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ANATOMY SEM 4 > bladder, urethra and prostate gland > Flashcards

bladder, urethra and prostate gland Flashcards

1
Q

what are the 2 main roles of the bladder?

A
  1. temporary storage of urine
  2. assists in the expulsion of urine
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2
Q

describe the bladder apex

A

located superiorly, pointing towards the pubic symphysis

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3
Q

what connects the bladder apex to the umbilicus?

A

median umbilical ligament = remnant of the urachus

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4
Q

what is the bladder fundus?

A

= the base
- located posteriorly
- it is triangular shaped, with the tip of the triangle pointing backwards

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5
Q

describe the bladder neck

A

formed by the convergence of the fundus and the two inferolateral surfaces. It is continuous with the urethra.

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6
Q

what are the orifices of the bladder marked by?

A

the trigone = a triangular area located within the fundus
- in contrast to the rest of the internal bladder, it has smooth walls — this is explained by the different embryological origin: the trigone is developed by the integration of two mesonephric ducts at the base of the bladder

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7
Q
A
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8
Q

what is the name of the specialised smooth muscle in the bladder wall?

A

detrusor muscle

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9
Q

the fibres of the detrusor muscle often become ___________ (presenting as _________ _________) in order to compensate for increased workload of the bladder emptying. This is very common in conditions that obstruct the urine outflow such as _______ _________ ________.

A
  • hypertrophic
  • prominent trabeculae
  • benign prostatic hyperplasia
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10
Q

describe the internal urethral sphincter in the male

A

consists of circular smooth fibres, which are under autonomic control. It is thought to prevent seminal regurgitation during ejaculation

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11
Q

describe the itnernal urethra sphincter in females

A

thought to be a functional sphincter (i.e. no sphincteric muscle present). It is formed by the anatomy of the bladder neck and proximal urethra.

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12
Q

describe the external urethral sphincter

A

has the same structure in both sexes. It is skeletal muscle, and under voluntary control. However, in males the external sphincteric mechanism is more complex, as it correlates with fibres of the rectourethralis muscle and the levator ani muscle.

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13
Q

arterial supply of the bladder

A

Arterial supply is via the superior vesical branch of the internal iliac artery. In males, this is supplemented by the inferior vesical artery, and in females by the vaginal arteries. In both sexes, the obturator and inferior gluteal arteries may also contribute small branches.

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14
Q

venous drainage of the bladder

A

achieved by the vesical venous plexus, which empties into the internal iliac veins. The vesical plexus in males is in continuity at the retropubic space with the prostate venous plexus (plexus of Santorini), which also receives blood from the dorsal vein of the penis

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15
Q

lymphatic drainage of the bladder

A
  • The superolateral aspect of the bladder drains into the external iliac lymph nodes.
  • The neck and fundus drain into the internal iliac, sacral and common iliac nodes.
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16
Q

sympathetic supply of the bladder. effects?

A
  • hypogastric nerve (T12 – L2) aka lumbar splanchnic
  • It causes relaxation of the detrusor muscle, promoting urine retention.
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17
Q

parasympathetic supply of the bladder. effect?

A
  • pelvic splanchnic nerve (S2-S4)
  • increased signals from this nerve causes contraction of the detrusor muscle, stimulating micturition.
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18
Q

somatic supply of the bladder. effect?

A
  • pudendal nerve (S2-4)
  • it innervates the external urethral sphincter, providing voluntary control over micturition.
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19
Q

In addition to the efferent nerves supplying the bladder, there are _______________ nerves that report to the brain. They are found in the bladder _______ and signal the need to ________ when the bladder becomes ____.

A

In addition to the efferent nerves supplying the bladder, there are sensory (afferent) nerves that report to the brain. They are found in the bladder wall and signal the need to urinate when the bladder becomes full.

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20
Q

what is the bladder stretch reflex?

A

The bladder stretch reflex is a primitive spinal reflex, in which micturition is stimulated in response to stretch of the bladder wall

During toilet training in infants, this spinal reflex is overridden by the higher centres of the brain, to give voluntary control over micturition.

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21
Q

describe the reflex arc of the bladder stretch reflex

A
  • Bladder fills with urine, and the bladder walls stretch. Sensory nerves detect stretch and transmit this information to the spinal cord
  • Interneurons within the spinal cord relay the signal to the parasympathetic efferents (the pelvic nerve)
  • The pelvic nerve acts to contract the detrusor muscle, and stimulate micturition
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22
Q

although the bladder stretch is non-functional post childhood, the bladder stretch reflex needs to be considered in what scenarios?

A
  • spinal injuries — where the descending inhibition cannot reach the bladder
  • neurodegenerative diseases — where the brain is unable to generate inhibition
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23
Q

what are the effects on the bladder of spinal cord transecting above T12?

