Transcript SO_Cyprus_med_14-15_urinarybladder_32

Urinary bladder
and Urethra
Prof. Dr. Selda Önderoğlu
Anatomy Department
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• Muscular sac (vesicle) for urine storage.
• Normal Volume=220ml.
- however can tolerate 500ml. of urine.
• Location in Adult; when empty: entirely
within lesser pelvis; when distended:
expands into abdominal cavity
• Location in child: even when empty in
lesser pelvis +abdominal cavity
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shape, surfaces
• Shape: triangular pyramid
• Has: base (fundus)
neck
apex
• Surfaces: 1 superior
2 inferolateral
Only superior surface is covered by
peritoneum.
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• When distended the bladder expands
into the abdominal cavity, may arise as
high as the umbilicus thus, can be
approached surgically by incisions or
punctures through the ant. Abd. wall
without traversing the peritoneum.
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Apex and Superior surface
• Apex: anterior end,directed forwards
and upwards to the umbilicus ( median
umbilical lig.(urachus) and fold)
• Superior surface: triangular,lat borders
run from apex backwards to the
entrance of of ureter into the bladder.
covered by peritoenuem except in female
very post. part is devoid of peritoneum
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(supravaginal part of cervix)
Superior surface in male and female
(peritoneal pouches)
• Male: from post. border the peritoneum
is reflected from bladder to rectum:
rectovesical pouch;at the sides of this
pouch located:paravesical fossae
• Female: peritoneum is reflected form
bladder to uterus: vesicouterine pouch
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Fundus (base)
• Directed backwards and downwards.
• Female: related to vagina
• Male:related to rectum
- upper part rectovesical pouch.
- lower part:seminal vesicles+deferent
ducts are located, the tissue bw. is
called the rectovesical fascia.
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neck
• Is the lowest region of bladder
• Pierced by the internal orifice of urethra
• In Male: rests on the base of prostate,
• In Female: rests on pelvic fascia
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Inferolateral surfaces (2)
• Face anteroinferiorly.
• Related to posterior surface of pubis,
filled with adipose tissue: retropubic
pad.
• Male: puboprostatic ligament
• Female: pubovesical ligament
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Ligaments of urinary bladder
(true and false ligs.)
• except superior surface (peritoneum)
other parts are connected to other
structures by a fibroareolar tissue (true
ligaments)
• On each side: lateral true ligs.
• Ant.’ly: puboprostatic ligs. (pubovesical
ligs.)
• Apex: median umbilical lig.(urachus)
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• Backwards: posterior lig.
False ligaments
• Folds of peritoneum
• Median umbilical fold
• Medial umbilical folds (2)
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Internal surface
• Has Folds of mucous membrane except
a small triangular area above and
behind the internal orifice of urethra.
• Apex: internal orifice of urethra.
• Base: interureteric crest.
• Both ends of base: R and L ureteric
orifice
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structure
• Peritoneum
• Muscular layer: detrusor muscle
3 layers: external longitudinal
middle circular (sphincter
vesicae muscle , at the internal urethral
orifice – involuntary-inn. By autonomic
nerv. Syst.)
inner longitudinal
• Mucous membrane
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Vessels,nerves,lymphatics
• Aa: superior&inferior vesical aa.(int.
iliaca.)
Vv: vesical plexus-drain into
internal iliac vv.
• Nn: symp.(lower 2 thor.+upper 2 lumbar
levels)+ parasymp.(S2-4)
• Lymph: external iliac-common iliac
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Male urethra
• 15-20cm.long
• Extends From internal urethral
orifice(urin. Bladd.) to external urethral
orifice at the tip of penis
• 3 Parts: prostatic
membranous
spongiose
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Prostatic part
• Widest part of male urethra.
• 3cm.long
• On the Posterior wall:
-urethral crest,
- prostatic sinus, orifices of prostatic
ducts.
-seminal colliculus, prostatic utricle(
vagina masculina)
-on each side opening of ejaculatory
ducts
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Membranous part
• Shortest and narrowest part. Least
dilatable part.2 cm.long
• Passes through perineal membrane
(urogenital diaphragm).
• The membranous urethra is surrounded
by the sphincter urethrae muscle
(external urethral sphincter)- voluntary
m.- inn. By Pudental n.
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Spongiose part
• 15cm.long
• Located in the corpus spongiosum
penis.
• Narrow (about 6mm.in diameter)
• most dilated parts: intrabulbal fossa(at
the commencement) + navicular
fossa(at glans penis)
• Narrowest place: external urethral
orifice
• Bulbourethral glands+ other urethral
glands open here.
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Female urethra
• 4-5cm. Long, 6mm.wide,much dilatable.
• From internal urethral orifice(bladder) to
external urethral ofifice(anteroposterior
slit which is 2,5cm.anterio to the
opening of vagina)
• 2 parts:pelvic&perineal
• Epithelium contains longitudinal
folds+urethral crest
• urethral glands(homologous to
prostate)+ minute
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recesses(lacunae)+paraurethral duct.
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Sphincters of urethra
1-ınternal sphicter – sphincter vesicae m.
-at the beginning,int.urethral orifice.
-involuntary –nonstriated m.fibers.
-innervated by: pelvic splancnic nn
2- external sphincter- sphincter urethrae
muscle
- at the urogenital diaphragm
-voluntary-striated m. fibers.
-innervated by: pudental n.
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