Urinary bladder
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Introduction
• Muscular reservoir of urine
• When empty it lies within pelvis
• When filled with urine it extends upwards into abdominal cavity reaching
upto umbilicus
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When empty
– Apex – directed forwards
– Base – Directed backwards
– Neck – lowest & fixed part
3 surfaces – Superior, Right & Left inferolateral
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When full
– Apex
– Neck
– Anterior & posterior surfaces
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Superior surface
Male
• Covered by peritoneum & related to sigmoid Colon & coils of terminal ileum
Female
• Peritoneum is reflected from superior surface to uterus to form vesicouterine
pouch
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Ligaments of bladder
• True ligaments: condensation of pelvic fasica
• False ligaments: peritoneal fold, don’t provide support
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Capacity
• Means 220 ml
• ≥220 ml desire to micturate
• 250 – 300 ml micturate
• Upto 500 ml tolerable
• ≥500 ml painful
Blood Supply
• Superior & inferior vesicle artery branches of internal iliac artery
Venous Drainage
• Vesicle venous plexus – Internal iliac vein
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Nerve Supply
• Parasympathetic - S2, 3, 4
– Motor to Detrussor muscle
– Inhibitory to sphincter vesicae
• Sympathetic - T11 to L2
– Inhibitory to Destrusor muscle
– Motor to sphincter vesicae
• Somatic
– Pudendal S2, 3,4 supplies sphincter urethrae which is voluntary
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Congenital anomalies of the bladder
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Persistent urachus
• The urachus is an embryological canal connecting the urinary bladder of
the fetus with the allantois, a structure that contributes to the formation
of the umbilical cord.
• The lumen (inside) of the urachus is normally obliterated during
embryonic development, transforming the urachus into a solid cord
(median umbilical ligament), a functionless remnant.
• The urachus lies in the space of Retzius, between the transversalis fascia
anteriorly and the peritoneum posteriorly.
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Anomalies of the urachus
• Urachal cyst
• Patent urachus
• Incomplete obliteration
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Patent urachus
• Urachal fistula
• Manifests in adult or old age
• Associated with obstruction of the lower urinary tract
• Management:
– Clearance of obstruction
– Excision of the urachus down to the apex of the bladder with closure of the urinary
bladder
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Urachal sinus
• The umbilical end of the urachus fails to obliterate
• Presents with discharge of mucus from the umbilicus
• Treatment:
– Excision
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Bladder exstrophy
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• This male infant was born with bladder
exstrophy. The bladder mucosa is everted and
lies on the abdomen. Both ureteric orifices lie
on the exstrophic bladder. Notice that the
penis is shortened and that there is no urethral
meatus. His urethra is actually a plate of deep
red mucosa lying on the dorsal penis. This is
called epispadias.
• His bladder was closed by inverting the
bladder plate and sewing it closed into a
sphere. Later, his urethra will be
reconstructed.
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