A

In this case, the afferent signals from the bladder wall are unable to reach the brain, and the patient will have no awareness of bladder filling. There is also no descending control over the external urethral sphincter, and it is constantly relaxed.

There is a functioning spinal reflex, where the parasympathetic system initiates detrusor contraction in response to bladder wall stretch. Thus, the bladder automatically empties as it fills – known as the reflex bladder.

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24
Q

what are the effects on the bladder of spinal cord transecting below T12?

A

A spinal cord transection at this level will have damaged the parasympathetic outflow to the bladder. The detrusor muscle will be paralysed, unable to contract. The spinal reflex does not function.

In this scenario, the bladder will fill uncontrollably, becoming abnormally distended until overflow incontinence occurs.

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25
Q

what is the most common cause of bladder obstruction ion in men?

A

prostate enlargement (BPH)

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26
Q

bladder position : empty vs full of urine

A
  • empty in adult: located entirely within the pelvis
  • as it fulls it ascends into the greater pelvis where it lies within the extra peritoneal fascia of the abdominal wall
  • in the infant and young child the bladder projects into the abdomen even when empty
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27
Q

what bladder surface is convered in peritoneum?

A

superior

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28
Q

what are the anterior and lateral relations of the bladder? (same for women and men)

A
  • anterior - retropubic fat pad, anterior abdominal wall, symphysis pubis
  • lateral - obturator internus muscle, levator ani muscle
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29
Q

what are the superior, inferior and posterior relations of the bladder in the female?

A

superior = body of uterus, uterovesical pouch
inferior = urogenital diaphragm
posterior = vagina

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30
Q

what are the superior, inferior and posterior relations of the bladder in the male?

A

superior = coils of ileum, sigmoid colon, peritoneal cavity
inferior = prostate gland
posterior = rectum, rectovesical pouch, vas deferens, seminal vesicles

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31
Q

what type of innervation is thought to be the major controller of bladder filling and emptying, provide motor innervation to the detrusor muscle and inhibitory fibres to the internal sphincter?

A

parasympathetic fibres

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32
Q

what sort of innervation may be inhibitory to the detrusor muscle and provide motor innervation to the internal sphincter, and is thought to be mainly responsible for vasomotor function in the bladder?

A

sympathetic fibres

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33
Q

what is the neurotransmitter for the hypogastric nerves?

A

noradrenaline

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34
Q

what is the neurotransmitter for the pelvic nerves?

A

acetylcholine

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35
Q

what is the pelvic pain line?

A
36
Q

visceral afferents for pain from the superior surface of the bladder follow the course of what fibres?

A

sympathetic fibres

37
Q

the female urethra forms an elevation on what wall of the vagina?

A

anterior

38
Q

what are homologise to the prostate of the male in women?

A

paraurethral glands - open into the sides of the external urethral meatus

39
Q

where does the male urethra extend?

A

internal to external urethral orifice which is located at the tip of the glans penis

40
Q

what are the 4 parts of the male urethra?

A

preprostatic, prostatic, intermembranous, spongy

41
Q

describe the preprostatic/intramural section of the male urethra

A
  • shortest component of the urethra
  • surrounded by the internal urethral sphincter
  • extends through the neck of the bladder
42
Q

describe the prostatic section of the male urethra

A
  • widest and most dilated part of urethra
  • urinary and reproductive tracts merge in this point
  • the posterior wall displays the prominent urethral crest
  • the ejaculatory ducts open into this part
43
Q

what merge to form the ejaculatory duct?

A

vas deferens and duct of seminal vesical

44
Q

describe the intermembranous section of the male urethra

A
  • the narrowest and least distensible part
  • passes throguh the deep perineal pouch
  • penetrates the perineal membrane
  • surrounded by the external urethral sphincter
45
Q

describe the spongy section of the male urethra

A
  • longest part
  • has a dilated section = navicular fossa
  • the bulbourethral glands open into this part
  • surround by corpus spongiosum of the penis
46
Q

arterial supply to proximal part of urethra : men vs women

A

men = some from middle rectal artery, but mainly inferior vesicle artery

women = vaginal artery

47
Q

arterial supply to distal part of male and female urethras

A

internal pudendal arteyr

48
Q

the prostate gland is a branched ________ gland which is embedded in a _______ ________

A
  • tubuloalveolar
  • fibromuscular stroma
49
Q

apex of prostate gland?

A

urethral sphincter

50
Q

base of prostate gland?

A

neck of bladder

51
Q

anteiror space of prostate gland?

A

rectopubic space

52
Q

inferolateral surface of prostate gland?

A

levator ani muscle

53
Q

posterior surface of prostate gland?

A

rectum

54
Q

what does the fibrous capsule of the prostate incorporate?

A

prostatic plexuses of nerves and veins

55
Q

approx 20-30 prostatic ducts open into what? location?

A

prostatic sinuses — located lateral to the urethral crest

56
Q

lymph from prostate drains where?

