Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Urinary Bladder Lecture PPT
INTRODUCTION
?IT IS A HOLLOW MUSCULO-
MEMBRANOUS SAC WHICH ACTS
AS A RESORVOIR FOR THE URINE.
? IT IS THE MOST ANTERIOR
ELEMENT OF THE PELVIC VISCERA.
?IT IS A SUBPERITONEAL ORGAN
AND HAS PARIETAL PERITONEUM
ONLY ON ITS SUPERIOR SURFACE.
?URINE ENTERS THE BLADDER VIA
URETERS AND EXITS VIA THE
URETHRA.
ANATOMICAL LOCATION
When "Empty" , the adult urinary bladder is located in the "Lesser
pelvis" lying partially superior to and partially postetior to the pubic
Bones.
As the bladder fills it enters the "Greater Pelvis".
In some individuals, a full bladder may ascend to the level of the
"Umbilicus".
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.
?Has a base (fundus), neck, apex, a superior and two inferolateral
surfaces.
?Mean capacity is 220 ml.
?150-250 ml collection lead to desire to micturition.
?Volume >500 ml caused pain due to its distension.
Superior surface-peritoneal
Base: upper part peritoneal
Other : non peritoneal
Surfaces:
?Superior surface
?Posterior surface (Base)
?Inferolateralsurfaces
Apex-directed anteriorly
Neck-directed inferiorly
Neck is encircled by
prostate in MALES
BASE OF BLADDER(Male)
Base of urinary bladder of
male
? Rectovesicle pouch
? Seminal vesicle
? Ampulla of vas deference
? Rectovesicle fascia
(Denonvillier's fascia)
NECK OF BLADDER
?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
surrounded by prostate gland.
?It is anchored into position by a pair of tough fibromuscular bands
?pubovesical ligaments in female
?puboprostatic ligaments in male.
SUPERIOR SURFACE OF BLADDER
Is triangular in shape,bounded on
each side by the lateral borders
extending from ureteric orifices
posterolaterally to the apex
anteriorly &posteriorly by the
posterior border which joins the
ureteric orifices.
In the male, it is completely covered
by the peritoneum which separates
it from: coils of the ileum, and/or
sigmoid colon.Along its lateral
borders, the peritoneum is reflected
on to the pelvic walls.
In the female, it is
covered by the
peritoneum except
for a small area
near the posterior
border, which is
related to the
supravaginal part
of the uterine
cervix. Here the
peritoneum
is reflected on to
the uterine
isthmus forming
vesicouterine
pouch.
INFEROLATERAL SURFACE OF BLADDER
These surfaces are separated from each other,
anteriorly
by the anterior border, and from the superior surface by
the lateral borders.
The inferolateral surfaces are devoid of peritoneum
INFEROLATERAL SURFACE OF BLADDER
Medial view of lower part of
lateral pelvic wall
RETROPUBIC SPACE(of RETZIUS)
RELATIONS OF THE BLADDER
SUPPORTS OF THE BLADDER
False ligaments
1. Median
umbilical fold
2. Medial
umbilical fold
3. Lateral false
ligaments
4. Posterior
false
ligaments
SUPPORTS(contd..)
True Ligaments
?Puboprastatic or
Pubovesicle ligament
?Lateral ligament
?Posterior ligament
?Median umbilical
ligament
INTERIOR OF BLADDER
coronal section.
TRIGONE OF URINARY BLADDER
It is smooth triangular part of
urinary bladder.
Mucosal lining of trigone is
smooth and firmly attached to the
underlying wall of the bladder.
Formed by Right and left
ureteral orifices.
Once the trigone of urinary
bladder is stretched to a certain
degree, siganl is sent to the brain
that bladder needs to be
emptied.
URETERAL ORIFICES
These are Slit like openings through which ureters enter the bladder
on the posterolateral angles of the trigone of urinary bladder.
MERCIER'S BAR
It is a mucous membane present between the two ureteral
orifices.
It is also called "InterUreteral Fold"
NECK OF URINARY BLADDER
It is the lowest portion of the bladder through which the "Urethra"
arises.
INTERNAL URETHRAL SPHINCTER
INTERNAL URETHRAL SPHINCTER
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.
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.
DETRUSOR MUSCLE
It is also referred as " Muscularis Propria".
It is smooth muscle , found around the wall of bladder ,comprised of
inner and outer longitudinal, and middle circular layer.
This muscle is relaxing during accomulation of urine in the bladder,
and contracts only during urination to void and empty the bladder.
ARTERIAL SUPPLY
Branches of internal iliac arteries.
Superior vesical arteries supply anterosuperior parts of the
bladder.
In males, inferior vesical arteries supply the fundus and neck
of the bladder.
In females, vaginal arteries replace the inferior vesical
arteries and small branches to posteroinferior parts of the
bladder.
Obturator and inferior gluteal arteries also supply small
branches to the bladder.
VENOUS DRAINAGE
The veins draining from the bladder correspond to the arteries
.
Veins from the Vesical venous plexus drain into the internal iliac
veins.
INNERVATION OF URINARY BLADDER
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.
Pudendal nerve (Somatic nerve) causes contraction of
External Sphincter. We are firing pudendal nerve when we
are trying to hold our urine.
Hypogastric nerve (Sympathetic nerve) causes relaxation of
Detrusor muscle and contraction of Internal sphincter.
Afferent Pelvic nerve that is sensory and comes from the
detrusor muscle. It is stimulated when the bladder is
stretched.
LYMPHATIC DRAINAGE OF BLADDER
In both sexes, lymphatic vessels leave the superior
surface of the bladder and pass to the "External iliac
lymph nodes".
Those from fundus pass to the "Internal iliac lymph
nodes".
Some vessels from the neck of bladder drain into the
"Sacral" to "Common iliac lymph nodes".
APPLIED ANATOMY
1. Trabeculated bladder- due to chronic
obstruction to the outflow of the urine by
enlarged prostate or stricture of the urethra.
2. Suprapubic cystostomy-An extraperitoneal
approach of opening the cavity of the urinary
bladder.
APPLIED ANATOMY
3. Neurogenic bladder
a. Automatic reflex bladder.
b. Autonomous bladder
Coverings of Kidney
?Fibrous capsule (true capsule)
?Perinephric fat
?Renal fascia( fascia of Gerota)
?Paranephric fat
Renal Fascia or fascia of Gerota
?Consists of two layers
1.Anterior layer or fascia of Toldt
2.Posterior layer of Fascia of Zuckerkandl
?Laterally: Both layer fused and continued with the
fascia transversalis
?Medially: Layers do not fuse.
This post was last modified on 30 November 2021