urinary bladder Flashcards
describe the size and position of bladder in young children?
abdominal organ
neck of the bladder lies at the level of upper border of symphysis pubis
what is the size and position of bladder in adults?
it is pelvic organ when empty
neck lies js above the plane of the lower border of symphysis
WHEN DISTENDED IT BECOMES ABDOMINO PELVIC but when empty = pelvic organ
So it varies with the amount of urine and age
what is the shape of urinary bladder?
tetrahedral when empty
ovoid when distended
what are the parts of urinary bladder?
apex —–> points anteriorly
base –> opposite to the apex = posterior
4 surfaces
4 borders
Neck
what are the borders of the bladder?
Anterior border running below the apex
two lateral borders ( on each side )
Posterior borders —> found on the bas
4 borders
what are the surfaces of the bladder?
4 surfaces
Posterior surface ( same as the base )
two inferolateral surfaces ( anteroinferior surface )
Superior surface
what is the structure attached to the apex?
median umbilical ligament
what is the structure attached to the SUPERO LATERAL ANGLES?
Ureters
what is the structure attached to the inferior angle?
Urethra
what is found on the neck of the bladder?
Prostate
what is the relation of posterior surface/base/fundus of the bladder in MALES?
Upper part ——> covered by peritoneum —> forms anterior wall of the rectovesical pouch
Lower part —-> separated from the rectum
the peritoneum comes from the anterior abdominal wall covering the superior surface of bladder then going to the posterior surface stopping at the upper part
what separates the lower part of posterior surface of bladder from the rectum in male?
Pair of seminal vesicles
van deferens
rectovesical fascia
why does the peritoneum stop at the upper part of posterior sruface?
when the peritoneum reaches the lower parts of the posterior surface of the urinary bladder it meets the following structure :
Seminal vesicles and van deferens —> cannot cover them with peritoneum instead it reflects to form —-> RECTOVESICAL POUCH
they are seen in sagittal view separated from the RECTUM by A FASCIA CALLED RECTOVESICAL FASCIA
what is the relation of the posterior surface of the bladder in FEMALES?
separated from the rectum BY THE UPPER OF VAGINA
what is ductus deferens ?
Highly convoluted duct behind the testis
Muscular tube
conveys sperms from the epididymis to the VAS DEFERENS
what is the location of ductus deferens ?
Posterior surface of the bladder :
Hooks over the ureter and runs medially to approach its opposite one
what happens to the terminal part of ductus deferens ?
get dilated to form :
Ampulla of the vas
what happens to the inferior of ampulla of the vas?
inferior end of ampulla joins the ducts of the seminal vesicle to :
Form ejaculatory duct which passes through the prostate to open into PROSTATIC URETHRA
We have ampullas and seminal vesicles on on each side and they both join together to form the ejaculatory ducts
Ampulla + seminal vesicles = ejaculatory ducts
on each side
eventually they open into the urethra
describe seminal vesicles?
two lobulated sacs
Lie on the posterior surface of the bladder
Their upper ends are WIDELY SEPARATED
their lower ends ARE CLOSE TOGETHER
join the ampulla of vas ( terminal part of ductus deferes ) —-> forms ejaculatory duct
what is the location of the terminal part of ampulla of vas?
medial side of the seminal vesicles
what are the features of the posterior wall of the prostatic urethra ?
urethral crests
seminal colliculus
prostatic utricle
prostatic sinus
what is urethral crest?
elevation in the middle of the urethra
medial longitudinal mucosal fold
what is urethral sinuses ?
since we have an elevation we have a depression on the sides
the depression is called urethral sinuses
mucosal gutters on each sides of the crest
what surrounds the urethra ?
prostate
which is a gland and it secretes and empties into the URETHRAL SINUSES
So the urethral sinuses receive openings of the ducts of prostatic glands
what is seminal colliculus ?
a swelling and a further elevation in the center of urethral crest
rounded eminence
what can we see in the seminal colliculus ?
opening of the right and left ejaculatory ducts
what is found above the openings of the ejaculatory ducts?
Prostatic utricle
Minute depression in the center of the urethral crest
what is prostatic utricle ?
Remnant of the vagina or female uterus
describe internal trigone?
triangular area inside the bladder that looks different compared to other interior
its the area where 2 ureters are opening into the bladder from above
urethra opens inside below
its a shiny area because it doesnt have a submucosa
rest of the interior has folds that allow it to distend whenever
what is the situation of external trigone ?
situated on the external aspect of the base of male bladder
ONLY FOUND IN MALES
what is the base of the external trigone ?
Posterior border of the bladder
what is the apex of the external trigone ?
Neck of the bladder
what forms the sides of the external trigone ?
seminal vesicles
vas deferens
what are the relations of the superior surface of the bladder in MALES?
empty bladder :
Triangular and covered with peritoneum ( Full bladder = oval shape )
Related to : Sigmoid colon , coils of small intestine
what is the superior surface of the bladder related to in FEMALES??