A

internal iliac nodes

57
Q

what does the prostate gland do?

A

secretes proteolytic enzymes into the semen, which act to break down clotting factors in the ejaculate. This allows the semen to remain in a fluid state, moving throughout the female reproductive tract for potential fertilisation.

58
Q

describe benign prostatic hyperplasia (BPH)

A
59
Q

roughly 2/3rds of the prostate gland structure is ______ and the remaining 1/3 is ______

A
  • glandular
  • fibromuscular
60
Q

what are the 3 histological zones of the prostate?

A
  1. central zone
  2. transitional zone
  3. peripheral zone
61
Q

describe the central zone of the prostate

A

– surrounds the ejaculatory ducts, comprising approximately 25% of normal prostate volume.
- the ducts of the glands from the central zone are obliquely emptying in the prostatic urethra, thus being rather immune to urine reflux.

62
Q

describe the transitional zone of the prostate

A
  • located centrally and surrounds the urethra, comprising approximately 5-10% of normal prostate volume.
  • the glands of the transitional zone are those that typically undergo benign hyperplasia (BPH)
63
Q

describe the peripheral zone of the prostate

A
  • makes up the main body of the gland (approximately 65%) and is located posteriorly.
  • the ducts of the glands from the peripheral zone are vertically emptying in the prostatic urethra; that may explain the tendency of these glands to permit urine reflux.
  • that also explains the high incidence of acute and chronic inflammation found in these compartments, a fact that may be linked to the high incidence of prostate carcinoma at the peripheral zone.
  • the peripheral zone is mainly the area felt against the rectum on DRE, which is of irreplaceable value.
64
Q

The ___________ stroma (or fourth zone for some) is situated _________ in the prostate gland. It merges with the tissue of the _________ _________. This part of the gland is actually the result of interaction of the prostate gland budding around the urethra during prostate embryogenesis and the common horseshoe-like muscle precursor of the smooth and striated muscle that will eventually form the internal and external urethra sphincter.

A
  • fibromuscular
  • anteriorly
  • urogenital diaphragm
65
Q
A
66
Q

arterial supply to prostate gland?

A

comes from the prostatic arteries, which are mainly derived from the internal iliac arteries. Some branches may also arise from the internal pudendal and middle rectal arteries

67
Q

venous drainage of prostate gland?

A

via the prostatic venous plexus, draining into the internal iliac veins. However, the prostatic venous plexus also connects posteriorly by networks of veins, including the Batson venous plexus, to the internal vertebral venous plexus.

68
Q

innervation of the prostate gland?

A
  • the prostate receives sympathetic, parasympathetic and sensory innervation from the inferior hypogastric plexus.
  • the smooth muscle of the prostate gland is innervated by sympathetic fibres, which activate during ejaculation
69
Q

what is PSA?

A

= prostate specific antigen

The Prostate Specific Antigen (PSA) is an enzyme (serine protease) secreted by the prostatic epithelium that aids the liquification of the ejaculate by lysing seminal vesicle proteins. However the main clinical use of PSA is as a tumor marker specific for prostate carcinoma.

Increased levels of serum PSA may suggest the presence of prostate cancer. Nonetheless other conditions that may “irritate” the prostate (such as inflammation, severe constipation, extended sexual intercourse or catheterisation) may also increase the PSA levels in the serum.

70
Q

name A-F

A

A = bladder
B = fundus of uterus
C = uterine tube
D = sigmoid colon
E = ovary
F = broad ligament

71
Q
A

A = bladder
B = uterus
C = rectum
D = ovary
E = round ligament of uterus
F = ureter
G = uterine tube
H = retropubic pouch
I = uterovesicle pouch
J = rectouterine pouch (of Douglas)

72
Q
A

A = symphysis pubis
B = bladder
C = rectum
D = anal canal
E = prostate
F = sigmoid colon
G = ureter
H = retropubic pouch
I = rectovesicle pouch
J = common iliac artery
K = internal iliac artery
L = external iliac artery

73
Q
A
74
Q
A
75
Q
A
76
Q
A

A = prostate
B = seminal vesical
C = bladder
D = ductus deferens
E = ureter

the ejaculatory duct

77
Q
A
78
Q

microscopic?

A

have i done

79
Q

names of the spaces either side of the bladder and rectum? made by peritoenum

A

bladder = paravesical

rectum = pararectal

80
Q

what is pouch of douglas?

A

rectouterine pouch

81
Q

what is the name of where the urethra widens at the end of the penis?

A

navicular fossa (opens into meatus)

82
Q

what urethra doesnt have an internal sphincter?

A

women

83
Q

at what level is the superior hypogastric plexus?

A

L3

84
Q

sympatheitc innervation

A

thoracolumbar splanchnic —> superior hypogastric plexus

85
Q

somatic innervation?

A

pudendal nerve S2-S4 = voluntary control

ANATOMY SEM 4 (12 decks)

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