PELVIC VISCERAPELVIC VISCERA

Urinary bladder, ureter, urethraUrinary bladder, ureter, urethra Sigmoid colon, rectumSigmoid colon, rectum Male genital organs: vas deferens, Male genital organs: vas deferens,

seminal vesicles, prostateseminal vesicles, prostate Female genital organs: ovaries, Fallopian Female genital organs: ovaries, Fallopian

tubes, uterus, vaginatubes, uterus, vagina

Ureters, Urinary BladderUreters, Urinary Bladder&&

Male UrethraMale Urethra

UreterUreter Crosses pelvic inlet Crosses pelvic inlet in front in front

of bifurcation of common of bifurcation of common iliac arteryiliac artery

Runs downward in front to Runs downward in front to internal iliac artery, internal iliac artery, reaches reaches ischial spineischial spine

Turns forward and Turns forward and medially , enters the medially , enters the upper upper lateral anglelateral angle of urinary of urinary bladderbladder

Near its termination, is Near its termination, is crossed by the vas crossed by the vas deferensdeferens

Ureter cont’dUreter cont’d Passes obliquely through Passes obliquely through

the wall of bladder for the wall of bladder for about about ¾ inch¾ inch before before opening into the bladder opening into the bladder cavity. cavity.

Bladder muscle Bladder muscle contraction mechanically contraction mechanically closes off ureteral orifice closes off ureteral orifice which prevents a reverse which prevents a reverse flow of urine toward the flow of urine toward the kidneykidney

Ureter cont’dUreter cont’d The ureter has The ureter has

constrictions at constrictions at three three points: points: ureteropelvic junctionureteropelvic junction crossing of crossing of

external/common external/common iliac artery iliac artery

where ureters enter where ureters enter bladderbladder

These are also sites of These are also sites of obstruction and stone obstruction and stone impactionimpaction

Urinary BladderUrinary Bladder Located immediately Located immediately

behind the pubic behind the pubic symphysissymphysis

Shape and relations vary Shape and relations vary according to the amount according to the amount of urine it containsof urine it contains

An empty bladder is An empty bladder is entirely a pelvic organentirely a pelvic organ; as ; as it fills, rises up into the it fills, rises up into the hypogastric regionhypogastric region

In young child the empty In young child the empty bladder projects above bladder projects above the pelvic inletthe pelvic inlet

Urinary Bladder Urinary Bladder cont’dcont’d The empty bladder is The empty bladder is

pyramidal in shape pyramidal in shape having:having:

An An apexapex A A base (posterior base (posterior

surface)surface) A A superiorsuperior surfacesurface Two Two infrolateral infrolateral

surfacessurfaces A A neckneck

Urinary Bladder Urinary Bladder cont’dcont’d

Apex:Apex: Lies behind the upper Lies behind the upper

margin of the margin of the symphysis pubissymphysis pubis

UrachusUrachus passes passes upwards to the upwards to the umbilicus forming the umbilicus forming the median umbilical median umbilical ligamentligament

Urinary Bladder Urinary Bladder cont’dcont’dBase or Posterior Base or Posterior

surface:surface: Triangular in shapeTriangular in shape Suprolateral anglesSuprolateral angles

joined by joined by uretersureters Inferior angleInferior angle gives gives

urethraurethra Upper partUpper part covered by covered by

peritoneumperitoneum Lower partLower part related to related to vas vas

deferentia and seminal deferentia and seminal vesiclesvesicles, that separate it , that separate it from rectumfrom rectum

Urinary Bladder cont’dUrinary Bladder cont’d

Superior surface:Superior surface: Completely covered Completely covered

by peritoneumby peritoneum. . Along its lateral Along its lateral margin, the margin, the peritoneum is peritoneum is reflected to the reflected to the lateral pelvic walllateral pelvic wall

Is Is related to the coils related to the coils of ileum or sigmoid of ileum or sigmoid coloncolon

As bladder fills, the As bladder fills, the superior surface superior surface bulges upward into bulges upward into abdominal cavity.abdominal cavity.

The peritoneal The peritoneal lining is peeled off lining is peeled off the lower part of the lower part of anterior abdominal anterior abdominal wall and the wall and the bladder comes into bladder comes into direct contact with direct contact with the anterior the anterior abdominal wallabdominal wall

Urinary Bladder cont’dUrinary Bladder cont’d

Infrolateral surfaces:Infrolateral surfaces: Related Related in frontin front to the to the

retropubic pad of fat & retropubic pad of fat & the pubic bonesthe pubic bones

PosteriorlyPosteriorly lie in contact lie in contact with the with the obturator obturator internusinternus above and above and levator anilevator ani below below

Urinary Bladder cont’dUrinary Bladder cont’dNeck:Neck: Lies Lies inferiorlyinferiorly and rests on and rests on

the the upper surface of upper surface of prostate.prostate.

