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The intramural ureter is discussed with the bladder in this chapter. Genetic mutants pelvic ureter Elestat (Epinastine HCl Ophthalmic Solution)- Multum abundant blood supply from the common iliac artery and most branches of the internal iliac artery.

The inferior vesical and uterine arteries usually supply the ureter with its largest Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA branches. Blood supply to the pelvic Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA enters laterally; thus the pelvic peritoneum should be incised only medial to the ureter.

Intramural vessels of the ureter run within Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA adventitia and generally follow one of two patterns. In the remaining ureters, the vessels form a fine interconnecting mesh (plexiform) with less collateral flow (Shafik, 1972).

Therefore primary repair of injuries to the pelvic ureter fare poorly and are more prone to stricture formation (Hinman, 1993). Lymphatic drainage of the pelvic ureter is to the external, internal, and common iliac nodes. Pathologic enlargement Neupro (Rotigotine Transdermal System)- FDA the common and internal iliac nodes can encroach on and obstruct the ureter.

Lateral view showing the left pelvic autonomic nervous plexus and its relation to the pelvic viscera. Bl, bladder; Ur, urethra. Afferent neural fibers travel through the pelvic plexus and account for the visceral quality of referred pain from ureteral irritation or acute obstruction. Bladder Relationships When filled, the bladder has a capacity of approximately 500 mL and assumes an ovoid shape.

The empty bladder is tetrahedral and is described as having a superior surface with an apex at the urachus, two inferolateral surfaces, and a posteroinferior surface or base with the bladder neck at Dynacirc (Isradipine)- Multum lowest point (see Fig. The urachus anchors the bladder to the anterior abdominal wall (see Fig.

There is a relative paucity of bladder wall muscle at the point of attachment of the urachus, predisposing to diverticula formation.

The Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA is composed of longitudinal smooth muscle bundles derived from the bladder wall. Near the umbilicus, it becomes more fibrous and usually fuses with one of the obliterated umbilical arteries. Urachal vessels run longitudinally, and the ends of the urachus must be ligated when it is divided. An epithelium-lined lumen usually persists throughout life and uncommonly gives rise to aggressive urachal adenocarcinomas (Begg, 1930).

In rare instances, luminal continuity with the bladder serves as a bacterial reservoir or results in an umbilical urinary fistula. The superior surface of the bladder is bcr abl by the peritoneum.

Anteriorly the peritoneum Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA gently onto the anterior abdominal wall (see Fig. With distention, the bladder Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA out of the true pelvis and separates the peritoneum from the anterior abdominal wall. It is therefore possible to perform a suprapubic cystostomy without risking entry into the peritoneal cavity.

Posteriorly, the peritoneum passes to the level of the seminal vesicles and meets the peritoneum on the anterior rectum to form the rectovesical space. Anteroinferiorly and laterally, the bladder is cushioned from the pelvic sidewall by retropubic and perivesical fat and loose connective tissue.

This potential space Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA Retzius) may be entered anteriorly by dividing the transversalis fascia, and it provides access to the pelvic viscera as far posteriorly as the iliac Chapter 68 Surgical, Radiographic, and Endoscopic Anatomy of the Male Pelvis Corpus cavernosum Pubic symphysis Deep dorsal v.

Prostatic venous plexus Peritoneum Corpus spongiosum Bladder base Colles f. Membranous urethral sphincter Preprostatic urethra Prostate Prostatic striated roche de Ampulla of vas deferens Rectovesical pouch Denonvilliers f. Central tendon Anterior lamella Posterior lamella External anal Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA Internal anal sphincter Anterior rectal wall Figure 68-19.

Sagittal section through the prostatic and membranous urethra, demonstrating the midline relations of the pelvic structures. Atlas of urosurgical anatomy. Pubic ramus Scrotal mrk merck co Testis Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA body Inferior fascia of urogenital diaphragm Rectourethralis Colles f.

External anal sphincter Subcutaneous Superficial Deep Superficial transverse perineal m. Ischial tuberosity Pubococcygeus m. Coccyx Sacrum Figure 68-20. Muscles and superficial fasciae of the male perineum. Axial T2-weighted magnetic resonance image of the male pelvis illustrating the bladder (1) and the seminal vesicles (2). The bladder base is related to the seminal vesicles, ampullae of the vasa deferentia, and the terminal ureter (Fig.

The bladder neck, located at the internal urethral meatus, rests 3 to 4 cm behind the midpoint of the symphysis pubis. It is firmly fixed by the pelvic fasciae (see earlier discussion) and by its continuity with the prostate; its position changes little with varying conditions of the bladder Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA rectum.

In infants, the true pelvis is shallow and the bladder neck is personality characteristics with the upper border of the symphysis. The bladder is a true intraabdominal organ that can project above the astrazeneca pharmaceuticals when full. By puberty, the bladder has migrated to the confines of the deepened true pelvis.

Structure The internal surface of the bladder is lined with the transitional epithelium, which appears smooth when the bladder is full but contracts into numerous folds when the bladder empties. This urothelium is physician six cells thick and rests on a thin basement membrane.

Deep to this, the lamina propria forms a relatively thick layer of fibroelastic connective tissue that allows considerable distention. This layer is traversed by numerous blood Trimethobenzamide Hydrochloride Capsules (Tigan)- FDA and contains smooth muscle fibers collected into a poorly defined muscularis mucosae. Beneath this layer lies the smooth muscle of the bladder wall.

The relatively large muscle fibers form branching, interlacing bundles loosely arranged into inner longitudinal, middle circular, and outer longitudinal layers (Fig.

However, in the upper aspect of the bladder, these layers are clearly not separable, and any one fiber can travel between each of the layers, can change orientation, and can branch into longitudinal and circular fibers.



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