URINARY BLADDER

• Hollow muscular viscus

• Shape
– Empty : Tetrahedral
– Distended : Ovoid
• Capacity:
– Anatomical capacity : 1 liter
– Physiological capacity : 120-320
ml
– Painful sensation : 450 ml
– Beyond voluntary control : 800 ml
• Location:
– In children : Abdominopelvic
– In adults : Pelvic when empty;
abdomino-pelvic when distended
 External features
• Tetrahedral / Pyramidal
– Apex
– Base (posterior surface or fundus)
– Neck
• Surfaces
– Superior
– Rt and Lt inferolateral
• Borders
– Anterior
– Posterior
– Rt and Lt lateral
 Relations of bladder

• Apex
– Upper margin of symphysis pubis
– Median umbilical ligament
• Superior surface
– In males : Peritoneum and coils of ileum
– In females : vesico-uterine pouch [except near the posterior border r/t uterine
cervix]
 Relations
• Infero-lateral surface
– Pubic symphysis
– Puboprostatic ligament (males) or Pubovesical ligament
(females)
– Retropubic space (of Retzius)
– Obturator internus (superiorly) and Levator ani muscles
(inferiorly)
 Relations
Base/Posterior surface
– superolateral angles : ureter
– inferior angle : urethra
• In males
– Rectovesical pouch containing coils of small intestine (superiorly)
– Terminal part of vas deferens (medially) and seminal vesicles (laterally)
– Rectovesical fascia of Denonvilliers (inferiorly)
• In females : Uterine cervix and vagina
 Relations
• Neck
– lies 3-4cms behind the lower margin of pubic
symphysis.
– In females : pelvic fascia and urogenital diaphragm
– In males : upper surface of prostate
 Retropubic space (of Retzius)
• Horse-shoe shaped perivesical space
• Boundaries
– Ant : Pubic symphysis and body of pubis
– Lat : Fascia covering the obturator internus and levator
ani muscles
– Posteromedially: Inferolateral surface of bladder
• Sup: Reflection of peritoneum from the bladder wall to
anterior abdominal wall
• Inf : Puboprostatic (males)/ Pubovesical (females)
ligaments
• Contents: Retropubic fat & Vesical plx of veins

• Clinical importance:
– Bursa for UB distension
– Suprapubic cystostomy / aspiration of UB
– Surgical approach to UB & prostate
 Supports of UB
• True ligaments: (9 in no.) formed by condensation of pelvic fascia
1. Median umbilical lig : Remnant of allantois/ urachus
2. Puboprostatic lig(males) / Pubovesical lig(females)
• Medial (paired)- pubis to prostatic sheath/neck of UB; running downward and backward.
• Lateral (paired) : tendinous arch of pelvic fascia to prostatic sheath / neck of UB ; running
downward and medially.
3. Lateral (true) ligament(paired): tendinous arch of pelvic fascia to inferolateral surface
of UB.
4. Posterior (true) ligament (paired): lateral pelvic wall to the posterior surface of UB;
running backwards & upwards; encloses vesical venous plx.
• False ligaments of UB:
(formed by peritoneal
folds; 7 in no.)
1. Median umbilical fold
2. Medial umbilical fold
(paired)
3. Lateral false ligaments
(paired)
4. Posterior lig (aka Sacro-
genital folds)
 Interior of UB
• Rugae: irregular mucosal folds
(d/t loose attachment of mucosa to underlying
muscle)
• Trigone of bladder:
– smooth triangular area as mucosa is firmly
adherent to the muscular coat
– Lies on the inner aspect of posterior
surface/base of UB.
• Features:
– Apex (Antero-inferior angle): dwd & fwd.
formed by crescentic urethral orifice.
– Postero-superior angle : oblique slit like
opening of ureters [Empty UB ureters are
2.5cms apart; distended UB ureters are 5cms ]
• Base: Transverse curved ridge connecting
the ureteric orifices called Interureteric
ridge or Bar of Mercier.

• Ureteric folds

• Uretero-Urethral ridge (aka Bell’s bar)

– Produced by the longitudinal muscle
of ureter extending to middle lobe of
prostate.

• Uvula vesicae:
– Produced by median lobe of prostate
• Clinical importance:
– Cystoscopy
– Interureteric ridge : guide to
ureteric opening
– Golf hole ureteric orifice in TB
– BPH: Enlargement of uvula
vesicae acts as a ball-valve
producing urinary obstruction.
• Developmental importance:
– Bladder mucosa: Endodermal origin (from cloaca)
– Trigone : Mesodermal origin
 Blood supply
• Arterial supply:
– Superior and inferior vesical artery (br
from anterior division of internal iliac
artery)
– Vaginal artery (in females)
– Others: Obturator, Inferior gluteal &
Uterine arteries
• Venous drainage:
– Vesical venous plx--- in retropubic space;
runs backward in posterior true
ligaments; drain into Internal iliac veins.
• Communications:
– In males – Prostatic venous plexus
– In females – veins at the base of broad
ligament
 Lymphatic drainage
• External iliac LN (3
groups)
– Anterior group : Apex &
inferolateral surface
– Middle group : superior
surface
– Posterior group : base

• Internal iliac LN & Lateral

Aortic LN
 Nerve Supply
• Inferior Hypogastric plexus through
vesical plx of nerves.

