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The edges of this muscular sheet can be thickened between the ureteric orifices (the interureteric crest or Mercier bar) and between the ureters and the internal urethral meatus (Bell non small cell lung cancer. 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 non small cell lung cancer gain access to the space between the Waldeyer sheath and the ureter.

Non small cell lung cancer this therapist education, 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 the muscular trigone is usually only three cells thick and adheres strongly to the underlying muscle by a dense lamina propria. During filling and emptying of the bladder, this mucosal surface remains smooth. Bladder Circulation 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 vesical 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.

These pedicles are the lateral and posterior vesical ligaments in the male (see Fig. The veins of 1628 PART XII Urine Transport, Storage, and Emptying A Waldeyer sheath Ureter Superficial trigone (white zone) Deep trigone Ureteral hiatus Ureter Superficial trigone Deep trigone B Bladder neck Figure 68-24. Normal ureterovesical junction and trigone. A, Section of the bladder wall perpendicular non small cell lung cancer the ureteral hiatus shows the oblique passage of the ureter through the detrusor and also shows the submucosal ureter with its detrusor backing.

Waldeyer sheath surrounds the prevesical ureter and extends inward to become the deep trigone. B, Waldeyer sheath continues in the bsl as the deep trigone, which is fixed at the bladder neck. Smooth muscle of the ureter forms the superficial trigone and is anchored at the verumontanum. Cystogram demonstrating left-sided vesicoureteral reflux into dilated ureter. A separate nonadrenergic, noncholinergic (NANC) component of the autonomic nervous system participates in activating the detrusor, although the neurotransmitter has not been identified (Burnett, 1995).

The female bladder neck has little adrenergic innervation. Like the bladder neck, it relaxes during micturition. Afferent innervation from the bladder travels with both sympathetic (via the hypogastric nerves) and parasympathetic nerves to reach cell bodies in the dorsal root ganglia located at thoracolumbar and sacral levels.

As a consequence, presacral neurectomy (division of the hypogastric nerves) is ineffective in relieving bladder pain. Right ureteric orifice and right hemitrigone with scattered small calculi. Lymphatics from the lamina propria and muscularis drain to channels on the bladder surface, which run with the superficial vessels within the thin visceral fascia. Small paravesical lymph nodes can be found along the superficial channels.

The bulk of the lymphatic drainage passes to the external iliac lymph nodes (see Fig. Some anterior and lateral drainage may go through the obturator and internal iliac nodes, non small cell lung cancer portions of the bladder base and trigone may drain into the internal and common iliac groups. PERINEUM The perineum lies between the pubis, thighs, and buttocks and is limited superiorly by the levator ani.

Viewed from below, the symphysis pubis, ischial tuberosities, and coccyx outline the diamond shape of the perineum; the inferior ischiopubic rami and sacrotuberous ligaments non small cell lung cancer its bony and ligamentous walls (Figs. A line drawn through the ischial tuberosities divides the perineum into an anal and a urogenital pfizer effect. Anal Triangle At the apex of the prostate, the rectum turns approximately 90 degrees posteriorly and inferiorly to become the anus (see Chapter 68 Surgical, Radiographic, and Endoscopic Anatomy of the Male Pelvis 1629 sedation x Anterior, or urogenital perineum x Posterior, or anal perineum Perineal a.

Artery of penis x Inf.

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