1. URINARY BLADDER
&
PELVIC PART OF URETERS
Dr. Ahmed Fathalla Ibrahim

2. Upper Surface
Inferolateral surface
Inferolateral surface
Apex
Neck

3. 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

4. MALE PELVIS

5. MALE PELVIS

6. BASE OF MALE BLADDER

7. FEMALE PELVIS

8. FEMALE PELVIS

9. 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

10. 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)

11. URINARY BLADDER BASE (POSTERIOR SURFACE): In male: In female:
Is directed backward
Its superolateral angles receive the ureters
In male:
Its upper part is covered by peritoneum
It is related to vasa deferentia & seminal vesicles separating it from rectum
In female:
It has no peritoneal covering
It is related to vagina

12. 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

13. URINARY BLADDER INFEROLATERAL SURFACES:
Are related to retropubic fat separating them from:
Body of pubis
Levator ani
Obturator internus

14. URINARY BLADDER NECK: In male: In female:
Is the lowest & most fixed part
Lies behind symphysis pubis
Is continuous with urethra
In male:
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:
Anteriorly: it is attached to pubovesical ligament
Posteriorly: it is related to anterior wall of vagina

15. URINARY BLADDER LIGAMENTS: Median umbilical ligament
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

16. INTERIOR OF URINARY BLADDER

17. INTERIOR OF URINARY BLADDER
The mucous membrane forms folds (rugae) that disappear when the bladder is distended
TRIGONE:
A triangular area in the base of bladder, bounded by the 2 ureteric orifices & the internal urethral orifice
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

18. URINARY BLADDER
Distended
Empty

19. 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

20. 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

21. 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

22. URINARY BLADDER NERVE SUPPLY: by the inferior hypogastric plexuses
Parasympathetic fibers: from S2,3,4 motor to detrusor muscle (muscle coat of bladder) & inhibitory to internal urethral sphincter, produce micturation
Sympathetic fibers: from first & second lumbar ganglia
Ascending sensory fibers: carry sensation of fullness (distention) & pain sensation

23. 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):
External iliac artery & vein
Obturator nerve, artery & vein
Curves forward & medially

24. IN MALE
It is crossed anteriorly by vas deferens

25. IN FEMALE
It passes below the root of broad ligament lateral to lateral fornix of vagina & is crossed superiorly by the uterine artery

26. 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

27. INTRAVENOUS UROGRAM

28. INTRAVENOUS UROGRAM