• MOTOR
– Parasympathetic: Pelvic splanchnic nv/
Nervi ergentes (S2,3,4)
• (+)Detrussor muscle ; (-) Internal urethral
sphicter
• Emptying of UB
– Sympathetic: T11 to L2
• (-) Detrussor muscle ; (+) Internal urethral
sphicter
• Filling of UB
– Somatic : Pudendal nv (S2,3,4)
• (+) External urethral sphincter ----
Voluntary control of micturition
• SENSORY :
– Majority along parasympathetic
– Few along sympathetic fibres
– Pain fibers--- ascends in antero-lateral white
columns
– Awareness of filling ascends in posterior column
tracts

• Clinical Importance :
– Anterolateral cordomtomy (B/L)
• for intractable pain of carcinoma of UB
• Awareness of filling & micturition remains normal
 Applied Anatomy
• Trabeculated Bladder:
– Cause : Chronic urinary
obstruction
– BPH or Urethral strictures
• Neurogenic bladder
– Types:
1. Automatic /Reflex bladder
2. Atonic bladder
3. Autonomous bladder
URETHRA
• A tubular structure
emerging from the neck of
bladder and opens to the
exterior
• Present in both male &
female but there are some
differences b/w the two
 Male urethra
• 18-20 cms long
• Extension: from Internal urethral orifice (in
UB) to External urethral orifice (meatus)
 PARTS OF URETHRA
• Two parts—
1] Posterior urethra (proximal urethra)
– 4 cms in length
– Lies in the pelvis
– 3 parts
a) pre-prostatic part
b) prostatic part
c) membranous part
2] Anterior urethra (distal urethra)
– 15 cms length
– Lies in the perineum and penis
– 2 parts
a) bulbar urethra
b)penile/pendulus urethra/spongy
urethra
 Preprostatic part
• 1-1.5 cm in length
• Extends vertically from bladder neck to prostate
• Surrounded by proximal/internal urethral sphincter ---
made up of smooth muscle bundle
• Function of internal urethral sphincter
– maintains the urinary continence
– prevents retrograde flow of seminal ejaculate into bladder
• Applied– this part can be damage by
a) bladder neck surgery
b) TURP(transurethral resection of prostate)
 Prostatic part
• 3-4 cm in length
• passes through the substance of prostate
• Posterior wall of this part– presents
a) Urethral crest
b) Prostatic sinus
c) Verumontanum / colliculus seminalis

* prostatic utricle – small blind sac,,develop from

paramesonephric duct or urogenital sinus,,
homologus to vagina of female,, also k/a vagina
musculine

*Ejaculatory duct= vas deferens + duct of seminal

vesicle
 Membranous part
• shortest part : 1.5 cm long
• 2nd most narrowest part (most narrowest part
is external urethral orifice)
• Passes through perineal membrane
• surrounded by distal / external urethral
sphincter
– has voluntary control
– maintains urinary continence
 Anterior Urethra
• extends from membranous urethra to
external urethral orifice
1) Bulbar urethra :
– lies in the bulbospongiosus (of penis)
– widest part of urethra
– Opening of Bulbourethral glands

2) Penile urethra
– lies in corpus spongiosum
– its terminal part is dilated in glans penis
–k/a navicular fossa
– Opening of numerous urethral glands
 Sphincters of urethra
1. Internal urethral sphincter
– Involuntary
– Surrounds internal
urethral orifice &
preprostatic urethra

2. External urethral
sphincter
– voluntary
– surrounds membranous
urethra
 Transverse section of different parts of
urethra
i) pre- prostatic part– stellate shape
ii) prostatic part– crescentic shape/semilunar
iii) membranous part--- stellate shape
iv) bulbar & penile part– transverse slit shape
v) external urethral orifice– sagittal slit shape
 Blood supply
• Arterial supply
1. Urethral artery– br. of internal pudendal artery
2. Dorsal artery of penis- br. of internal pudendal
artery
• Venous drainage
1. Anterior urethra—drained by dorsal vein of
penis----internal pudendal vein--- prostatic venous
plexus
2. Posterior urethra— drained by prostatic and
vesicle -venous plexus-----internal iliac veins
• Lymphatic drainage
1. prostatic urethra---- internal iliac LN
2. membranous urethra---- internal iliac LN
3. anterior urethra & glans ---deep inguinal LN

• Nerve supply : (autonomic nerve)

1. Sympathetic fibres from superior hypogastric plexus [L1-
L2segment]
2. Parasympathetic fibres-S2 to S4 sp. Segments
3. Somatic fibres from pudendal nerves

• Source of development— vesicourethral canal of

primitive urogenital sinus
 Applied anatomy
1. Urethritis
2. Rupture of urethra
3. Hypospadias
4. Epispadias
 Female urethra
• 4cm long & 6mm in width
• Homologus to prostatic urethra
• begins from internal urethral orifice and passes
downwards & forwards
• Opens in the vestibule b/w clitoris & vaginal orifice
• Ext. urethral opening lies 2.5 cm behind the glans clitoris
 Female urethral glands
1. Urethral glands– mucous glands
2. Para-urethral glands : corresponds to
prostate
3. Greater vestibular glands
• Arterial supply
1. Superiorvesical artery
2. Vaginal artery

• Venous drainage
– vesical venous plexus into internal pudendal vein

• Lymphatic drainage
– Internal and external iliac lymph node

• Nerve supply
– Sympathetic,, parasympathetic & somatic nerve fibres

• Applied– urethritis ,, rupture of urethra d/t injury

 Epithelium of Urethra
1. Transitional epithelium at the proximal end
(near the bladder)
2. Stratified and pseudostratified columnar –
mid urethra (in males)
3. Stratified squamous epithelium at the distal
end (near the urethral opening)
THANK YOU