Urology 5th year, 1st lecture (Dr. Ali Kamal)

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The lecture has been given on Feb. 16th, 2011 by Dr. Ali Kamal.
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  • 1. THE URINARY BLADDER <br />ANATOMY AND PHYSIOLOGY<br />Dr. Ali Kamal M. Sami<br />M.B.Ch.B. M.A.U.A.<br />F.I.B.M.S. M.I.U.A.<br />
  • 2. Gross Appearance<br />A hollow muscular organ<br />A reservoir for urine<br />The adult bladder normally has a capacity of 400–500 ml.<br />
  • 3. When empty, bladder lies behind the pubic symphysis &it is a pelvic organ. <br />In infants and children , it is situated higher. <br />When it is full, it rises above the symphysis and can readily be palpated or percussed. <br />When over distended, as in acute or chronic urinary retention, it may cause the lower abdomen to bulge visibly.<br />
  • 4. Extending from the dome of the bladder to the umbilicusis a fibrous cord, the median umbilical ligament, whichrepresents the obliterated urachus .<br />
  • 5. Uretersenter the bladder posteroinferiorlyare about 5 cm apart . <br />The orifices,situated at interureteric ridge that forms the proximal border of the trigone, are about 2.5 cm apart. <br />The trigone occupies the area between the ridge and the bladder neck.<br /> <br />
  • 6.
  • 7.
  • 8.
  • 9. RELATIONS<br />
  • 10.
  • 11.
  • 12.
  • 13.
  • 14. The bladder is related to the posterior surface of the pubic symphysis,<br />and, when distended, it is in contact with the lower<br />abdominal wall.<br />
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  • 16.
  • 17.
  • 18. Histology<br />
  • 19.
  • 20. Blood Supply<br />
  • 21.
  • 22. A. ARTERIAL<br />1-Superior Vesical, <br />2-Middle Vesical, <br />3-Inferior Vesical arteries, which arise from<br />the anterior trunk of the internal iliac (hypogastric)artery, <br />4-The obturator artery.<br />5-The inferior gluteal artery. <br />In females, the 6-uterine and 7-vaginal<br />arteries also send branches to the bladder.<br />
  • 23. B. VENOUS<br />Surrounding the bladder is a rich plexus of veins that ultimately empties into the internal iliac (hypogastric) veins.<br />
  • 24. Lymphatics<br />The lymphatics of the bladder drain into <br />1-the vesical,<br />2-external iliac, <br />3-internal iliac (hypogastric), <br />4-common iliac lymph nodes.<br />
  • 25. Physiology<br />
  • 26. The nerves concerned in micturition are as follows.<br />1-The parasympathetic input; derived from the anterior primary divisions of the second, third and fourth sacral segments ( S2 ,S3,S4). These fibers pass through the pelvic splanchnic nerves inferior hypo gastric plexus, from which they are distributed to the bladder. <br />The pelvic plexus is easily damaged during excisions of the rectum, following which disturbances of micturition and sexual function may occur.<br />
  • 27. 2-The sympathetic input;These nerves arise in the 11th thoracic to the second lumbar segments (T11,T12,L1,L2). <br />Pass via the presacral hypo gastric nerveand the sympathetic chains to the inferior hypo gastric plexus, which is situated lateral to the rectum, the bladder<br />
  • 28. 3-Somatic innervations;<br />passes to the distal sphincter throughthe Pudendal nerves and through the inferior hypo gastric plexus .<br />
  • 29. The sympathetic nerves convey afferent painful stimuli following over distension of the fundus , from the mucosa where they respond to touch, temperature and pain, and also from the muscle of the detrusor and lamina propria where they convey stretch information.<br />These afferents pass via the inferior hypo gastric plexus. <br />Efferent fibers pass via the pelvic parasympathetics. Normal micturition is coordinated in the Pons in the midbrain where detrusor contraction is timed with inhibition of the distal sphincter mechanism. <br />
  • 30. Thank you<br />
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