URINARY BLADDER AND URETHRA GROSS ANATOMY

1. URINARY BLADDER
Dr Vinay KVS
MBBS, MD, PGCD, PGDBEME
.
For feedbacks email : bhushetty102@gmail.com

2.  Introduction.
 Position.
 Shape.
 Parts.
 Relations.
 Trigone of Urinary bladder.
 Blood supply.
 Nerve supply.
 Urethra: parts, sphincter, blood supply
 Applied Aspects.

3. Position:
 In children:
Abdomino-pelvic
In adults:
Pelvic organ

4. Shape:
Tetrahedral when empty.
Ovoid when distended

5.  ANATOMICAL CAPACITY: about 1lit. Or more.
 AVERAGE CAPACITY: 120 to 320ml.
 SENSE OF FILLING: 100 to 150ml.
 DESIRE FOR MICTURITION: 150 to 250ml.
 PAINFUL SENSATION: above 450ml.
Capacity

6.  Apex
 Base
 3 surfaces
 4 borders
 Neck.
Superior
2 Infero lateral
Anterior
Posterior
2 Lateral
PARTS

7. RELATIONS:
 Apex:
Gives attachment to
the median umbilical
ligament.
 PATENT URACHUS

8. Base (fundus or posterior surface):
 IN MALE: seminal vesicles,
vas deferens and recto vesical
pouch.
 IN FEMALE : vagina and
supra vaginal part of cervix of
uterus.

9. Gluteus medius
Gluteus maximus
Tensor fascia lata
Iliotibial tract
Fascia lata
Superior
surface:
Related to sigmoid
colon, coils of small
intestine
In female :
anterior surface of the
uterus.

10. Infero lateral surfaces:
• Non-peritoneal.
Related to body of pubis,
pubic symphysis and
fascia covering levator ani
muscle.
• Space of Retzius:
Horse-shoe shaped
potential space. Contains
Retro-pubic pad of fat &
vesical plexus of veins.

11. Neck
In male :
bladder neck surrounded
by the base of prostate.
In female :
superior fascia of
urogenital diaphragm.

12. 1. Median umbilical
ligament
2. 4 Puboprostatic /
pubovesical lig.
3. A pair of lateral
ligaments.
4. A pair of posterior true
ligaments.
True Ligaments:
SUPPORTS OF URINARY BLADDER

13. False Ligaments:
Peritoneal folds :
• Median umbilical fold- umb.
Lig
• medial umbilical fold
• lateral false ligaments
• sacrogenital folds.

14. Trigone of the Bladder
It is an equilateral
triangle on the inner
aspect of the base.
INTERIOR OF URINARY BLADDER

15. Boundaries
 Apex: internal urethral
orifice.
 Base: interureteric
ridge.
 Posterolateral angles:
by ureteric orifices.
 Sides: by urethro-
ureteric lines.

16. 1. Most fixed and dependent part of the bladder
2. Richly supplied with blood vessels and nerves
3. Developed from the mesoderm .
4. Rest of the bladder mucosa is developed from the
endoderm .
Importance of trigone:

17. External trigone:
Base: posterior border of the
bladder.
Apex : at the neck of the
bladder.
On either sides : seminal
vesicle & vas deferens.
• Boundaries

18. Blood supply:
 Superior vesical artery
 Inferior vesical artery
 Obturator artery
 Inferior gluteal artery
 In female uterine artery
 Veins: correspond to the
arteries and form a
vesical venous plexus.

19. SYMPATHETIC (T11-L2):
Mainly vasomotor
Inhibitory to detrusor
Motor for sphincter vesicae
Nerve of filling.
Parasympathetic fibres S2,3,4 (nervi
erigentes)
motor to the detrusor muscle
inhibitory to sphincter vesicae.
Nerve of emptying
Sensory fibres : are carried mainly by
parasympathetic nerves and partly
by sympathetic.
Nerve supply

20. Nerve supply
 Somatic fibres :
Derived from S2, S3, S4 spinal segments. They
are motor to external urethral sphincter.

21. Neurological control and disorders of
Micturition
 Reflex or Automatic bladder: due to complete
transection of spinal cord above S2 segments
(overflow incontinence).
 Atonic bladder: due to a lesion involving afferent
limb of Loop 3 neurons.
 Autonomous bladder: due to lesion of both
afferent and efferent limbs of Loop 3 neurons
(bladder become small and hypertrophied).
 Uninhibited bladder: This is associated with urge
incontinence with sudden uncontrolled
evacuation.Due to involvement of Loop 1
neurons.

22. It is common tubular passage for the
elimination of urine & semen.
Extends from the internal urethral orifice
to external urethral orifice.
Measurements; 18-20cm.
It has 3 parts.

23. Parts of male urethra;

24. It runs vertically within the prostate gland.
Junction of ant 1/3rd & post 2/3rd.
Widest, dilatable part.
C/s cresentric lumen.
Features;
Urethral crest; mucosal fod,formed by trigonal musculature.
Colliculus seminalis; rounded elevation at the middle of the
crest, presents 3 orifices;
Prostatic utricle, formed by median lobe of the prostate.
Opening of ejaculatory ducts on either side.
Opening of ejaculatory ducts
Prostatic part:

25. Relations of prostatic urethra;
In front; isthmus of
prostate.
Each side; lateral lobe
of prostate.
Behind;
upper part- median
lobe.
lower part- 2 lateral
lobes.

26. Membranous part
It runs with a slightly curved
course, towards the bulb of penis.
Pierces perineal membrane about
2.5cm behind the lower border of
symphysis pubis.
Ant wall is more prolonged.
c/s stellate in appearance.
Relations;
Surrounded by- sphincter urethrae
muscle.
Each side- bulbo-urethral glands.
Front- deep dorsal vein of penis.

27. Spongy part.
15 cm long.
Passes through the bulb,body & glans
penis, terminates at the external
urethral orifice, at the tip of the glans.
Features; urethral glands & urethral
lacunae.
Presents 2 dilatations;
Intra-bulbar fossa within the bulb of penis.
Trapezoid in shape &ducts of bulbo-urethral
glands.
Terminal fossa (navicular) in the glans
penis.

28. Sphincters of urethra.
Internal Sphincter.(sphincter vesicae).
surrounds the internal urethral orifice.
External Sphincter.
Voluntary & derived from sphincter
urethrae muscle which surrounds the
membranous urethra.

29. Arterial supply;
Inferior vesical, middle rectal,internal pudendal.
Veins correspond to the arteries.
Lymphatic drainage;
Prostatic & membranous parts drain into external &
internal iliac lymph nodes.
Spongy part;deep inguinal nodes
Nerve supply;
Sympathetic fibres.
Parasympathetic fibres,
Somatic fibres, derived from the urethral
branch of the pudendal nerves

30. Interior of the
bladder and
its orifices can
be examined
with a
cystoscope.
Applied anatomy
Cystoscopy

31. Tumour is
removed in
small fragments
Transurethral resection of a tumour:

32. Cystocoele
(Hernia of the bladder)
Loss of bladder support
in females by damage
to perineal muscles

33. Suprapubic cystotomy
Distended bladder can
be punctured surgically
superior to the pubic
symphysis.

34. Urinary Bladder Stones

35. CYSTOGRAM
 Filling cystogram
 Bladder capacity Bladder
compliance (detrusor
instability)

36. THANK YOU
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