Medial puboprostatic ligament

The medial puboprostatic ligament is the medial component of the paired puboprostatic ligaments (also termed pubovesical ligaments), which are fibromuscular bands extending from the posterior aspect of the pubic symphysis to the anterolateral surface of the prostate gland and bladder neck. It is distinguished from the lateral puboprostatic ligament by its more midline position, running closer to the dorsal vein complex and the urethral suspensory mechanism.

he puboprostatic ligament is not a simple discrete fascial band but rather a complex, pyramid-shaped fibromuscular structure composed of collagen fibers, smooth muscle, and contributions from the detrusor apron and the pubococcygeus portion of the levator ani muscle. Specifically, the detrusor apron splits anteriorly into layers, with its anterior layer contributing to the puboprostatic ligament, while decussated and undecussated fibers of the pubococcygeus also insert into it. The ligament inserts onto the periosteum of the posterior pubic symphysis.

The puboprostatic ligaments are intimately related to the dorsal venous complex, which is embedded within their fibrous structures. The neurovascular bundle runs beneath the ligament. The medial puboprostatic ligament, together with the lateral ligament, forms part of a broader suspensory system that stabilizes the prostate, bladder neck, and membranous urethra against the pubic bone. This system is continuous with the urethral suspensory mechanism, which Steiner described as comprising anterior, intermediate, and posterior pubourethral components the puboprostatic ligament corresponding to the posterior pubourethral ligament.