Uterovesical pouch
peritoneum comes from the anterior abdominal wall , it covers the superior surface of the urinary bladder
meets the uterus so it covers the anterior surface of the uterus ——> FORMING THE UTEROVESICAL POUCH ( in males its called rectovesical pouch )
what does the uterovesical pouch separates?
the superior superior surface of the bladder
from
Body of the uterus
why is the pouch empty except when the uterus is retroverted?
if the uterus is going to be retroverted ( leaning posteriorly on the ano rectal canal instead of urinary bladder )
the pouch will be covered by coils of small intestine
what is suprapubic puncture ?
as the bladder fills
the superior surface enlarges and enters the abdomen peeling off peritoneum from the anterior abdominal wall
so the bladder comes into direct contact with the anterior abdominal wall
Suprapubic puncture ( cystostomy ) can be performed without entering the peritoneum
Urinary calculi , small tumors , foreign bodies may also be removed from the bladder through a suprapubic extraperitoneal approach
what are the relations of the inferior lateral surfaces of the bladder?
Non PERITONEAL = no peritoneum
Related to the body of :
Pubis
Pubic symphysis
Fascia covering levator ani muscle
what separates the bladder from pubis, pubic symphysis , fascia covering levator ani muscle ?
space of retzius
what is found in the space of retzius ?
retropubic pad of fat
Vesical venous plexus
what is the importance of space of retzius ?
in surgical operation the bladder and prostate are approached through this space
what supports the bladder from the sides?
levator ani
and its fascia covering it
More lateral to it LEVATOR ani is OBTURATOR INTERNUS
what is the neck ?
anatomical it is the lowest point from where urethra begins
describe the neck of the bladder in males?
Lodges the prostate
below the prostate gland we have urogenital diaphragm
describe the neck of the bladder in FEMALES?
lies at the lower level and comes in contact with the superior fascia of urogenital diaphragm
Cuz no prostate , the bladder is with direct contact with urogenital diaphragm
what is are 2 pouches found in the perineal region ?
Superficial space / pouch
Deep space/ pouch
deep pouch = we have deep transverse perineal muscle —–> FORMS UROGENITAL DIAPHRAGM
on top of this muscle we have —-> superficial fascia of urogenital diaphragm
Below this muscle ——> FASCIA = DEEP UROGENITAL DIAPHRAGM
describe the bladder interior mucous membrane?
mucous membrane of the greater part of the empty bladder ( the rest of the bladder is the trigone which is always smooth )
is drawn into folds
the folds disappear when the bladder is full
what is the trigone?
internal surface of the base of the bladder
describe the mucous membrane of the trigone?
mucous membrane —> always smooth even when empty ( the other part of the bladder is folded when empty and smooth when full )
has different embryological origin that the rest of the bladder
what makes the mucous membrane of the trigone always smooth?
firmly adherent to the underlying muscle coat
has no submucosa
what is the superior angle of the trigone of the bladder?
ureters
what is the inferior angle of the trigone of the bladder ?
internal urethral meatus
what forms the superior limit of the trigone?
interureteric ridge
Ureters pierce the bladder wall obliquely
muscular ridge which runs between the opening of the 2 ureters
what is interureteric ridge?
line between the 2 openings of the ureters into the bladder
what is the uvula vesicae ?
small elevation behind the urethral orifice in the male
what is the urethral orifice?
opening of the urethra in the bladder
what produces the uvula vesicae ?
underlying median lobe of the prostate
it could inflame and push upwards into the urinary bladder to form swelling into the ureteric orifice
what is the bladder bed?
number of structure upon which bladder rests on
what are the structures which the bladder rest on?
Symphysis pubis
Fascia of levator ani
obturator internus
Base of prostate ( M ) / superior fascia of urogenital diaphragm ( F )
ampulla of rectum ( M ) / anterior wall of vagina (F)
what is sphincter vesicae ?
involuntary muscle formed by the Destrusor muscle at the neck surrounds the urethra
what is the function of sphincter vesicae ?
CONTRACTS —> during ejaculation to prevent retrograde ejaculation of semen into the bladder
prevent urine from going into the urethra
what is uvula?
projection of the trigone , prominent in males formed by median lobe of prostate
projects into the interior and causes obstruction to easy flow of urine in benign prostatic hypertrophy ( BPH )
what are the arteries supplying the bladder?
Superior vesical artery
Inferior vesical artery
BRANCHES OF THE INTERNAL ILIAC ARTERY
what does the superior vesical artery supply?
superior part of the urinary bladder
what does the inferior vesical artery supply ?
Posterior inferior part of the bladder
prostate
seminal vesicles
artery to the ductus deference
What does the inferior vesical artery corresponds to in females?
Vaginal artery in the females
what is the venous supply of the bladder?
Correspond to the arteries
Form vesical venous plexus —> ALONG the INFEROLATERAL SURFACE OF THE BLADDER
finally drains into —> INTERNAL ILIAC VEIN
TUMOR CELLS CAN SPREAD VIA THE VENOUS PLEXUS
what is the lymphatic drainage of bladder ?
