Ureter and bladder
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This document discusses the anatomy and surgical risks related to the ureter. It describes the course, blood supply, innervation and identification of the ureter. It also outlines the types of operative ureteral injuries that can occur during gynecologic surgery, including crushing, ligation, transection, angulation and ischemia. The most common sites of injury are near the pelvic brim during hysterectomy when attempting hemostasis. Laparoscopic injuries typically result from thermal damage to the ureter. Surgical procedures like hysterectomy, adnexectomy, incontinence surgery and radical trachelectomy carry risks of ureteral injury.
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The ureter is at risk of injury during gynecologic surgeries, especially at the pelvic brim near the infundibulopelvic ligament during procedures like hysterectomy. The most common type of injury is obstruction, which can result from attempts to obtain hemostasis in the pelvic area. Ureteral injuries may be diagnosed intraoperatively or postoperatively, and long term sequelae include complications like reflux or hydronephrosis if not repaired. Laparoscopic procedures can also cause thermal injuries to the ureter, especially during coagulation of uterine vessels or transection of the infundibulopelvic ligament. Careful identification and protection of the ure
Ureter
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This document summarizes the anatomy and clinical features of the ureter. It describes the course and branches of the ureter as it passes from the kidney to the bladder. Key points include that the ureter is 10 inches long and has abdominal, pelvic, and intravesical portions. It discusses the blood supply and mentions that the ureter is susceptible to stone formation at three narrow points along its course. The document also notes clinical signs like vermicular movements and how the ureter can be identified during surgery or on imaging studies.
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The vas deferens are two muscular tubes that transport sperm from the epididymis to the ejaculatory duct. Each vas deferens begins at the testis and ascends behind the testis and epididymis into the spermatic cord. It then passes through the inguinal canal into the abdomen and loops around blood vessels in the pelvis before joining the seminal vesicle duct to form the ejaculatory duct. A vasectomy involves cutting and sealing a short segment of each vas deferens to prevent sperm from being ejaculated and cause male sterilization.
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The jejunum and ileum are the coiled parts of the small intestine located between the duodenum and colon. Together they are around 6 meters long. The jejunum is located in the middle of the small intestine, between the duodenum and ileum. The ileum is the final section of the small intestine leading to the large intestine. Both sections are supplied by the superior mesenteric artery and drained by the superior mesenteric vein. They absorb nutrients and pass contents to the large intestine.
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Surgical anatomy inguinal canal dr mnr
1) The inguinal canal is an oblique passage located between the superficial and deep rings in the anterior abdominal wall. It contains the spermatic cord in males and round ligament in females.
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The peritoneum is a thin serous membrane that lines the abdominal and pelvic cavities and covers the organs within. It is derived from mesoderm. The peritoneal cavity is divided into the greater and lesser sacs. The peritoneum has several functions including movement of viscera, protection, and absorption. It is innervated by both autonomic and somatic nerves. The peritoneum forms several folds and structures that suspend organs, including the mesentery, transverse mesocolon, and greater and lesser omenta. It covers both peritoneal organs, which are attached via mesentery, and some retroperitoneal organs.
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The testis is the male gonad that produces and stores sperm. It is oval shaped and suspended in the scrotum by the spermatic cord. The testis has three layers of coverings and is made up of lobules containing seminiferous tubules that produce sperm. Sperm exit the testis via the rete testis and efferent ductules into the epididymis for storage. The testis receives blood supply from the testicular artery and drains into the pampiniform plexus of veins. Lymphatic and nerve supply also allow for sensation and vasomotor control.
Peritoneum slides
The peritoneum is a serous membrane that lines the abdominal cavity and covers organs. It has two layers, with a potential space between called the peritoneal cavity filled with fluid. The peritoneal cavity is divided into greater and lesser sacs connected by the epiploic foramen. Various peritoneal folds, ligaments and omenta attach organs and allow for movement. The peritoneum facilitates organ movement and absorption within the abdominal cavity.
