Urinary Bladder &

Urethra
Sylvia Santos
The pelvic parts of the urinary system consists of:
- Terminal parts of ureters
- Bladder
- Proximal part of the urethra
Terminal part of the Ureter
● Ureter crosses the pelvic inlet and enters the pelvic
cavity anterior to the bifurcation of common iliac
artery.

● Then it continues along the pelvic wall and floor to

join the base of the bladder

● In the pelvis, ureter is crossed by

- Ductus deferens in men
- Uterine artery in women
Urinary Bladder
 Urinary Bladder
● Temporary reservoir for urine. Capacity - 500ml

● When empty, the adult urinary bladder is located in

the lesser pelvis as the bladder fills, its superior wall
rises up into the hypogastric region (up to umbilicus)

● In infants and young children, the urinary bladder is in

the abdomen even when empty. The bladder usually
enters the greater pelvis by 6 years of age; however, it is
not located entirely within the lesser pelvis until after
puberty.
 Urinary Bladder
● Empty bladder is tetrahedral in shape
- Apex (points anteriorly)
- Base (posterior)
- Surfaces - superior and two inferolateral
- Neck - where inferolateral surfaces and
base meet, origin of the urethra
Urinary Bladder
 Urinary Bladder
Relations:

● Apex - median umbilical ligament

● Base -
- Males - rectovesical pouch, rectovesical fascia of Denonvilliers,
seminal vesicles, terminal parts of vas deferens
- Females - uterine cervix, vagina
● Superior surface - peritoneum (coils of ileum, sigmoid colon)
- Females - vesicouterine pouch
● Inferolateral surfaces - retropubic pad of fat (retropubic space of
Retzius), pubic bones, obturator internus and levator ani
muscles
● Neck of the bladder is held in position by the puboprostatic
ligaments in the male; pubovesical ligaments in the female
(pelvic fascia)
Urinary Bladder
Urinary Bladder
Urinary Bladder
 Urinary Bladder
Interior of the bladder:
● Mucosal folds (rugae)

● The area of mucous membrane covering the

internal surface of the base of the bladder is
called the trigone. Trigone is smooth because
the mucous membrane is firmly adherent to
the underlying muscular coat.

● Ureteric orifices and the internal urethral

orifice are at the angles of the trigone of the
bladder
 Urinary Bladder
● Between the ureteric orifices - interureteric ridge

● Ureters pierce the bladder wall obliquely, and this provides a valvelike action, which
prevents a reverse flow of urine toward the kidneys as the bladder fills.

● Muscle of the bladder - detrusor

● Toward the neck of the male bladder, the muscle fibers form the involuntary internal
urethral sphincter. This sphincter contracts during ejaculation to prevent reflux of semen
into the bladder
Uvula (vesicae) is a small
elevation situated immediately
above the urethral orifice,
which is produced by the
underlying median lobe of the
prostate
 Urinary Bladder
● Arteries: superior vesical artery, inferior vesical arteries (males) , vaginal artery (females)

● Veins: vesical venous plexus

● Lymphatics: external and internal iliac lymph nodes

● Nerves: Via Inferior hypogastric plexus and pelvic splanchnic nerves

- Sympathetic - T11 - L2 - Inhibit contraction of detrusor, closes internal urethral sphincter
- Parasympathetic - S2 - S4 - stimulate contraction of detrusor and relaxes/ opens/ inhibits
internal urethral sphincter
- External urethral sphincter - pudendal nerve
 Urethra
Urethra is a muscular tube that conveys urine from the internal urethral orifice of the urinary bladder to
the external urethral orifice.
 Male Urethra
● 18-20 cm long

● Common passageway for urine and semen

● Parts
- Preprostatic (intramural part)
- Prostatic
- Membranous
- Spongy / penile
Male Urethra
Male Urethra
 Male Urethra - Prostatic Part
● Urethral crest - a median ridge between bilateral grooves, the prostatic sinuses

● The secretory ducts of the prostate open into the prostatic sinuses

● Seminal colliculus (verumontanum) is a rounded eminence in the middle of the urethral

crest with a slit-like orifice that opens into a small blind pouch, the prostatic utricle
(homologous to uterus)

● Opening of ejaculatory ducts on sides of prostatic utricle (or within it)

 Male Urethra
During erection of the penis, the bend between the root and body of the penis disappears
 Female Urethra
● 4 cm long
● Slightly curved
● Opens in the vestibule
● External urethral orifice anterior to vaginal orifice
● 2.5 cm behind glans clitoris
● Paraurethral mucous gland (Skene’s glands) - ducts open onto the lateral margin of external
orifice (homologous to prostate gland)
Female Urethra
 Urethra
● Arteries - Internal pudendal artery and inferior vesical arteries (vaginal arteries – in females)
● Veins - Follow the arteries
● Lymphatics - Internal iliac, external iliac and deep inguinal lymph nodes
● Nerves - Pudendal nerve, prostatic plexus (in males), pelvic splanchnic nerves
 Micturition
● Micturition is a reflex action that, in the toilet-trained individual, is controlled by higher
centers in the brain.
● The reflex is initiated when the volume of urine reaches about 300 mL; stretch receptors
in the bladder wall are stimulated and transmit impulses to the central nervous system,
and the individual has a conscious desire to micturate.
● Most afferent impulses pass up the pelvic splanchnic nerves and enter the 2nd, 3rd, and
4th sacral segments of the spinal cord.
● Some afferent impulses travel with the sympathetic nerves via the hypogastric plexuses
and enter the first and second lumbar segments of the spinal cord.
● Efferent parasympathetic impulses leave the cord from the second, third, and fourth
sacral segments and pass via the parasympathetic preganglionic nerve fibers through the
pelvic splanchnic nerves and the inferior hypogastric plexuses to the bladder wall, where
they synapse with postganglionic neurons.
● By means of this nervous pathway, the smooth muscle of the bladder wall (the detrusor
muscle) is made to contract, and the sphincter vesicae is made to relax.
● Efferent impulses also pass to the urethral sphincter via the pudendal nerve (S2, 3, and
4), and this undergoes relaxation.
● Once urine enters the urethra, additional afferent impulses pass to the spinal cord from
the urethra and reinforce the reflex action.
● Micturition can be assisted by contraction of the abdominal muscles to raise the
intra-abdominal and pelvic pressures and exert external pressure on the bladder
Catheterization and Cystoscope
Clinically Significant Differences between Male and Female Urethrae

● The female urethra is distensible because it contains considerable elastic tissue, as well as
smooth muscle.
● It can be easily dilated without injury; consequently, the passage of catheters or cystoscopes
is easier in females than in males.
● Infections of the urethra, and especially the bladder, are more common in women because
the female urethra is short, more distensible, and is open to the exterior through the vestibule
of the vagina (close proximity with vaginal and anal openings)