Lec.

-4

Pelvic organs
Anatomy of Bladder and Urethra

Prof. Dr. Diyaa Aljaza

MSc. Anatomy and histology (Baghdad)
Ph.D Mycotoxicology (England)
Objectives

To know
1) The anatomical structure of the urinary
bladder and its blood and nerve supply.

2) To know the anatomical structure of female

and male urethra.
 The Urinary Bladder

The urinary bladder is an organ of the urinary system. It

plays two main roles:

• Temporary storage of urine

The bladder is a hollow organ with distensible walls. It has a
folded internal lining (known as rugae), which allows it to
accommodate up to 400-600ml of urine in healthy adults.

• Assists in the expulsion of urine

The musculature of the bladder contracts during micturition, with
concomitant relaxation of the sphincters.
Shape of the Bladder
The appearance of the bladder varies depending on the amount of
urine stored. When full, it exhibits an oval shape, and when
empty it is flattened by the overlying bowel.

The external features of the bladder are:

• Apex – located superiorly, pointing towards the pubic
symphysis. It is connected to the umbilicus by the median
umbilical ligament (a remnant of the urachus).
• Body – main part of the bladder, located between the apex and
the fundus.
• Fundus (or base) – located posteriorly. It is triangular-shaped,
with the tip of the triangle pointing backwards.
• Neck – formed by the convergence of the fundus and the two
inferolateral surfaces. It is continuous with the urethra.
Surfaces of the urinary bladder
There are 4 surfaces (superior, two inferolateral and posterior
surfaces):

 Superior surface

• In males entire superior surface is covered by peritoneum.

• In females - Anterior 2/3 is covered by peritoneum. Posterior

1/3 is not covered by peritoneum and related to supravaginal
part of the cervix
 Inferolateral surfaces

 Are related pelvic floor.

 Between bladder and pubis there is a space called retropubic
space filled with retropubic fat.

 Posterior surface

 In male, upper part of this surface is covered by peritoneum

and related to rectovesical pouch. Lower part is not covered
by peritoneum and related to seminal vesicle and vas deferens.
 In female whole of this surface is related to anterior wall of
vagina.
 Urine enters the bladder through the left and right ureters, and
exits via the urethra. Internally, these orifices are marked by
the trigone – a triangular area located within the fundus.

 In contrast to the rest of the internal bladder, the trigone has

smooth walls.
Musculature
• The musculature of the bladder plays a key role in the storage
and emptying of urine.

• In order to contract during micturition, the bladder wall contains

specialized smooth muscle – known as detrusor muscle. Its
fibers are orientated in multiple directions, thus retaining
structural integrity when stretched. It receives innervation from
both the sympathetic and parasympathetic nervous systems.

• The fibers of the detrusor muscle often

become hypertrophic (presenting as prominent trabeculae) in
order to compensate for increased workload of the bladder
emptying. This is very common in conditions that obstruct the
urine outflow such as benign prostatic hyperplasia.
There are also two muscular sphincters located in the urethra:

 Internal urethral sphincter:

• Male – consists of circular smooth fibers, which are under
autonomic control. It is thought to prevent seminal
regurgitation during ejaculation.
• Females – thought to be a functional sphincter (i.e. no
sphincteric muscle present). It is formed by the anatomy of
the bladder neck and proximal urethra.

 External urethral sphincter:

Has the same structure in both sexes. It is skeletal muscle, and
under voluntary control. However, in males the external
sphincteric mechanism is more complex, as it correlates with
fibers of the rectourethralis muscle and the levator ani muscle.
Blood supply

The vasculature of the bladder is primarily derived from

the internal iliac vessels.

• Arterial supply is via the superior vesical branch of the

internal iliac artery.
• In males, this is supplemented by the inferior vesical artery,
and in females by the vaginal arteries.
• In both sexes, the obturator and inferior gluteal arteries may
also contribute small branches.
Venous drainage
• Is achieved by the vesical venous plexus, lying on the
inferolateral surfaces, which empties into the internal iliac
veins.

• The vesical plexus in males is in continuity at the retropubic

space with the prostate venous plexus.

Lymphatics
 The superolateral aspect of the bladder drains into the external
iliac lymph nodes.

 The neck and fundus drain into the internal iliac, sacral and
common iliac nodes.
Nervous Supply

Neurological control is complex, with the bladder receiving input

from both the autonomic/ Vesical nerve plexus (sympathetic and
parasympathetic) and somatic arms of the nervous system:

 Sympathetic – hypogastric nerve (T12 – L2). It causes

relaxation of the detrusor muscle, promoting urine retention.
 Parasympathetic – pelvic nerve (S2-S4). Increased signals
from this nerve causes contraction of the detrusor muscle,
stimulating micturition.
 Somatic – Pudendal nerve (S2-4). It innervates the external
urethral sphincter, providing voluntary control over
micturition.
 The Urethra

The urethra is the terminal segment of the genitourinary

systems, a fibro muscular tube responsible for transporting urine
from the bladder to an external opening in the perineum.

The female urethra is a simple short tube, that transports

urine out of the body, extending from the internal urethral orifice
of the bladder to the external urethral orifice in the vestibule of
the vagina.
The female urethra:
Measures approximately 4 cm in length. It is embedded in the
anterior vaginal wall and runs with the vagina through the
urogenital hiatus.

• It lies immediately in front of the vagina and forms a palpable

bulge on the anterior vaginal wall.
• Para urethral (skene ) glands line the urethra at the external
urethral meatus.

Relations
• Anteriorly: pubic symphysis.
• Posteriorly: vagina.
• Laterally: puborectalis muscle.
Arterial supply
• Internal pudendal and vaginal arteries.

Venous drainage
• Internal pudendal and vaginal veins.

Lymphatic drainage
• Internal iliac nodes.

Innervation
• Pudendal nerve.
The male urethra:

Has a longer, more complicated, course than the female

urethra and is also more prone to pathology.
• The male urethra measures, on average, 18-20 cm in length.
• It commences at the internal urethral orifice in the trigone of
the bladder and opens in the navicular fossa of the glans penis
at the external urethral meatus.

The male urethra can be divided into anterior and posterior

portions.
• The anterior urethra is composed of the penile and bulbar
urethra to the level of the urogenital diaphragm.
• The posterior urethra is composed of the membranous and
prostatic urethra.
Anterior urethra

 Penile (spongy, pendulous) urethra (~16 cm long): encased by

corpus spongiosum of the penis.
• The longest portion.
• The fossa navicularis is a small normal dilatation of the
distal penile urethra.

 Bulbar (bulbous) urethra: traverses the root of the penis.

Posterior urethra

 Membranous urethra (1 cm long): passes through the

urogenital diaphragm, surrounded by sphincter urethrae
muscle and perineal membrane. It is the shortest, narrowest
portion and the least dilatable portion of the urethra.

 Prostatic urethra (3 cm long): surrounded by the prostate

gland. Pass through the prostate from the base to the apex.
This is the widest and most dilatable portion of the urethra.
Arterial supply

• Prostatic urethra – inferior vesical artery.

• Membranous urethra –bulbourethral artery.
• Penile urethra – branches of the internal pudendal artery.

Venous drainage

• Dorsal veins of the penis and internal pudendal vein that

drain to the prostatic and vesical venous plexuses.
• Prostatic and vesical venous plexuses drain to internal iliac
veins.
Lymphatic drainage

Posterior urethra:
• Internal iliac lymph nodes.
• External iliac lymph nodes.

Anterior urethra:
• Deep inguinal lymph nodes.
• Superficial inguinal lymph nodes.

Innervation
Prostatic plexus.
Thank you for your attention