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bladder, Prostate, Urethra.pptx

The document discusses the anatomy of the urinary bladder, prostate, and urethra. It describes the urinary bladder as a reservoir for urine located in the pelvis. It details the shape and positions of the bladder as well as its relations to surrounding structures. It also discusses the interior of the bladder including the trigone and ureteric orifices. The document then covers the anatomy of the male and female urethra and prostate gland, including their histology, vascular supply, innervation and relations.

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Urinary Bladder, prostate and urethra Mr. M. Banda 4/24/2023 1
Urinary Bladder • Introduction: - Is a reservoir of urine - Size, shape, position and relations vary according to content and state of neighbouring viscera - When empty: entirely in lesser pelvis - When full: anterosuperiorly in abdominal cavity 4/24/2023 2
Urinary Bladder - Empty bladder: tetrahedral in shape Base (fundus): directed backwards Neck: lowest/fixed part Apex: directed forwards  3 surfaces: superior, Rt/Lt inferolateral surfaces 4 borders: 2 lateral, one anterior and one posterior 4/24/2023 3
Urinary Bladder 4/24/2023 4
Relations of Urinary Bladder Base: • Females: - Uterus separating it from rectum 4/24/2023 5
Relations of Urinary Bladder Base: • Males: - Rectum separated from it by:  Rectovesical pouch anteriorly  Seminal vesicle and vas deferens on each side  Denonvillier’s fascia 4/24/2023 6
Relations of Urinary Bladder • Neck: - Lies most inferiorly - 3–4 cm behind symphysis pubis - Is above plane of inferior aperture of lesser pelvis - Essentially internal urethral orifice - In males, rests on base of the prostate - In females, related to pelvic fascia 4/24/2023 7
Relations of Urinary Bladder • Apex: - Both sexes faces towards upper part of the symphysis pubis - Median umbilical ligament (urachus) ascends behind anterior abdominal wall from apex to umbilicus - Ligament covered by peritoneum to form the median umbilical fold 4/24/2023 8
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4/24/2023 10
Relations of Urinary Bladder Anterior surface: - Separated from transversalis fascia by fat in retropubic space (of Retzius) Inferolateral surface: - In males, anteriorly to pubis and puboprostatic ligaments - In females, relations are similar except that pubovesical ligaments replace the puboprostatic ligaments - Inferolateral surfaces are not covered by peritoneum 4/24/2023 11
Relations of Urinary Bladder Superior surface: - In males, completely covered by peritoneum - Rectovesical pouch separates it from rectum - Sigmoid colon and terminal coils of the ileum - In females, superior surface is largely covered by peritoneum - Reflected posteriorly onto the uterus to form vesicouterine pouch - Posterior part of the superior surface is devoid of peritoneum 4/24/2023 12
Ligaments of the Bladder • Attach bladder to pubis, lateral pelvic side-walls, and rectum True ligaments: 1. Pubovesical ligaments 2. Pubourethral ligaments 3. Puboprostatic (medial/lateral)ligaments in male 4. Median umbilical ligament 5. Lateral true ligament in male 6. Posterior vesical ligaments in male 4/24/2023 13
Ligaments of the Bladder 4/24/2023 14
Ligaments of the Bladder 4/24/2023 15
Ligaments of the Bladder False ligaments: 1. Median umbilical fold 2. Two medial umbilical folds 3. Lateral false ligament 4. Posterior false ligament 4/24/2023 16
Bladder Interior Vesical mucosa • Almost all is attached loosely to subjacent muscle • Folds when the bladder empties • Folds stretched flat as it fills • Over trigone, is adherent to the subjacent muscle layer and mucosa is always smooth 4/24/2023 17
Bladder Interior • Trigone is formed by: - Anteroinferior angle: internal urethral orifice - Posterolateral angles: ureteric orifices - Superior trigonal boundary has interureteric bar • Trigone consists of 2 distinct layers: - Superficial trigonal muscle - Deep trigonal detrusor muscle 4/24/2023 18
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Bladder Interior • Ureteric orifices - Are placed at posterolateral trigonal angles - In empty bladders: 2.5 cm apart, and 2.5 cm from the internal urethral orifice - Bladder distension: measurements may be doubled • Internal urethral orifice - Is sited at the trigonal apex - Lowest part of the bladder 4/24/2023 20
Capacity of Bladder • Mean capacity: 220 mL • Varies from 120-320 mL • Filling beyond 220 mL causes desire to micturate • Filling up to 500mL maybe tolerated but beyond that it becomes painful • Referred pain is felt in lower anterior abdominal wall, perineum, penis (T11 to L2; S2-S4) 4/24/2023 21
Vascular Supply and Lymphatic Drainage of Bladder • Arteries - Principally by superior and inferior vesical arteries - Supplemented by obturator and inferior gluteal arteries - In female: branches of uterine and vaginal arteries • Veins - Vesicle venous plexuses on inferolateral surfaces drain into internal iliac veins • Lymphatics - External iliac nodes 4/24/2023 22
Nerve Innervation of the Urinary Bladder • Both autonomic and somatic Efferent nerves: 1. Parasympathetic efferent fibres (S2-S4): - Motor to detrusor muscle - Inhibitory to sphincter vesicae (internal sphincter) - If these are destroyed, normal micturition is not possible 2. Sympathetic efferent fibres (T10-L2): - Inhibitory to detrusor muscle - Motor to sphincter vesicae 4/24/2023 23
