ANATOMY OF THE BLADDER

The bladder is a hollow, muscular organ situated in the pelvis when empty but
able to extend up into the abdomen when full, particularly in situations where
bladder emptying is impeded. At birth, the pelvis is relatively small in
comparison to the abdomen, and thus, the bladder has a larger abdominal
component at birth and becomes more “pelvic” as growth and maturity proceed.
By puberty, the bladder has migrated to the confines of the deepened true pelvis.
The bladder is described as having an apex, a superior surface, two
inferolateral surfaces, a base or posterior surface, a trigone, and a neck. The apex
reaches a short distance cephalad above the pubic bone and ends as a fibrous
cord, the remnant of the fetal urachus, which connects the bladder to the
allantois. The urachus lies anterior to the peritoneal cavity and is important as
tumors can arise in the urachal remnant. The superior surface is covered by the
peritoneum, again an important anatomical feature as it means that there is
bowel lying superiorly to the bladder, which is potentially a critical site to
consider when planning radiotherapy, particularly in men. In women, it is
associated with the uterus and ileum. The base of the bladder is posterior and is
separated from the rectum by the vas deferens, seminal vesicles, and ureters in
the male and by the uterus and vagina in the female. The seminal vesicles form a
V-shaped structure at the base of the bladder, with the vas deferens entering the
middle of the “V.” The ureters enter into the bladder slightly superior and lateral
to the seminal vesicles, with the vas deferens coursing above and in a caudal
direction to the ureters. Again, these relations are critical as enlarging tumors
either at the base or in the prostate can involve the ureters with consequent
hydronephrosis. Inferiorly and laterally to the bladder lie the various pelvic
bones and muscles: pubis, the levator ani, and obturator internus muscles. Within
the pelvis, the lateral parts of the bladder are surrounded by loose connective
tissue. Anteriorly, the bladder is separated from the pubic bone by the retropubic
space. The inferior part of the bladder is described as the neck and is in
continuity with the urethra and, very importantly, the prostate gland in males.
The neck of the bladder is anchored in the pelvis, and the superior portions
distend and expand upward as the bladder fills.
The mucosal lining of the bladder comprises a transitional epithelium that
extends from the renal pelvis to the urethra. The most common tumors arising in
the urinary system are transition cell (or urothelial) carcinomas (TCC or UC).
These tumors can arise from anywhere within the urothelium, so diagnosis,
treatment, and surveillance protocols must take account of this important
biologic feature. As a distensible organ, the macroscopic appearance of the
urothelium varies with distension from smooth and flat to folded when empty. A
ridge called the interureteral fold lies between the ureteric orifices