Here, the smooth muscle Here, the smooth muscle fibers of the bladder are fibers of the bladder are continuous with those of the continuous with those of the prostateprostate

The circular muscle fibers The circular muscle fibers thickened to form the thickened to form the sphincter vesicaesphincter vesicae

Held in place by Held in place by puboprostatic ligamentpuboprostatic ligament (in (in male) and male) and pubovesical pubovesical ligamentligament (in female), formed (in female), formed by thickening of the pelvic by thickening of the pelvic fasciafascia

Trigone of the Urinary BladderTrigone of the Urinary Bladder TheThe trigonetrigone is a smooth is a smooth

triangular region on the triangular region on the internal surface of the base internal surface of the base of bladder, between the of bladder, between the openings of the two ureters openings of the two ureters and the urethra and the urethra

Superior angles correspond Superior angles correspond to openings of to openings of uretersureters and and inferior angle to the inferior angle to the opening of urethraopening of urethra

Limited above by a Limited above by a muscular ridge between the muscular ridge between the ureteric openings, called ureteric openings, called the the interureteric ridge interureteric ridge

Trigone of the Urinary Bladder cont’dTrigone of the Urinary Bladder cont’d The The mucous membrane is mucous membrane is

always smoothalways smooth even when even when the bladder is empty (unlike the bladder is empty (unlike rest of mucous membrane rest of mucous membrane which is thrown into folds in which is thrown into folds in empty bladder) as it is empty bladder) as it is firmly adherent to the firmly adherent to the underlying muscular coat underlying muscular coat (detrusor muscle)(detrusor muscle)

Uvula vesicaeUvula vesicae, a small , a small elevation located just elevation located just behind the urethral orifice, behind the urethral orifice, produced by the produced by the median median lobe of prostate.lobe of prostate.

Urinary BladderUrinary Bladder

Arterial supplyArterial supply: : Superior & inferior vesical Superior & inferior vesical arteriesarteries, branches of internal iliac artery, branches of internal iliac artery

VeinsVeins form form vesical venous plexusvesical venous plexus, which , which communicates with communicates with prostatic plexusprostatic plexus and is and is drained into the internal iliac veindrained into the internal iliac vein

LymphaticsLymphatics drain into drain into internal & external internal & external iliac lymph nodesiliac lymph nodes

Urinary Bladder: Nerve SupplyUrinary Bladder: Nerve Supply The nerves form the vesical The nerves form the vesical

nerve plexus that contains:nerve plexus that contains: Sympathetic fibersSympathetic fibers derived derived

mainly from mainly from L1, 2 nervesL1, 2 nerves Parasympathetic fibersParasympathetic fibers

derived from pelvic splanchnic derived from pelvic splanchnic nerves nerves S2,3,4S2,3,4

Sensory fibersSensory fibers from the from the bladder are visceral and bladder are visceral and transmit pain sensation transmit pain sensation resulting from overdistentionresulting from overdistention

Micturition reflexMicturition reflex

Male UrethraMale Urethra About About 8 inches8 inches long long Extending from the Extending from the

neck of bladder to the neck of bladder to the external urinary meatus external urinary meatus on the tip of the glans on the tip of the glans penispenis

Divided into Divided into threethree parts:parts: ProstaticProstatic MembranousMembranous PenilePenile

Prostatic UrethraProstatic Urethra WidestWidest and the and the most most

dilatable partdilatable part of the urethra of the urethra About About 11/411/4 inches long inches long Begins at the neck of the Begins at the neck of the

bladder, becomes bladder, becomes continuous with the continuous with the membranous urethra at the membranous urethra at the apex of the prostateapex of the prostate

Posterior wall shows Posterior wall shows urethral urethral crestcrest, , prostatic sinusprostatic sinus, , prostatic utericleprostatic utericle, , openings openings of the ejaculatory ductsof the ejaculatory ducts

Prostatic utericle & openings of the ejaculatory ducts

Uvula vesicaeUvula vesicae

Membranous UrethraMembranous Urethra

About About ½ inch½ inch long long Least dilatableLeast dilatable part part Lies within the Lies within the

urogenital diaphragmurogenital diaphragm surrounded by the surrounded by the sphincter urethraesphincter urethrae musclemuscle

Penile (Spongy) UrethraPenile (Spongy) Urethra About About 6 inches6 inches long long Enclosed in the Enclosed in the bulb and bulb and

corpus spongiosumcorpus spongiosum of the of the penispenis

Within the glans penis, it is Within the glans penis, it is dilated to form the dilated to form the fossa fossa terminalis (navicular fossa)terminalis (navicular fossa)

Receives the openings of the Receives the openings of the ducts of the ducts of the bulbourethral bulbourethral glandsglands just below the just below the urogenital diaphragmurogenital diaphragm

External urinary meatus is the External urinary meatus is the narrowest part of the entire narrowest part of the entire urethraurethra

navicular fossa

External urinary meatus

Clinical NotesClinical Notes

Urinary retentionUrinary retention Suprapubic aspirationSuprapubic aspiration Ureteric stones: Ureteric stones:

impaction at the impaction at the constrictionsconstrictions

FLY HIGH