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ANATOMY OF URINARY BLADDER

The urinary bladder, a hollow viscus with strong muscular walls, is


characterized by its distensibility . The urinary bladder is a
temporary reservoir for urine and varies in size, shape, position, and
relationships according to its content and the state of neighboring
viscera.
Location :
Bladder separated from pubic bones by the potential
retropubic space (of Retzius) and lies mostly inferior to the
peritoneum,
Anterior : pubic bones and pubic symphysis
Posterior : the prostate (males) or anterior wall of the vagina
posteriorly
Relation to other organs
free within the extraperitoneal subcutaneous fatty tissue,
except for its neck, which is held firmly by the lateral
ligaments of bladder and the tendinous arch of the pelvic
fasciaespecially its anterior component, the puboprostatic
ligament in males and the pubovesical ligament in females
In females, since the posterior aspect of the bladder rests
directly upon the anterior wall of the vagina, the lateral
attachment of the vagina to the tendinous arch of the pelvic
fascia, the paracolpium, is an indirect but important factor in
supporting the urinary bladder
Position when empty
In infants and young children: in the abdomen even when
empty. The bladder usually enters the greater pelvis by 6
years of age; however, it is not located entirely within the
lesser pelvis until after puberty.
In adult :
o almost entirely in the lesser pelvis, lying partially
superior to and partially posterior to the pubic bones
o As the bladder fills, enters the greater pelvis as it
ascends in the extraperitoneal fatty tissue of the
anterior abdominal wall
When empty, the bladder is somewhat tetrahedral externally has an
apex,body, fundus, and neck.
The apex of the bladder points toward the superior edge of
the pubic symphysis when the bladder is empty.

The fundus of the bladder is opposite the apex, formed by


the somewhat convex posterior wall.
The body of the bladder is the major portion of the bladder
between the apex and the fundus.
The fundus and inferolateral surfaces meet inferiorly at the
neck of the bladder.

: the fundus is directly related to the superior anterior wall


of the vagina
The bladder is enveloped by a loose connective tissue visceral
fascia

The walls of the bladder are composed chiefly of the detrusor


muscle. Toward the neck of the male bladder, the muscle fibers
form the involuntary internal urethral sphincter. This sphincter
contracts during ejaculation to prevent retrograde ejaculation
(ejaculatory reflux) of semen into the bladder. Some fibers run
radially and assist in opening the internal urethral orifice. In
males, the muscle fibers in the neck of the bladder are continuous
with the fibromuscular tissue of the prostate, whereas in females
these fibers are continuous with muscle fibers in the wall of the
urethra.

The bladders four surfaces (superior, two inferolateral, and


posterior) are most apparent when viewing an empty, contracted
bladder that has been removed from a cadaver, when the bladder
appears rather boat shaped.
The bladder bed is formed by the structures that directly contact it.
On each side, the pubic bones and fascia covering the levator
ani and the superior obturator internus lie in contact with the
inferolateral surfaces of the bladder
Only the superior surface is covered by peritoneum.
: the fundus is separated from the rectum centrally by only
the fascial rectovesical septum and laterally by the seminal
glands and ampullae of the ductus deferentes

The ureteric orifices and the internal urethral orifice are at the
angles of the trigone of the bladder (Fig. 3.28C). The ureteric
orifices are encircled by loops of detrusor musculature
that tighten when the bladder contracts to assist in preventing reflux
of urine into the ureter. The uvula of the bladder is a slight
elevation of the trigone; it is usually more prominent in older men
owing to enlargement of the posterior lobe of the prostate.

Arterial Supply of Bladder.