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This document provides an overview of the anatomy of the rectum and anal canal. It describes the rectum as the distal part of the large gut located between the sigmoid colon and anal canal. The rectum is curved and proceeds downward and forward, following the concavity of the sacrum and coccyx. It is around 12 cm long and ends at the anorectal junction. The anal canal is located below the pelvic diaphragm and is around 3.8 cm long, extending from the anorectal junction to the anus. It is lined by different types of epithelium in the upper, middle, and lower sections. The document also outlines the blood supply, nerve supply, and sphincter
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Anatomy of Rectum and Anus - Dr Peter Andre Soltau
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Ureter and bladder
- 2. HISTOLOGY
- 8. BLOOD SUPPLYOF URETER Dissect from lateral side Dissect from medial side
- 9. NERVE SUPPLYAND LYMPHATIC DRAINAGE SYMPATHETIC NERVE SUPPLY= T10 – L2 Pelvic plexus Inferior mesenteric plexus Ovarion plexus LYMPHATIC DRAINAGE: Abdominal part – Lumbar LN Pelvic part – External and Internal iliac LN
- 10. BLADDER
- 11. Hollow organ Spherically shaped when full Stores urine Size varies with urine volume, reaching a maximum volume of at least 300 mL The bladder mucosa is transitional cell epithelium and the muscle wall (detrusor). Rather than being arranged in layers, it is composed of intermeshing muscle fibers.
- 12. Divided into two areas Base of the bladder – urinary trigone posteriorly and a thickened area of detrusor anteriorly. The three corners of the trigone are formed by the two ureteral orifices and the opening of the urethra into the bladder. The bladder base receives α- adrenergic sympathetic innervation Is the area responsible for maintaining continence.
- 13. Dome of the bladder – Area above the bladder base Parasympathetic innervation and is responsible for micturition. The bladder is positioned posterior to the pubis and lower abdominal wall and anterior to the cervix, upper vagina, and part of the cardinal ligament. Laterally, it is bounded by the pelvic diaphragm and obturator internus muscle.
- 14. Blood Supply The blood supply to the bladder is from the superior, middle, and inferior vesical arteries, with contribution from the uterine and vaginal vessels. Innervation The innervation to the bladder is from the vesical plexus, with contribution from the uterovaginal plexus.
- 15. Urethra The vesical neck is the region of the bladder that receives and incorporates the urethral lumen. The female urethra is about 3 to 4 cm in length and extends from the bladder to the vestibule, traveling just anterior to the vagina
- 16. IDENTIFICATION OFURETER PALE GLISTENING STRUCTURE PERISTALSIS LONGITUDINALVESSELSONTHE SURFACE UNIQUE SNAP
- 18. TYPESOF OPERATIVE URETERAL INJURIES 1. Crushing with clmap(necrosis) 2. Ligation (suture/stapler) 3. Transection 4. Angulation (with secondary obstruction) 5. Ischemia (diathermy /stripping of adventitia) 6. Resection
- 19. URETERAL INJURY LOCATIONS 1. Cardinal ligament where the ureter crosses under the uterine artery 2. Tunnel ofWertheim 3. Intramural portion of the ureter 4. Dorsal to the infundibulo-pelvic ligament near or at the pelvic brim 5. Lateral pelvic sidewall above the uterosacral ligament
- 20. URETERAL INJURY ASSOCIATED WITH GYNECOLOGIC SURGERY: “MOST COMMONS” Most common site: Pelvic brim near the infundibulopelvic ligament Most common procedure: Simple abdominal hysterectomy Most common type of injury: Obstruction Most common “activity” leading to injury: Attempts to obtain hemostasis Most common time of diagnosis: None: 50-50 split between intraoperative and postoperative Most common long-term sequelae: None
- 21. Laparoscopy- Associated Ureteral Injuries Uncommon-0.3% to 0.4% Result of a thermal injury than incision, transaction, or encroachment/ligation- extreme caution! Delayed diagnosis- 2 to 5 days after the surgery A) decreases the probability of a successful immediate primary repair and B) increases the risk of a long-term complication M/c sites of injury- laparoscopic hysterectomy- i)When the uterine vessels are stapled or electrocoagulated Ii)When the infundibulopelvic ligament is transected
- 22. OTHER SURGICAL RISKS SIMPLE HYSTERECTOMY- i) Reapplication of clamp to uterine artery Ii) Suturing at vaginal fornices OBSTETRIC HYSTERECTOMY- i) Distorted anatomy ii)Vascularity ADNEXECTOMY INCONTINENCE SURGERY- i) Burch colposuspension(high sutures) Ii) Overzealous dissection of space of ritzeous Iii) Excessive mobilisation of bladder
- 23. SURGICAL RISKS VVF REPAIR-Transvescical approach WERTHEIM’S HYSTERECTOMY- i) Below uterine artery Ii)At tunnel ofWherthim Iii) Over anterior fornix RADICALTRACHELECTOMY- (more risk than werthim’s)
- 25. THANKYOU