Bladder And Male Pelvis

Question 1

Visceral pelvic fascia

Answer 1

. Btw pelvic peritoneum and parietal pelvic fascia
. Varies in consistency
. Condensations reinforced by smooth muscle support pelvic viscera and names as pelvic ligaments

Question 2

Pelvic peritoneum

Answer 2

. Extends into true pelvis
. Invests pelvic organs w/ partial peritoneal coverings and forming folds and spaces
. Pararectal fossae: R/L, lat. to rectum
. Paravesical fossae: R/L, lat. to urinary bladder

Question 3

Parts of pelvic peritoneum unique to males

Answer 3

. Rectovesical pouch: btw rectum and seminal vesicles and urinary bladder
. Sacrogenital folds: raised by sacrogenital ligaments, extend from sacrum to prostate and bladder

Question 4

Pelvic peritoneum components unique to females

Answer 4

. Broad ligament of uterus: transverse peritoneal fold enclosing female reproductive organs, divides pelvis into ant/post. Regions
. Rectouterine pouch of Douglas: btw rectum and uterus and vagina
. Vesicouterine pouch: btw uterus ad bladder
. Sacrouterine folds: raised by sacrouterine ligaments, extend from sacrum to cervix

Question 5

Ureter

Answer 5

. Muscular tube that conveys urine from kidney to bladder

. Retroperitoneal

Question 6

Ureter course in female

Answer 6

. Descends on psoas major surface, crosses pelvic brim into true pelvis
. Female: Descends close to ovarian a. And passes inf. To uterine a. As it enters pelvis minor
. Male: passes inf. To ductus deferens
. Enters bladder posterolaterally
. Oblique course through bladder wall prevents urine reflux as bladder fills

Question 7

Ureter blood supply and innervation

Answer 7

. Branches of renal and ovarian/testicular aa. And direct and indirect branches of abdominal aorta and iliac a.
. Venous drainage via renal and ovarian/testicular vv.
. N: same a kidney, pain refers to T11-L2 dermatomes

Question 8

Urinary bladder shape

Answer 8

. Pyramid
. Apex: pointed ant., continuous w/ median umbilical ligament
. Base (fundus): opposite apex, post, side
. Sup, R and L inferolateral surfaces
. Neck: continuous inf. W/ urethra

Question 9

Bladder anatomical relations

Answer 9

. Inferolateral surfaces anchored by lat. Iigaments of bladder that rest against pelvic diaphragm and are separated from parietal pelvic fascia by retropubic space
. Sup. Surface bladder in contact w/ peritoneum of abdominal cavity
. Adult bladder: below pelvic brim when empty, extends to abdominal cavity when full
. Kids: in abdominal cavity even if empty

Question 10

Anatomical relations unique to male bladder

Answer 10

. Base of bladder in contact w/ rectum separated by peritoneum-lined rectovesical pouch
. Neck of bladder in contact w/ prostate gland
. Neck anchored to pubic bodies by puboprostatic ligaments

Question 11

Anatomical relations unique to female bladder

Answer 11

. Base of bladder contacts ant. Vaginal wall
. Sup. Surface contacts uterus and is separated by peritoneum lined vesicouterine pouch
. Neck of bladder contacts and is supported by muscles of urogenital diaphragm
. Neck anchored to pubic bodies by pubovesical ligaments

Question 12

Bladder wall structure

Answer 12

. Adventitia
. Deter us or muscle: intermediate smooth muscle layer
. Mucosa: internal epithelial lining, has rugae when it is empty

Question 13

Trigone in bladder

Answer 13

. Triangular region on post. Bladder wall
. Superficial muscle layer continuous w/ smooth muscle of proximal urethra
. Defined by ureteric orifices and internal urethral orifice
. Mucosa is smooth w/ no rugae
. Prostate can cause median bulge (uvula) just sup. To internal urethral orifice

Question 14

Internal urethral sphincter

Answer 14

. Involuntary smooth muscle sphincter around the internal urethral orifice

Question 15

Artery blood bully of bladder

Answer 15

. Branches of internal iliac a. 
. Sup. Vesicle aa.: upper bladder
. Inf. Vesicle aa.: lower bladder 
. Vaginal aa.: lower bladder and urethra 
. Internal pudendal aa.: lower urethra

Question 16

Venous drainage of bladder

Answer 16

. Vesicle venous plexus envelop bladder neck and intrapelvic portions of urethra
. Veins correspond to aa. And drain into internal iliac v.
. Lymph drainage to external and internal iliac lymph nodes

Question 17

Bladder innervation

Answer 17

. Autonomic and visceral afferents from vesicle plexus (from inf. Hypogastric plexus)
. Sympathetic: superficial trigone and internal sphincter contracts
. Parasympathetic: detrusor contracts and sphincter relaxes
. Visceral afferents follow S and P paths
. Parasympathetic- assoc. visceral afferent fibers convey sensations of bladder distension

