Topics

Topic

design image
Vesicovaginal space

The vesicovaginal space is a potential fascial space in the female pelvis located between the anterior vaginal wall and the posterior surface of the bladder. It is filled with loose connective tissue and is an important surgical and radiological landmark. This space allows for surgical dissection during gynecologic and urologic procedures and is clinically relevant in conditions such as fistula formation, malignancy, and infection.

Synonyms

  • Vesicovaginal septum

  • Anterior vaginal space

  • Vesicovaginal fascial plane

Location and Boundaries

  • Anteriorly: Posterior wall of the urinary bladder

  • Posteriorly: Anterior wall of the vagina

  • Superiorly: Uterine cervix and vesicouterine pouch

  • Inferiorly: Vaginal vestibule and urethra

  • Laterally: Endopelvic fascia and pubocervical ligaments

Relations

  • Closely related to the bladder base, urethra, and anterior vaginal wall

  • Superiorly continuous with the vesicouterine pouch

  • Inferiorly related to the urethrovaginal space

  • Laterally bounded by pelvic connective tissue and vasculature

Function

  • Acts as a potential space allowing mobility between bladder and vagina

  • Provides a surgical dissection plane for gynecologic and urologic operations

  • Facilitates expansion of the bladder and vagina without direct friction

  • Functions as a barrier space limiting the spread of infection or tumors between bladder and vagina

Clinical Significance

  • Site of vesicovaginal fistula formation, often following surgery, trauma, or malignancy

  • Important in pelvic oncologic staging for cervical and bladder cancers

  • Utilized as a plane of access in pelvic reconstructive surgery

  • May be a route of spread for abscesses or pelvic infections

  • In pelvic MRI, evaluation of this space is crucial for assessing tumor invasion

MRI Appearance

T1-weighted images:

  • Vesicovaginal space shows low signal intensity due to connective tissue

  • Fat interspersed within fascia appears high signal intensity

T2-weighted images:

  • Space appears as an area of intermediate to high signal intensity due to loose connective tissue and fat

  • Tumor infiltration or fluid collections appear with bright signal intensity

STIR (Short Tau Inversion Recovery):

  • Suppresses fat, leaving the space as low to intermediate signal

  • Pathology such as edema, inflammation, or abscess appears bright

T1 Fat-Sat Post-Contrast:

  • Normal vesicovaginal space shows minimal or no enhancement

  • Tumors or inflammatory lesions show abnormal heterogeneous or rim enhancement

CT Appearance

Non-Contrast CT:

  • Appears as a soft tissue density plane between bladder and vagina

  • Fatty tissue may help identify the space

  • Pathology may obliterate or distort the space

Post-Contrast CT:

  • Normally not distinctly enhancing

  • Tumor invasion or inflammatory processes cause enhancement or mass effect within the space

  • Abscess formation shows rim-enhancing low-density collections

MRI image

Vesicovaginal space MRI axial anatomy image-img-00000-00000

MRI image

Vesicovaginal space MRI sagittal anatomy image-img-00000-00000

CT image

Vesicovaginal space CT axial anatomy image-img-00000-00000

CT image

Vesicovaginal space CT sagittal anatomy image-img-00000-00000