Bladder And Male Pelvis Flashcards
Visceral pelvic fascia
. Btw pelvic peritoneum and parietal pelvic fascia
. Varies in consistency
. Condensations reinforced by smooth muscle support pelvic viscera and names as pelvic ligaments
Pelvic peritoneum
. 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
Parts of pelvic peritoneum unique to males
. Rectovesical pouch: btw rectum and seminal vesicles and urinary bladder
. Sacrogenital folds: raised by sacrogenital ligaments, extend from sacrum to prostate and bladder
Pelvic peritoneum components unique to females
. 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
Ureter
. Muscular tube that conveys urine from kidney to bladder
. Retroperitoneal
Ureter course in female
. 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
Ureter blood supply and innervation
. 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
Urinary bladder shape
. 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
Bladder anatomical relations
. 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
Anatomical relations unique to male bladder
. 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
Anatomical relations unique to female bladder
. 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
Bladder wall structure
. Adventitia
. Deter us or muscle: intermediate smooth muscle layer
. Mucosa: internal epithelial lining, has rugae when it is empty
Trigone in bladder
. 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
Internal urethral sphincter
. Involuntary smooth muscle sphincter around the internal urethral orifice
Artery blood bully of bladder
. 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
Venous drainage of bladder
. 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
Bladder innervation
. 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
Micturition/urination
. 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)
Ductus deferens
. 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
Vasectomy
. Ligation of ductus deferens
Seminal vesicle
. 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
Ejaculatory duct
. Short (2.5 cm)
. Courses obliquely through prostate gland to open into prostatic urethra on surface of seminal colliculus
Prostate gland
. 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
Prostatic sheath
. Fascia
. Condensation of visceral pelvic fascia continuous w/ ant. W/ puboprostatic ligaments
Rectovesical septum
. Sheet of visceral pelvic fascia separating rectum from prostatic fascia
Anatomical lobes of prostate
. 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
Functional zones of prostate
. 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
BPH is the enlargement of what zone in prostate?
Transition zone
WHat zone in prostate is most commonly affected by carcinomas?
Peripheral zone
Urethral crest
. 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
Prostatic sinuses
. Paired vertical grooves lat. to urethral crest
. Receive prostatic ducts
Preprostatic sphincter
. Smooth muscle continuous w/ internal urethral sphincter
. Under sympathetic control (inf. Hypogastric plexus)
External urethral sphincter
Voluntary muscles of UG diaphragm
. Mainly sphincter urethrae
What drugs affect the inhibition of retrograde ejaculation?
Adrenergic-blocking drugs because the sphincter closing is under sympathetic control
Blood supply of prostate. And seminal vesicles
. 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
Lymph drainage of prostate
Internal iliac sand sacral nodes
Innervation of prostate
. Prostatic plexus (division of hypogastric plexus)
WHat explains high incidence of spinal metastases of prostatic carcinomas?
. Communication btw prostatic venous plexus and internal vertebral venous plexus
Damage to what can cause impotence and incontinence following prostate surgery?
. Damage to hypogastric plexus
