Urinary Bladder Flashcards
Females: UB
Posterior: related to anterior vaginal wall
Anterior: related to pubic symphysis & retropubic space of Retzius
Superior: related to vesicouterine pouch (peritoneal cavity) & uterus
Apex: Related to
- MEDIAN UMBILICAL LIGAMENT or URACHUS (remnant of allantois)
- 2 MEDIAL UMBILICAL LIGAMENTS (remnant of R & L umbilical artery)
- 2 LATERAL UMBILICAL LIGAMENTS (R & L inferior epigastric artery & vein)
Neck: related to Urogenital diaphragm
Internal structure
Mucosa: transitional epithelium
Smooth muscle: DETRUSOR MUSCLE
Trigone: located on posterior surface, defined by openings of ureters superiorly & by urethra inferiorly
Locations
Infants: within the ABDOMINAL CAVITY
Adults: within the PELVIC INLET, as it fills ➡️ rides out of the MINOR PELVIS, above PELVIC INLET, as high as UMBILICUS
Suprapubic cystostomy: skin ➡️ superficial fascia (CAMPER & SCARPA) ➡️ linea alba ➡️ transversalis fascia ➡️ extraperitoneal fat ➡️ bladder wall without entering the peritoneal cavity to remove the urine from the bladder
Urine leakage as a result of trauma
Rupture of superior wall (dome)
Rupture of anterior wall
Rupture of urethra above the Urogenital diaphragm
Rupture of urethra just below the Urogenital diaphragm
Rupture of penile urethra
Rupture of superior wall
Compression on full bladder
Result: Intraperitoneal extravasation of urine
Rupture of anterior wall
Fractured pelvis that punctures the bladder
Result: extraperitoneal extravasation of urine within retropubic space of Retzius
Rupture of urethra above the Urogenital diaphragm
Fractured pelvis or improper catheter insertion
Result: extraperitoneal extravasation of urine within retropubic space of Retzius
Rupture of urethra below the Urogenital diaphragm
Most common type
Straddle injury
Result: extraperitoneal extravasation of urine within superficial perineal space & extends into scrotal, penile & abdominal wall
Rupture of penile urethra
Crushing injury to penis
Result: extraperitoneal extravasation of urine beneath the deep fascia of Buck
If Buck fascia is not torn –> extravasation is confined in the penis
If torn –> extravasation within superficial perineal space
Urine leakage as a result of incontinence
Total incontinence
Stress incontinence
Urge incontinence
Overflow incontinence
Continuous involuntary loss of urine
Cause: ectopic ureter, vesicovaginal fistula
Tx: surgery repair
Total incontinence
Associate with ⬆️ abdominal pressure (coughing, sneezing, Valsalva, after childbirth)
Tx: ephedrine, Phentolamine or surgery repair
Stress incontinence
Associated with intense desire to void
Cause: uncontrolled contraction of DETRUSOR muscle
Tx: oxybutynin or imipramine
Urge incontinence
Bladder filling overcomes sphincter control
Cause: prostate CA, urethral stricture, atonic neurogenic bladder
Tx: catheterization, surgery
Overflow incontinence
Types of neurogenic bladder
Hypertonic
Atonic
Small bladder and DETRUSOR hperreflexia/overactivity
–> thickened walls of the bladder (pine tree bladder)
Urgent, frequent voiding
Upper motor neuron lesions
Tx: Anticholinergics, catheterization, surgery augmentation
Hypertonic
Large bladder and detrussor areflexia/underactivity
Urinary retention –> overflow incontinence
Lower motor neuron lesions
Tx: catheterization, surgery urine diversion
Atonic
Most common type of tumor in the bladder (>90%)
Painless hematuria
Transitional cell CA
Urinary bladder prolapses into the anterior vaginal wall
Cystocele
Males: UB
Posterior: related to rectovesical pouch, rectum, seminal vesicles, ampulla of ductus deferens
Anterior: related to pubic symphysis & retropubic space of Retzius
Superior: related to peritoneal cavity
Apex: Related to
- MEDIAN UMBILICAL LIGAMENT or URACHUS (remnant of allantois)
- 2 MEDIAL UMBILICAL LIGAMENTS (remnant of R & L umbilical artery)
- 2 LATERAL UMBILICAL LIGAMENTS (R & L inferior epigastric artery & vein)
Neck: related to prostate gland & prostatic urethra
