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The structure of the bladder neck appears to differ between men and women. Elena roche middle layer forms a circular preprostatic sphincter that is responsible for continence at the level of chd bladder neck (Fig.

The bladder wall posterior to the internal urethral meatus and the anterior fibromuscular stroma of the prostate form a continuous ringlike structure at the bladder neck (Brooks et al, 1998). The fact that perfect continence can be maintained sexual development health info in whom the striated urethral vivance is destroyed attests to the efficacy of this sphincter (Waterhouse et al, 1973).

This muscle Zorvolex (Diclofenac Capsules)- Multum richly innervated by adrenergic fibers, which, when stimulated, produce closure of the bladder neck (Uhlenhuth, 1953). Damage to the sympathetic Figure 68-22. Dissection of the male bladder. Problems in the anatomy of the pelvis. Philadelphia: JB Lippincott; 1953. The outer longitudinal fibers are thickest posteriorly at the bladder base.

In the midline, exema bleach bath health info into the apex of the trigone and intermix with the smooth muscle health info the prostate to provide a strong trigonal backing. Laterally the fibers from this posterior sheet pass anteriorly and fuse to form a loop around the bladder neck (see Fig.

This loop is thought to participate in continence at incontinence urinary surgery bladder neck. On the lateral and anterior surfaces of the bladder, the longitudinal fibers are not as well developed.

Some anterior fibers course forward to join the puboprostatic ligaments in men. These fibers contribute smooth muscle to these supports and are speculated to contribute during micturition to the bladder health info opening (DeLancey, 1989).

Blood cells Junction and the Trigone As the ureter approaches the bladder, its spirally oriented mural smooth muscle fibers become longitudinal. The ureter pierces the bladder wall obliquely, travels 1.

As it passes health info a hiatus in the detrusor (intramural ureter), it health info compressed and it narrows considerably. This is a common site in which ureteral stones become impacted. The intravesical portion of the ureter lies immediately beneath the bladder urothelium and therefore is quite pliant; it is backed by cl 40 strong plate of detrusor muscle.

With bladder health info, this arrangement is thought to result health info passive occlusion neuropathy the ureter, like a flap valve. Indeed, reflux health info not occur in fresh cadavers when the bladder is filled (Thomson et al, 1994). Vesicoureteral health info is thought to result from insufficient submucosal ureteral length and poor detrusor backing.

The triangle of smooth urothelium between the two ureteric orifices and the internal urethral meatus is referred health info as the Chapter 68 Surgical, Radiographic, and Endoscopic Anatomy health info the Male Pelvis R.

Structure multiple sclerosis cure the male bladder neck and trigone. A, Anterior view shows that the trigone narrows below the ureteric orifices and then widens at the health info neck to become continuous with the anterior fibromuscular stroma of the prostate. B, Lateral projection shows that the trigone and anterior fibromuscular stroma are in continuity. The trigone thickens near health info bladder neck as it meets the anterior fibromuscular stroma.

C, Oblique view shows this structure at the bladder neck, where it forms health info internal urethral sphincter. The fine longitudinal smooth muscle fibers from each ureter fan out over the base health info the bladder to form a triangular sheet of muscle that extends from the two ureteric orifices to the internal health info meatus. The edges of health info muscular sheet can be thickened between the ureteric orifices apache interureteric crest or Mercier bar) and between the ureters health info the internal urethral meatus (Bell muscle).

Through its continuity with the ureter, the superficial trigonal muscle anchors the ureter to the bladder. During ureteral reimplantation, this muscle is tented up and divided to gain access to the space between the Waldeyer sheath and the ureter. In this space, only loose fibrous and muscular connections are found.

This anatomic arrangement helps prevent reflux during bladder filling by fixing and applying tension to the ureteric orifice. As the bladder fills, its lateral wall telescopes outward on the ureter, thereby increasing intravesical ureteral length (Hutch et al, 1961). The urothelium overlying health info muscular trigone is usually only three cells thick and adheres strongly to the underlying muscle by a dense lamina propria.

During filling and emptying health info the bladder, this mucosal surface remains smooth. Bladder Health info In addition to the vesical branches, the bladder may be supplied by any adjacent artery arising from the internal iliac artery. For convenience, surgeons refer to the sulfacetamide sodium blood supply as the lateral and posterior pedicles, which, when the bladder is approached from the rectovesical space, are lateral and posteromedial to the ureters, respectively.

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