External lymph nodes
Internal lymph nodes
Common iliac lymph nodes
Sacral lymph nodes
what happens if cancer is in the prostate gland ?
1- the vein drainage is very closely associated to the venous drainage of the urinary bladder
so they get to the vesical venous plexus
2- Behind the vertebral column so some of the veins drain/connected to the vertebral column and cancer can spread there
whats the nerve supply of bladder?
Vesicle plexus of nerves
contain both symp and parasymph components
what is the sympathetic nerve supply of the bladder?
T11-L2 from lateral horn cells —> SACRAL SPLANCHNICS
Spinal cord:
Superior hypogastric plexus (found near the bifurcation of the common iliac, single plexus ) —>THEN
Hypogastric nerve THEN
inferior hypogastric plexus ( at both sides of the bladder )
then after that the post ganglionic fibers supply the bladder
whats the motor sympathetic supply of the bladder?
Internal sphincter
inhibitory to detrusor ( NERVE OF FILLING cuz it relaxes the shpincter allowing urine to go from bladder to urethra and when it contracts it prevent that.)
Seminal vesicles and ejaculatory ducts
where does the hypogastric plexus, hypogastric nerve, inferior hypogastric plexus RELAY ALONG?
ALONG THE VESICAL ARTERY BLADDER
what conveys painful sensation from the bladder?
sensory sympathetic fibers
the cells bodies in dorsal root ganglia of T11-L2 spinal NERVES
SUPERIOR SURFACE OF THE BLADDER IS COVERED BY PERITONEUM SO BY SYMPATHETIC
OTHER PARTS THAT DOESNT HAVE PERITONEUM WILL BE BY PELVIC SPLANCHNIC NERVE
what is the parasympathetic supply of the bladder?
Pre-ganglionic fibers from :
S2,3,4 segment of the spinal cord
Pelvic splanchnic nerves ( NERVI ERIGENTES )
then reach the body and neck of the bladder by post ganglionic fibers
where are the cell bodies of parasympathetic supply located at?
Cell bodies of the postganglionic neurons
Are situated close or within the bladder wall
these fibers supply the detrusor muscle and the muscle of the proximal urethra
what is the motor supply of parasympathetic of the bladder?
detrusor muscle ( contract to empty the bladder)
inhibitory to sphincter vesicae ( Relax to open the sphincter )
also called nerve of emptying or voiding
where are the sensation of distention and painful sensation of the bladder and proximal urethra carried?
Sensory parasympathetic fibers —>
Cell bodies —->
Dorsal root ganglia of S2-S4 spinal nerves
pelvic splanchnic nerve carry pain WHERE PERITONEUM IS NOT PRESENT ( EVERYWHERE EXCEPT THE SUPERIOR SURFACE WHICH IS COVERED BY PERITONEUM ) ( S2-S4)
what is pelvic pain line phenomena ?
pelvic viscera are that are in contact with peritoneum are superior to the pelvic pain line :
Pain impulses from viscera superior to the pain line are carried by –> SYMPATHETIC FIBERS —> ABDOMINOPELVIC SPLANCHNIC NERVES ( T11-L2) ( like the superior surface of the bladder cuz its covered by peritoneum )
Pain impulses from the viscera inferior to the pain line are carried by —> PARASYMPATHETICS FIBERS —> PELVIC SPLANCHNIC NERVE ( S2-S4 ) ( like the rest of the bladder cuz it is not covered by the peritoneum )
what is cystocele?
herniation of the bladder into vaginal wall
Loss of bladder support in females by damage to perineal muscles or pelvic floor so it drops to the vaginal wall
what happens in rupture of the bladder?
distended bladder may be injured by injuries to the inferior part of the anterior abdominal wall or by fracture of pelvis
Rupture of the superior part of the bladder —> TEARS THE PERITONEUM AND RESULTS IN INTRAPERITONEAL EXTRAVASATION OF URINE ( urine inside the peritoneum –> greater sac )
Elsewhere —> rupture will results in EXTRAPERITONEAL EXTRAVASATION ( urine outside peritoneum )
what prevents urine reflux from the bladder to the ureters?
1- Oblique direction of the intra-vesical part ureter :
the posterior wall of the ureter is firmly anchored to the detrusor muscle of the bladder
anterior wall is more flexible , increased intra vesical pressure anterior wall of the ureter will be compressed against the posterior wall like flap valve preventing reflux
2- Peristalsis o the ureteral muscle pass downwards , urine is collected in the bladder by jets and not drops
3- normally the ureteric orifice presents an oblique slit ( IN TUBERCULOSIS OF THE KIDNEY ONE ORIFICE MAYBE CIRCULAR DUE TO SHORTENING OF URETER —> GOLF HOLE URETER )—> PATHOLOGY, orifice becomes circular instead of oblique
