Transcript 9.Urinary bladder

Dr. Ahmed Fathalla Ibrahim
Upper Surface
Inferolateral surface
Inferolateral surface
Apex
Neck
URINARY BLADDER
SHAPE:
• It has the shape of three-sided pyramid
placed on one of its angles, with the
apex of pyramid is directed forward &
its base is directed backward
SITE:
• It lies behind the body of pubis & is
separated from it by the retropubic
space
MALE PELVIS
MALE PELVIS
BASE OF MALE BLADDER
FEMALE PELVIS
FEMALE PELVIS
URINARY BLADDER
RETROPUBIC SPACE:
• It is a space filled with extraperitoneal
fatty tissue continuous with that of
lower part of anterior abdominal wall
• It accomodates distention of urinary
bladder
• In case of rupture of urinary bladder,
urine may escape upward into the
anterior abdominal wall
URINARY BLADDER
APEX:
• Is directed forward
• Is related to upper border of symphysis
pubis
• Is connected to umbilicus by the
median umbilical ligament (obliterated
part of urachus)
URINARY BLADDER
BASE (POSTERIOR SURFACE):
•
•
Is directed backward
Its superolateral angles receive the ureters
• In male:
1. Its upper part is covered by peritoneum
2. It is related to vasa deferentia & seminal
vesicles separating it from rectum
• In female:
1. It has no peritoneal covering
2. It is related to vagina
URINARY BLADDER
SUPERIOR SURFACE:
• Is covered by peritoneum in both sexes
• In male: it is related to sigmoid colon &
loops of ileum
• In female: it is related to the uterus
separating it from sigmoid colon &
loops of ileum
URINARY BLADDER
INFEROLATERAL SURFACES:
• Are related to retropubic fat
separating them from:
1. Body of pubis
2. Levator ani
3. Obturator internus
URINARY BLADDER
NECK:
•
•
•
Is the lowest & most fixed part
Lies behind symphysis pubis
Is continuous with urethra
•
In male:
1.
2.
3.
It rests on upper surface of prostate
Anteriorly: it is attached to puboprostatic ligament
Posteriorly: it is related to beginning of ejaculatory
ducts
•
In female:
1.
2.
Anteriorly: it is attached to pubovesical ligament
Posteriorly: it is related to anterior wall of vagina
URINARY BLADDER
LIGAMENTS:
1. Median umbilical ligament
2. Puboprostatic (pubovesical) ligament:
• Forms the floor of retropubic space
• In male: is called “puboprostatic” &
extends from body of pubis to
prostatic fascia & neck of bladder
• In female: is called “pubovesical” &
extends from body of pubis to neck of
bladder
INTERIOR OF URINARY BLADDER
INTERIOR OF URINARY BLADDER
•
The mucous membrane forms folds (rugae)
that disappear when the bladder is
distended
• TRIGONE:
1. A triangular area in the base of bladder,
bounded by the 2 ureteric orifices & the
internal urethral orifice
2. Its mucous membrane is elastic, more
vascular & more sensitive
• UVULA VESICA: is an elevation
immediately behind internal urethral orifice
produced by the underlying median lobe of
prostate
URINARY BLADDER
Distended
Empty
URINARY BLADDER
CAPACITY:
• Is about 300 ml with a maximum
capacity of 500 ml
• Distended bladder:
• Is circular in shape
• Bulges upward into abdominal cavity
• Removes peritoneum form lower part of
anterior abdominal wall & becomes into
direct contact with it
URINARY BLADDER IN CHILD
• It is an abdominal
organ even when
empty
• It begins to enter the
enlarging pelvis at
six years of age
• It is not entirely a
pelvic organ till after
puberty
Median sagittal section of
a new-born female child
URINARY BLADDER
ARTERIAL SUPPLY:
• Superior & inferior vesical arteries
VENOUS DRAINAGE:
• Veins from the vesical venous plexus
that drain into the internal iliac vein
LYMPHATIC DRAINAGE:
• Into internal & external iliac lymph
nodes
URINARY BLADDER
•
NERVE SUPPLY: by the inferior
hypogastric plexuses
1. Parasympathetic fibers: from S2,3,4
motor to detrusor muscle (muscle
coat of bladder) & inhibitory to
internal urethral sphincter, produce
micturation
2. Sympathetic fibers: from first &
second lumbar ganglia
3. Ascending sensory fibers: carry
sensation of fullness (distention) &
pain sensation
PELVIC PART OF URETER
• Crosses the front of
bifurcation of
common iliac artery
to reach the pelvis
• Descends downward
& backward, along
the lower border of
internal iliac artery,
crossing (from
above downward):
1. External iliac artery
& vein
2. Obturator nerve,
artery & vein
• Curves forward &
medially
IN MALE
• It is crossed
anteriorly by
vas deferens
IN FEMALE
• It passes below
the root of
broad
ligament,
lateral to lateral
fornix of
vagina & is
crossed
superiorly by
the uterine
artery
PELVIC PART OF URETER
TERMINATION:
• It reaches the posterosuperior angle of
bladder
• It runs an oblique course of about 2 cm
through the wall of bladder before it
opens into its lumen (intramural part of
ureter). This part forms a valve-like
mechanism that prevents reflux of
urine into the ureter when bladder is
distended
INTRAVENOUS UROGRAM
INTRAVENOUS UROGRAM