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URINARY BLADDER & PELVIC PART OF URETERS

URINARY BLADDER & PELVIC PART OF URETERS. Dr. Ahmed Fathalla Ibrahim. Upper Surface. Inferolateral surface. Inferolateral surface. Apex. Neck. URINARY BLADDER. SHAPE:

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URINARY BLADDER & PELVIC PART OF URETERS

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  1. URINARY BLADDER & PELVIC PART OF URETERS Dr. Ahmed Fathalla Ibrahim

  2. Upper Surface Inferolateral surface Inferolateral surface Apex Neck

  3. 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

  4. MALE PELVIS

  5. MALE PELVIS

  6. BASE OF MALE BLADDER

  7. FEMALE PELVIS

  8. FEMALE PELVIS

  9. 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

  10. 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)

  11. 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

  12. 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

  13. URINARY BLADDER INFEROLATERAL SURFACES: • Are related to retropubic fat separating them from: • Body of pubis • Levator ani • Obturator internus

  14. 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

  15. 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

  16. INTERIOR OF URINARY BLADDER

  17. 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

  18. URINARY BLADDER Empty Distended

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. IN MALE • It is crossed anteriorly by vas deferens

  25. IN FEMALE • It passes below the root of broad ligament lateral to lateral fornix of vagina & is crossed superiorly by the uterine artery

  26. 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

  27. INTRAVENOUS UROGRAM

  28. INTRAVENOUS UROGRAM

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