Urinary bladder 1 2 3 Introduction Muscular reservoir

Urinary bladder 1

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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 4

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When empty – Apex – directed forwards – Base – Directed backwards – Neck – lowest & fixed part 3 surfaces – Superior, Right & Left inferolateral 6

When full – Apex – Neck – Anterior & posterior surfaces 7

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 8

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Ligaments of bladder • True ligaments: condensation of pelvic fasica • False ligaments: peritoneal fold, don’t provide support 12

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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 14

Nerve Supply • Parasympathetic - S 2, 3, 4 – Motor to Detrussor muscle – Inhibitory to sphincter vesicae • Sympathetic - T 11 to L 2 – Inhibitory to Destrusor muscle – Motor to sphincter vesicae • Somatic – Pudendal S 2, 3, 4 supplies sphincter urethrae which is voluntary 15

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Congenital anomalies of the bladder 19

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. 20

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Anomalies of the urachus • Urachal cyst • Patent urachus • Incomplete obliteration 22

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 23

Urachal sinus • The umbilical end of the urachus fails to obliterate • Presents with discharge of mucus from the umbilicus • Treatment: – Excision 24

Bladder exstrophy 25

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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. 28