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Detailed anatomical information about the urinary bladder, including shape, structure, ligaments, and internal features, in relation to the male and female pelvis anatomy. Learn about the pelvic part of ureters and their termination.
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URINARY BLADDER & PELVIC PART OF URETERS Dr. Ahmed Fathalla Ibrahim
Upper Surface Inferolateral surface Inferolateral surface Apex Neck
URINARY BLADDER SHAPE: • It has the shape of three-sided pyramid placed on one of its angles, with the apex of pyramid is directed forward & its base is directed backward SITE: • It lies behind the body of pubis & is separated from it by the retropubic space
URINARY BLADDER RETROPUBIC SPACE: • It is a space filled with extraperitoneal fatty tissue continuous with that of lower part of anterior abdominal wall • It accomodates distention of urinary bladder • In case of rupture of urinary bladder, urine may escape upward into the anterior abdominal wall
URINARY BLADDER APEX: • Is directed forward • Is related to upper border of symphysis pubis • Is connected to umbilicus by the median umbilical ligament (obliterated part of urachus)
URINARY BLADDER BASE (POSTERIOR SURFACE): • Is directed backward • Its superolateral angles receive the ureters • In male: • Its upper part is covered by peritoneum • It is related to vasa deferentia & seminal vesicles separating it from rectum • In female: • It has no peritoneal covering • It is related to vagina
URINARY BLADDER SUPERIOR SURFACE: • Is covered by peritoneum in both sexes • In male: it is related to sigmoid colon & loops of ileum • In female: it is related to the uterus separating it from sigmoid colon & loops of ileum
URINARY BLADDER INFEROLATERAL SURFACES: • Are related to retropubic fat separating them from: • Body of pubis • Levator ani • Obturator internus
URINARY BLADDER NECK: • Is the lowest & most fixed part • Lies behind symphysis pubis • Is continuous with urethra • In male: • It rests on upper surface of prostate • Anteriorly: it is attached to puboprostatic ligament • Posteriorly: it is related to beginning of ejaculatory ducts • In female: • Anteriorly: it is attached to pubovesical ligament • Posteriorly: it is related to anterior wall of vagina
URINARY BLADDER LIGAMENTS: • Median umbilical ligament • Puboprostatic (pubovesical) ligament: • Forms the floor of retropubic space • In male: is called “puboprostatic” & extends from body of pubis to prostatic fascia & neck of bladder • In female: is called “pubovesical” & extends from body of pubis to neck of bladder
INTERIOR OF URINARY BLADDER • The mucous membrane forms folds (rugae) that disappear when the bladder is distended • TRIGONE: • A triangular area in the base of bladder, bounded by the 2 ureteric orifices & the internal urethral orifice • Its mucous membrane is elastic, more vascular & more sensitive • UVULA VESICA: is an elevation immediately behind internal urethral orifice produced by the underlying median lobe of prostate
URINARY BLADDER Empty Distended
URINARY BLADDER CAPACITY: • Is about 300 ml with a maximum capacity of 500 ml • Distended bladder: • Is circular in shape • Bulges upward into abdominal cavity • Removes peritoneum form lower part of anterior abdominal wall & becomes into direct contact with it
URINARY BLADDER IN CHILD • It is an abdominal organ even when empty • It begins to enter the enlarging pelvis at six years of age • It is not entirely a pelvic organ till after puberty Median sagittal section of a new-born female child
URINARY BLADDER ARTERIAL SUPPLY: • Superior & inferior vesical arteries VENOUS DRAINAGE: • Veins from the vesical venous plexus that drain into the internal iliac vein LYMPHATIC DRAINAGE: • Into internal & external iliac lymph nodes
URINARY BLADDER • NERVE SUPPLY: by the inferior hypogastric plexuses • Parasympathetic fibers: from S2,3,4motor to detrusor muscle (muscle coat of bladder) & inhibitory to internal urethral sphincter, produce micturation • Sympathetic fibers: from first & second lumbar ganglia • Ascending sensory fibers: carry sensation of fullness (distention) & pain sensation
PELVIC PART OF URETER • Crosses the front of bifurcation of common iliac artery to reach the pelvis • Descends downward & backward,along the lower border of internal iliac artery,crossing(from above downward): • External iliac artery & vein • Obturator nerve, artery & vein • Curves forward & medially
IN MALE • It is crossed anteriorly by vas deferens
IN FEMALE • It passes below the root of broad ligament lateral to lateral fornix of vagina & is crossed superiorly by the uterine artery
PELVIC PART OF URETER TERMINATION: • It reaches the posterosuperior angle of bladder • It runs an oblique course of about 2 cm through the wall of bladder before it opens into its lumen (intramural part of ureter). This part forms a valve-like mechanism that prevents reflux of urine into the ureter when bladder is distended