Question 18

Micturition/urination

Answer 18

. Neck of bladder elevated and compressed by levator ani m. And muscles of UG diaphragm (innervated pudendal n.), voluntary relaxation initiations peeing
. Relaxation of internal sphincter (P stimulation via pelvic splanchnic nn.) allows urine to pass into urethra
. Contraction of detrusor (P stim) clamps down ureteric orifices (preventing reflux and assists emptying)

Question 19

Ductus deferens

Answer 19

. Traverses inguinal canal and passes sup. To ureter as it goes toward base of bladder
. Lies med. to seminal vesicle at bladder base
. Supplied by deferential a. (Branch of inf. Vesicle a.)
. Autonomic n. Fibers derived from inf. Hypogastric plexus

Question 20

Vasectomy

Answer 20

. Ligation of ductus deferens

Question 21

Seminal vesicle

Answer 21

. Coiled blind tube 5 cm long
. Post. To bladder base and lat. to ductus deferens
. 2 vesicles Make V shape on post. Bladder
. Contribute fructose and alkaline secretions
. Short duct of seminal vesicle joints ampulla of ductus deferens to form ejaculatory duct

Question 22

Ejaculatory duct

Answer 22

. Short (2.5 cm)

. Courses obliquely through prostate gland to open into prostatic urethra on surface of seminal colliculus

Question 23

Prostate gland

Answer 23

. Largest accessory gland
. Makes milky white, alkaline secretion
. Cone-shaped
. Base by neck of bladder sup.
. Apex rests on UG diaphragm
. Prostatic (true) capsule: smooth, dense CT and smooth muscle
. Prostatic ducts: 20 small ducts opening directly into prostatic urethra
. Prostatic urethra and ejaculatory ducts pass through prostate

Question 24

Prostatic sheath

Answer 24

. Fascia

. Condensation of visceral pelvic fascia continuous w/ ant. W/ puboprostatic ligaments

Question 25

Rectovesical septum

Answer 25

. Sheet of visceral pelvic fascia separating rectum from prostatic fascia

Question 26

Anatomical lobes of prostate

Answer 26

. Ant. Lobe (isthmus): fibromuscular region ant. To urethra
. Median lobe: sup. To ejaculatory ducts, adjacent to bladder neck
. Post. Lobe: post. To urethra and inf. To ejaculatory ducts
. Lat. lobes (R/L): lat. to urethra

Question 27

Functional zones of prostate

Answer 27

. Transition zone: post. And lat. to prostatic urethra, sup. To central zone
. Central: surrounds ejaculatory ducts
. Peripheral: largest, partially surrounds central zone
. Fibromuscular: ant. To urethra, nonglandular, CT, smooth and striated muscle continuous w/ sphincter urethrae

Question 28

BPH is the enlargement of what zone in prostate?

Answer 28

Transition zone

Question 29

WHat zone in prostate is most commonly affected by carcinomas?

Answer 29

Peripheral zone

Question 30

Urethral crest

Answer 30

. Median ridge on post. Urethral wall
. Seminal colliculus is a central bulge on urethral crest
. Prostatic utricle: blind evagination opening on surface of colliculus
. Ejaculatory ducts open on colliculus lat. to utricle

Question 31

Prostatic sinuses

Answer 31

. Paired vertical grooves lat. to urethral crest

. Receive prostatic ducts

Question 32

Preprostatic sphincter

Answer 32

. Smooth muscle continuous w/ internal urethral sphincter

. Under sympathetic control (inf. Hypogastric plexus)

Question 33

External urethral sphincter

Answer 33

Voluntary muscles of UG diaphragm

. Mainly sphincter urethrae

Question 34

What drugs affect the inhibition of retrograde ejaculation?

Answer 34

Adrenergic-blocking drugs because the sphincter closing is under sympathetic control

Question 35

Blood supply of prostate. And seminal vesicles

Answer 35

. Arteries: inf. Vesical, middle rectal, and internal pudendal aa.
. Veins: prostatic venous plexus communicates w/ vesical plexus, drains into internal iliac v.
. Prostatic venous plexus received deep dorsal v. Of penis and communicates w/ internal vertebral venous plexus on other side

Question 36

Lymph drainage of prostate

Answer 36

Internal iliac sand sacral nodes

Question 37

Innervation of prostate

Answer 37

. Prostatic plexus (division of hypogastric plexus)

Question 38

WHat explains high incidence of spinal metastases of prostatic carcinomas?

Answer 38

. Communication btw prostatic venous plexus and internal vertebral venous plexus

Question 39

Damage to what can cause impotence and incontinence following prostate surgery?

Answer 39

. Damage to hypogastric plexus