  • Can harbor abscesses or infections that spread from bladder or pelvis

  • Important landmark in radical prostatectomy, Burch colposuspension, and other urological/gynecologic surgeries

  • May demonstrate tumor spread from bladder, prostate, or gynecologic malignancies

MRI Appearance

T1-weighted images:

  • No fluid: Space appears filled with fat (bright signal) and thin low-signal lines of connective tissue

  • Fluid: Appears dark (low signal) replacing the normally bright fat

  • Fat: Bright signal, easily distinguishes space from bladder and pubic symphysis

T2-weighted images:

  • No fluid: Fat shows  bright signal; connective tissue remains dark

  • Fluid: Bright signal within the space

  • Fat: Bright, outlines bladder wall and pubic symphysis

STIR (Short Tau Inversion Recovery):

  • No fluid: Fat is suppressed and appears dark; connective tissue remains low signal

  • Fluid: Bright hyperintense signal fills the space

  • Fat: Suppressed completely, providing contrast for fluid or pathology

T1 Fat-Sat Post-Contrast:

  • No fluid: Fat suppressed, leaving dark background with minimal enhancement

  • Fluid: Non-enhancing unless complicated (infected/abscessed)

  • Fat: Suppressed and dark; inflammatory or neoplastic tissue shows focal enhancement

CT Appearance

Non-Contrast CT:

  • No fluid: Space filled with fat (low attenuation) anterior to bladder

  • Fluid/hematoma: Appears as soft tissue or hyperdense collection replacing fat

  • Fat: Clearly outlines bladder and pubic symphysis as low-density tissue

Post-Contrast CT:

  • No fluid: Space unchanged, fat remains low attenuation

  • Fluid: Simple fluid does not enhance; abscess may show rim enhancement

  • Fat: Low attenuation; tumor or inflammatory infiltration may cause stranding or enhancing soft tissue nodules

MRI image

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MRI image

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MRI image

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CT image

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