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The urinary

bladder & the


urethra
Urinary
bladder:
• Temporary reservior of urine
• Lies in the anterior part of the pelvic
cavity
• Varies in its size ,shape & position
• When empty lies in the pelvis,
• When it fills,it expands upward into
the abdominal cavity
• Empty bladder – tetrahedral,
• Full bladder -ovoid
• Empty bladder has :
an apex,
a base,
a neck,
3 surfaces( superior/rt & lt.
inferiolateral)
& 4 borders( 2
lateral/anterior/posterior)
• A full bladder has:
an apex,
a neck
& 2 surfaces
( anterior/posterior)
Relations
• 1. Apex:
-connected to the
umbilicus by the medial
umbilical ligament
• 2. Base:
in females:
-uterine cervix,
& vagina
in males:
-upper part: coils of
intestine
-lower part: seminal
vesicles & vas deferens
• 3.neck:
-lowest and most fixed part of the bladder
-lies 3-4 cms behind the pubic symphysis
-piearced by the internal urethral orifice
In males:
-covered by the prostate
In females:
-pelvic fascia
• 4. Superior surface:
In males:
completely covered by the peritoneum
sigmoid colon & coils of terminal ileum
In females:
peritoneum covers the greater part,
except a small area near the posterior
border( w/c is related to cervix)
the peritoneum from the superior
surface is reflected to the uterus forms
vesicouterine pouch
• 5. Inferiolateral surfaces:
- devoid of peritoneum
- seperated from each other by the ant. border &
from the sup. Surface by lateral borders.
In males:
-the pubis,puboprostatic ligament,retropubic
fat,levator ani & obturator internus
In females:
-same,except that puboprostatic ligament
replaced by pubovesical ligament.
# as bladder fills inferiolateral sur = ant.surface
Ligaments of the
bladder:
• True ligaments
• False ligaments
True ligaments
• Around the neck and base of
the bladder
1.lateral true ligament
2. lateral puboprostatic
ligament
3. medial puboprostatic
ligament
4.median umbilical ligament
5.posterior ligament
False ligaments
• Peritoneqal folds w/c does not
support the bladder
1.the median umbilical fold
2.the lateral false ligament
3.the median umbilical fold
4.the posterior false ligament
Interior of the bladder
• In an empty bladder:
greater part of the mucosa
shows irregular folds
traingular area over the
lower part of the
base,mucosa of w/c will be
smooth.
this area is known as
TRIGONE OF THE BLADDER.
• Trigone of the bladder;
-the apex of the trigone is directed
downwards & forwards.
Importance :
-the internal urethral opening opens
in to the apex.
-the ureters opens at the
posteriolateral angles of the trigone.
-slight elevations just above the
urethral opening-uvula vesicae.
Capacity
• In an adult:
220 ml ( 120- 320 ml )
> 220 ml – desire to micturate
> 500 ml - painful
Artery supply
• Main:
- superior vesical & inferior vesical
artery
• Additional :
- obturator,inf. Gluteal
- uterine & vaginal artery ( females)
Venous drainage
• Internal ileac vein
Lymphatic drainage
• External ileac nodes
• Internal ileac nodes,
lateral aortic nodes
Nerve supply
• Parasympathetic
S2- S4
• Sympathetic
T11 – L2
Applied
• Cystoscopy
• Urinary incontinence
The urethra
• Male urethra
• Female urethra
The male urethra
• Muscular tube
• About 18-20 cms long
• Conveys urine from
internal urethral orifice –
external urethral orifice
• In the flaccid state – 2
curvatures, shape as ‘S’.
4 parts of the urethra
• 1.Urethra in the bladder
neck ( preprostatic
urethra )
• 2. Prostatic urethra
• 3.membranous urethra (
intermediate )
• 4.spongy urethra ( pelvic
)
• 1.Urethra in the
bladder neck:
- preprostatic urethra
- 1.5 – 2 cms
- neck of the bladder
– sup. Aspect of the
prostate.
• 2. prostatic part:
- 4 cms. Long
- continuous with the urethra in the
bladder neck
- widest & most dilated part
- more widest in its middle part
Notable features:
- urethral crest:
- prostatic sinus
- seminal colliculus
- openings for the ejaculatory duct
• 3.membranous urethra:
- 1.5 – 2 cms long
- passes thru the external urethral
sphincter
- extends from the prostatic
urethra – spongy urethra
- narrowest & least distensible
part
- bulbourethral glands are placed
one on each side.
• 4.spongy urethra:
-penile part
- longest part
- 15 cms long
- distal end of the membranous
part of the urethra – external
urethral orifice
- passes thru the bulb of the corpus
spongiosum of the penis
-lumen 5 mm
- expanded in the bulb of the penis
( intra bulbar fossa) & glans penis
( navicular fossa )
- ducts of bulbo urethral glands
opens
Artery supply
• Proximal 2 parts
branches of the internal vesical &
middle rectal arteries
• Distal 2 parts
branches from the internal
pudendal artery
Lymphatics:
• Internal ileac
• External ileac
• Deep inguinal
Female urethra
• Anterioinferiorly from the internal
urethral orifice- external urethral
orifice
• 4 cms long
• Urethral glands are present
Artery supply
• Internal pudendal and
• Vaginal artery
lymphatics
• Sacral and internal ileac
Applied
• Catheterization
• Urethritis
• hypospadiasis
• thanks

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