The main arteries supply : branches of the internal iliac arteries
Anterosuperior : The superior vesical
: inferior vesical arteries supply the fundus and neck of the
bladder.
: vaginal arteries replace the inferior vesical arteries and
send small branches to posteroinferior parts of the bladder
.The obturator and inferior gluteal arteries also supply small
branches to the bladder.
Venous Drainage
from the bladder correspond to the arteries and are tributaries of the
internal iliac veins.
: the vesical venous plexus is continuous with the prostatic
venous plexus, and the combined plexus complex envelops
the fundus of the bladder and prostate, the seminal glands,
the ductus deferentes, and the inferior ends of the ureters. It
also receives blood from the deep dorsal vein of the penis,
which drains into the prostatic venous plexus. The vesical
venous plexus is the part of the plexus complex that is most
directly associated with the bladder itself. It mainly drains
through the inferior vesical veins into the internal iliac veins;
however, it may drain through the sacral veins into the
internal vertebral venous plexuses.
: the vesical venous plexus envelops the pelvic part of the
urethra and the neck of the bladder, receives blood from the
dorsal vein of the clitoris, and communicates with the vaginal
or uterovaginal venous plexus
Innervation of Bladder.
Sympathetic fibers
Conveyed from inferior thoracic and upper lumbar spinal cord
levels to the vesical (pelvic) plexuses primarily through the
hypogastric plexuses and nerves
Stimulates ejaculation simultaneously contraction of the
internal urethral sphincter prevent reflux of semen into the
bladder.
A
sympathetic
response
at
moments
other
than
ejaculation(e.g., self-consciousness when standing at the
urinal infront of a waiting line) can cause the internal

sphincter to contract, hampering the ability to urinate until


parasympathetic inhibition of the sphincter occurs.
parasympathetic fibers
From sacral spinal cord levels are conveyed by the pelvic
splanchnic nerves and the inferior hypogastric plexus
motor to the detrusor muscle and inhibitory to the internal
urethral sphincter of the male bladder. Hence, when visceral
afferent fibers are stimulated by stretching, the bladder
contracts reflexively, the internal urethral sphincter relaxes (in
males), and urine flows into the urethra
Sensory fibers from most of the bladder are visceral; reflex afferents
follow the course of the parasympathetic fibers, as do those
transmitting pain sensations (such as results from
overdistension) from the inferior part of the bladder. The superior
surface of the bladder is covered with peritoneum and is therefore
superior to the pelvic pain line; thus pain fibers from the superior
bladder follow the sympathetic fibers retrogradely to the inferior
thoracic and upper lumbar spinal ganglia (T11L2 or L3).

HISTOLOGY OF URINARY BLADDER


The mucosa of bladder is lined by unique stratified transitional
epithelium or urothelium. This is surrounded by folded lamina propria
and submucosa, followed by dense sheath of interwoven smooth
muscle layers and adventitia.
Urothelium is composed of the following 3 layers :
single layer of small basal cells resting on a very thin
basement membrane
an intermediate region containing from one to several layers
or more columnar cells
a superficial layer of very large, polyhedral, or bulbous cells
called umbrella cells (occasionally bi- or multinucleated and
are highly differentiated to protect underlying cells against the
cytotoxic effect of hypertonic urin
o Umbrella cells well developed in bladder
o Up to 100m in diameter
o Have extensive intercellular junctional complexes
surrounding unique apical membranes
o Most of apical surface consist of assymetric unite
membrane (outer lipid layer appear twice as thick as
the inner leaflet
Lipid rafts containing uroplakins which assembly
into paracrystalline arrays of stiffened plaques
16 m in diameter impermeable and protect
cytoplasm
and
underlying
cells
from
hyperosmotic effects
Bladders lamina propria and dense irregular connective tissue of
submucosa are highly vascularized. The muscular consist of three
poorly delineated layers, call detrusor muscle, which contract to
empty the bladder. This detrusor muscle are seen most distinctly at
the neck of the bladder near the urethra.

The ureter pass through the wall of bladder obliquely, forming a


valve prevents backflow of urine into ureters.
All the urinary passage are covered externally by an adventitia layer,
except for the upper part of bladder which is covered by serous
peritoneum.

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