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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