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10: The Gastrointestinal and Urinary Systems
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Urology Care Foundation. Premo C, et al. Trimodality therapy in bladder cancer: Who, what and when? The Urologic Clinics of North America. Efstathiou JA, et al.
Bladder preservation treatment options for muscle-invasive urothelial bladder cancer. Accessed March 14, How is upper urinary tract cancer treated? Bellmunt J. Treatment of metastatic urothelial cancer of the bladder and urinary tract. Accessed March 28, Leibovich BC expert opinion. June 19, Amin MB, et al. Urinary bladder. New York, NY: Springer; It is thought that the differing groups of muscle fibers aid in bladder neck opening during micturition and bladder neck closure during bladder filling and urine storage phases.
In addition to these muscle layers, the pubourethral ligament serves to support the bladder neck and urethra via attaching these structures to the dorsal aspect of the pubis.
In males, the bladder neck is contiguous with the prostate and both serve together as the internal urethral sphincter. The prostate is attached to the pubis by puboprostatic ligaments. The trigone is a triangular portion of the bladder floor bordered ventrally by the internal urethral opening or bladder neck and dorsolaterally by the orifices of the right ureter and left ureter.
Anatomy of the Bladder and Urinary Tract | curevilfage.ga
The ureters , which transport urine from the kidneys to the bladder and insert into the trigone, approach the bladder as they course inferiorly from their posterolateral locations. The superior or dorsal border of the trigone is a raised area termed the interureteric ridge, which courses from one ureteral meatus to the other.
The intravesical ureteral orifices are roughly cm apart. The intramural ureters are each about 1. The arterial blood supply of the bladder arrives primarily via the internal iliac hypogastric arteries. These branch into the umbilical artery, which supplies several superior vesicle branches, and inferior vesical arteries, which come as direct internal iliac branches in males or from the vaginal arteries in females.
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The arterial supply of the bladder is also derived in part from the obturator artery and inferior gluteal artery. In females, this is via the uterine artery and vaginal artery. The venous return of the bladder is a rich network of vessels that generally parallels the arteries in both anatomic course and name. The vast majority of venous return from the bladder drains into the internal iliac vein. The lymphatic drainage of the bladder is into the obturator, external iliac, internal iliac hypogastric , and common iliac lymph nodes.
As with any region of the body, prior surgery may alter the lymphatic outflow of the region.
Anatomy of the Urinary System
The internal iliac lymph nodes are usually the primary site of lymphadenopathy related to bladder pathology. In males, the seminal vesicles, ductus deferens, ureters, and rectum border the inferoposterior aspect of the bladder and prostate.
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Anterior to the bladder is the space of Retzius or retropubic space, which is composed of fibroadipose tissue and the prevesical fascia. The dome and posterior surface of the bladder are covered by parietal peritoneum, which reflects superiorly to the seminal vesicles and is continuous with the anterior rectal peritoneum. In females, the posterior peritoneal reflection is continuous with the uterus and vagina and is referred to as the anterior cul-de-sac or vesicouterine pouch.
The inferoposterior aspect of the bladder thus rests on the anterior vaginal wall, through which the urethra courses. As a result of positioning adjacent to the reproductive organs and behind the bony pubis, the bladder neck and urethra are at risk for both direct and hypoxic injury during childbirth.
The bladder wall is most organized at the bladder neck, where 3 relatively distinct layers are observed. The inner longitudinal muscular layer fuses with the inner longitudinal layer of the urethra. The middle circumferential muscular layer is most prominent in the proximity of the bladder neck, and it fuses with the deep trigonal muscle layer.
The outer longitudinal muscular layer contributes some anterior fibers to the pubovesical muscles that terminate on the posterior pubis. Posteriorly, the outer longitudinal muscle fibers interdigitate with the deep trigonal muscle fibers and the detrusor muscle itself. Deep to the mucosa, there are 2 muscular layers in the trigone. The superficial layer connects to the longitudinal urethral musculature.
The deep muscle layer fuses with the detrusor fibers. It also joins the Waldeyer sheaths or fibromuscular coverings of the intramural ureters. Here, the muscle fibers are longitudinal in orientation.