Bladder - Normal Anatomy

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Bladder

Normal anatomy

Author: Nat Pernick, M.D.

Last revised: 22 June 2010, last major update June 2010

General

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● Epithelial lined muscular viscus that can distend and hold up to 400-500 ml of urine without a change in intraluminal pressure

● Can also initiate and sustain a contraction until empty

● ICD-O-3 coding

Parts of bladder

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● Apex/dome: most anterosuperior point, site of insertion of median umbilical ligament

● Base: posterior surface

● Neck: most distal portion of bladder

● Trigone: area between ureteral and urethral orifices, continuous with bladder neck

Relationship to other structures

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● Located in part within the abdomen in children, enters pelvis major at age 6, found entirely within pelvis minor (“true” or obstetric pelvis) after puberty

● Distended adult bladder may reach level of umbilicus

● Adult bladder rests on rectum and seminal vesicles (males) or cervix and vagina (females); thus cystectomy for tumor may be combined with removal of prostate and seminal vesicles (males) or hysterectomy and partial vaginectomy (females)

● Bladder is relatively free within pelvis (which permits its expansion as it distends), but neck is secured by puboprostatic ligaments (male) and pubovesical ligaments (female)

● Bladder neck occasionally contains prostate ducts (males)

Lymphatic drainage:

● Internal and external iliac nodes; bladder neck drains to sacral or common iliac nodes

Blood supply:

● Superior and inferior vesical arteries, derived from internal iliac artery; drained by vesical venous plexus, which empties into internal iliac veins

Nerve supply:

● Sympathetic from T11-L2 nerves, plays no role in micturition

● Parasympathetic from S2-4, travel to bladder via pelvic nerve and inferior hypogastric plexus, cause contraction of muscularis propria fibers, which puts traction on bladder neck, which opens internal sphincter; important in micturition

Drawings

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Position of bladder in male pelvis

Position of bladder in female pelvis

Interior

Gross description (Macroscopy)

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● Hollow viscus resembling inverted pyramid when empty, sphere when distended

Gross images

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Normal bladder with urethritis

End of Bladder > Normal Anatomy

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