Download MBBS Urinary Bladder Lecture PPT

INTRODUCTION

?IT IS A HOLLOW MUSCULO-

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MEMBRANOUS SAC WHICH ACTS

AS A RESORVOIR FOR THE URINE.

? IT IS THE MOST ANTERIOR

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ELEMENT OF THE PELVIC VISCERA.

?IT IS A SUBPERITONEAL ORGAN

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AND HAS PARIETAL PERITONEUM

ONLY ON ITS SUPERIOR SURFACE.

?URINE ENTERS THE BLADDER VIA

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URETERS AND EXITS VIA THE

URETHRA.
ANATOMICAL LOCATION

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When "Empty" , the adult urinary bladder is located in the "Lesser

pelvis" lying partially superior to and partially postetior to the pubic

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Bones.
As the bladder fills it enters the "Greater Pelvis".
In some individuals, a full bladder may ascend to the level of the

"Umbilicus".

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In infants and young children,the urinary bladder is in the abdomen

even when empty.

?An empty bladder is somewhat tetrahedral and oval when full.

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?Has a base (fundus), neck, apex, a superior and two inferolateral

surfaces.

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?Mean capacity is 220 ml.

?150-250 ml collection lead to desire to micturition.

?Volume >500 ml caused pain due to its distension.

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Superior surface-peritoneal

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Base: upper part peritoneal

Other : non peritoneal

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Surfaces:

?Superior surface

?Posterior surface (Base)

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?Inferolateralsurfaces

Apex-directed anteriorly

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Neck-directed inferiorly


Neck is encircled by

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prostate in MALES

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BASE OF BLADDER(Male)


Base of urinary bladder of

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male

? Rectovesicle pouch

? Seminal vesicle

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? Ampulla of vas deference

? Rectovesicle fascia

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(Denonvillier's fascia)



NECK OF BLADDER

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?The neck of the bladder surrounds the origin of the urethra.

?The neck is the most inferior and also the most 'fixed' part of the bladder. In male it is

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surrounded by prostate gland.

?It is anchored into position by a pair of tough fibromuscular bands

?pubovesical ligaments in female

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?puboprostatic ligaments in male.


SUPERIOR SURFACE OF BLADDER

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Is triangular in shape,bounded on

each side by the lateral borders

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extending from ureteric orifices

posterolaterally to the apex

anteriorly &posteriorly by the

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posterior border which joins the

ureteric orifices.

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In the male, it is completely covered

by the peritoneum which separates

it from: coils of the ileum, and/or

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sigmoid colon.Along its lateral

borders, the peritoneum is reflected

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on to the pelvic walls.



In the female, it is

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covered by the

peritoneum except

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for a small area

near the posterior

border, which is

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related to the

supravaginal part

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of the uterine

cervix. Here the

peritoneum

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is reflected on to

the uterine

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isthmus forming

vesicouterine

pouch.

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INFEROLATERAL SURFACE OF BLADDER

These surfaces are separated from each other,

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anteriorly

by the anterior border, and from the superior surface by

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the lateral borders.

The inferolateral surfaces are devoid of peritoneum

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INFEROLATERAL SURFACE OF BLADDER

Medial view of lower part of

lateral pelvic wall

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RETROPUBIC SPACE(of RETZIUS)

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RELATIONS OF THE BLADDER


SUPPORTS OF THE BLADDER

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False ligaments

1. Median

umbilical fold

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2. Medial

umbilical fold

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3. Lateral false

ligaments

4. Posterior

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false

ligaments
SUPPORTS(contd..)

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True Ligaments

?Puboprastatic or

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Pubovesicle ligament

?Lateral ligament

?Posterior ligament

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?Median umbilical

ligament

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INTERIOR OF BLADDER

coronal section.

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TRIGONE OF URINARY BLADDER

It is smooth triangular part of

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urinary bladder.

Mucosal lining of trigone is

smooth and firmly attached to the

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underlying wall of the bladder.

Formed by Right and left

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ureteral orifices.

Once the trigone of urinary

bladder is stretched to a certain

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degree, siganl is sent to the brain

that bladder needs to be

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emptied.



URETERAL ORIFICES

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These are Slit like openings through which ureters enter the bladder

on the posterolateral angles of the trigone of urinary bladder.

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MERCIER'S BAR

It is a mucous membane present between the two ureteral

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orifices.

It is also called "InterUreteral Fold"

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NECK OF URINARY BLADDER

It is the lowest portion of the bladder through which the "Urethra"

arises.

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INTERNAL URETHRAL SPHINCTER


INTERNAL URETHRAL SPHINCTER

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It is comprised of smooth muscle that is located at the junction of

urethra and the urinary bladder.
It is innervated by S2-S4 nerves of the pelvic plexus.

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It's function is to constrict the internal urethra ,preventing the urine

leakage and also prevents the Retrograde ejaculation (Ejaculatory Reflex

) of semen into the bladder.

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DETRUSOR MUSCLE

It is also referred as " Muscularis Propria".

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It is smooth muscle , found around the wall of bladder ,comprised of

inner and outer longitudinal, and middle circular layer.

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This muscle is relaxing during accomulation of urine in the bladder,

and contracts only during urination to void and empty the bladder.
ARTERIAL SUPPLY

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Branches of internal iliac arteries.

Superior vesical arteries supply anterosuperior parts of the

bladder.

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In males, inferior vesical arteries supply the fundus and neck

of the bladder.
In females, vaginal arteries replace the inferior vesical

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arteries and small branches to posteroinferior parts of the

bladder.
Obturator and inferior gluteal arteries also supply small

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branches to the bladder.

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VENOUS DRAINAGE

The veins draining from the bladder correspond to the arteries

.

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Veins from the Vesical venous plexus drain into the internal iliac

veins.
INNERVATION OF URINARY BLADDER

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Pelvic Nerve (Parasympathetic nerve) comes from the

sacral region of spinal cord. It is not under our control. It

causes contraction of the Detrusor muscle.

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Pudendal nerve (Somatic nerve) causes contraction of

External Sphincter. We are firing pudendal nerve when we

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are trying to hold our urine.

Hypogastric nerve (Sympathetic nerve) causes relaxation of

Detrusor muscle and contraction of Internal sphincter.

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Afferent Pelvic nerve that is sensory and comes from the

detrusor muscle. It is stimulated when the bladder is

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stretched.

LYMPHATIC DRAINAGE OF BLADDER

In both sexes, lymphatic vessels leave the superior

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surface of the bladder and pass to the "External iliac

lymph nodes".

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Those from fundus pass to the "Internal iliac lymph

nodes".

Some vessels from the neck of bladder drain into the

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"Sacral" to "Common iliac lymph nodes".


APPLIED ANATOMY

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1. Trabeculated bladder- due to chronic

obstruction to the outflow of the urine by

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enlarged prostate or stricture of the urethra.

2. Suprapubic cystostomy-An extraperitoneal

approach of opening the cavity of the urinary

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bladder.
APPLIED ANATOMY

3. Neurogenic bladder

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a. Automatic reflex bladder.
b. Autonomous bladder
Coverings of Kidney

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?Fibrous capsule (true capsule)

?Perinephric fat

?Renal fascia( fascia of Gerota)

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?Paranephric fat
Renal Fascia or fascia of Gerota

?Consists of two layers

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1.Anterior layer or fascia of Toldt

2.Posterior layer of Fascia of Zuckerkandl

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?Laterally: Both layer fused and continued with the

fascia transversalis

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?Medially: Layers do not fuse.