Nerve Innervation of the Urinary Bladder 3. Somatic: Pudendal nerve (S2-S4) - Supplies the voluntary sphincter urethrae (external sphincter) Afferent nerves: - Pain sensations pass via mainly the parasympathetic and partly via sympathetic nerves - In spinal cord, pain pass via lateral spinothalamic tract and awareness of bladder distension via posterior columns 4/24/2023 24
Innervation of the Bladder • Dashed lines indicate sensory nerves • Parasympathetic innervation is shown at the left • Sympathetic at the upper right • Somatic at the lower right 4/24/2023 25
Male Urethra • Is 18–20 cm long • From internal urethral orifice in urinary bladder to external opening, or meatus • Two parts: 1. Anterior urethra (16 cm) - Bulbar - Pendulous or penile 2. Posterior urethra (4 cm) - Preprostatic - Prostatic - Membranous 4/24/2023 26
Male Urethra 4/24/2023 27
4/24/2023 28
Vascular, lymphatic drainage and innervation of male urethra Vascular supply: Artery: - Urethral artery, a branch of internal pudendal artery Veins: - Dorsal veins of penis and internal pudendal veins - These drain to prostatic plexus - Posterior urethra drains into prostatic and vesical venous plexuses, which drain into the internal iliac veins 4/24/2023 29
Vascular, lymphatic drainage and innervation of male urethra Lymphatic drainage - Posterior urethra: internal iliac nodes - Anterior urethra: accompany that of glans, then deep inguinal Innervation: - Prostatic plexus supplies smooth muscle of prostate and prostatic urethra - Greater cavernous nerves carry sympathetic supply for contraction of preprostatic sphincter during ejaculation and prevents reflux of ejaculate into the bladder 4/24/2023 30
Vascular, lymphatic drainage and innervation of male urethra • Parasympathetic preganglionic fibres are axons from neurones in S2-S4 sacral spinal segments • Nerve supply to external urethral sphincter is the neurones in Onuf’s nucleus and by perineal branches of pudendal nerve 4/24/2023 31
Female Urethra • Is approximately 4 cm long and 6 mm in diameter • Begins at internal urethral orifice of bladder, runs anteroinferiorly behind symphysis pubis • Is embedded in anterior wall of the vagina • Ends at external urethral orifice in vestibule as an anteroposterior slit • Many small mucous urethral glands open into urethra • At lower end of urethra, Skene’s glands open into para-urethral duct 4/24/2023 32
Female Urethra 4/24/2023 33
Female Urethra Vascular Supply and Lymphatic Drainage • Artery - Internal pudendal artery via the urethral artery is the principal supply • Veins - Urethral venous plexus drains into vesical venous plexus around bladder neck, and into internal pudendal veins • Lymphatic drainage - Internal and external iliac nodes 4/24/2023 34
Female Urethra • Innervation - Parasympathetic preganglionic fibres: S2-S4 pelvic splanchnic nerves - Postganglionic fibres: smooth muscle of the urethral wall - Somatic fibres to the striated muscle: S2 to S4 - Postganglionic sympathetic fibres arise from plexus around vaginal arteries 4/24/2023 35
Histology of Urinary Bladder and Urethra 4/24/2023 36
Prostate gland • Is a pyramidal fibromuscular accessory gland • Surrounds prostatic urethra from bladder base to the membranous urethra • Unlike the thyroid gland, its neurovascular bundle lies between the true and the false capsules • During prostatectomy, the neurovascular tissue is preserved to avoid damage to the prostatic plexus which is a component of the inferior hypogastric plexus (autonomic) • Damage to prostatic plexus can cause erectile dysfunction 4/24/2023 37
Prostate gland • Numerous fibromuscular septa which divide glandular tissue into indistinct lobules • Muscular tissue within prostate is mainly smooth muscle • In female, prostate is represented by paraurethral glands of Skene 4/24/2023 38
Prostate gland • Size and weight: - Measures:  4cm transversely at base 2 cm anteroposterior diameter 3 cm vertical diameter - Weight varies: Average of 8g in youth In BPH: 40-150 g 4/24/2023 39
Prostate Gland • Blood supply: Arteries: branches from - Inferior vesical - Middle rectal - Internal pudendal Veins: - Prostatic venous plexus communicate with vesical plexus and internal iliac veins - Communicates with Batson’s plexus of veins via which prostate carcinoma can spread 4/24/2023 40
Prostate Gland • Lymphatic drainage: - Internal iliac nodes - Sacral nodes - Partly external iliac nodes • Nerve supply: - Autonomic via the prostatic plexus which comes from inferior hypogastric plexus 4/24/2023 41
Zonal Anatomy of the Prostate • Anatomically; glandular tissue is subdivided into three distinct zones: - Peripheral (70% by volume) - Central (25% by volume) - Transitional (5% by volume) • Non-glandular tissue (fibromuscular stoma) fills up space between peripheral zones anterior to the preprostatic urethra 4/24/2023 42
Zonal Anatomy of the Prostate 4/24/2023 43
Zonal Anatomy of the Prostate 4/24/2023 44
Zonal Anatomy of the Prostate 4/24/2023 45
Zonal Anatomy of the Prostate 4/24/2023 46
Histology of the Prostate Gland • Epithelium: pseudostratified columnar • Has tubuloalveolar glands • Rich fibromuscular stroma surrounds the glands • Is surrounded by fibroelastic capsule rich in smooth muscle • Septa from capsule penetrate gland and divide it into lobes that are indistinct in adult men 4/24/2023 47
Histology of the Prostate Gland • Has small spherical bodies of glycoproteins, 0.2-2 mm in diameter and often calcified • Are called prostatic concretions, or corpora amylacea • Their significance is not understood, but their number increases with age • Prostatic secretions are slightly acid, and contain acid phosphatase, amylase, Prostate-specific Antigen (PSA), fibrinolysin and zinc 4/24/2023 48
Histology of the Prostate Gland 4/24/2023 49
The End Thank you! 4/24/2023 50