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Bladder

Normal anatomy


Reviewers: Alcides Chaux, M.D., Instituto de Patología e Investigación (see Reviewers page)
Revised: 12 June 2011, last major update September 2010
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

General
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● Hollow organ that serves as a reservoir for urine
● Adult bladder can hold up to 400-500 ml of urine without a change in intraluminal pressure
● In addition, can initiate and sustain a contraction until empty
● Distended adult bladder may reach level of umbilicus
ICD-O-3 coding

Parts of bladder
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Apex/dome: most anterosuperior point; is covered by peritoneum; site of insertion of median umbilical ligament (obliterated urachus) which anchors the bladder to the abdominal wall
Base: posterior surface, is also covered by peritoneum
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
● 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)
● Ureters enter the bladder posteroinferiorly and obliquely, travel 1.5-2 cm through the bladder wall (intravesical portion), and open at the ureteral orifices
● Bladder neck is formed by interlacing and converging fiber of detrusor muscle forming 3 well-defined layers; occasionally contains prostatic ducts (males)
● Anteroinferiorly and laterally, there is abundant fat and loose connective tissue (space of Retzius)
● 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)

Blood supply:
● Superior, middle and inferior vesical arteries, derived from the anterior trunk of the internal iliac artery
● In addition, minor branches are derived from obturator and inferior gluteal arteries and, in women, uterine and vaginal arteries
● Venous drainage by a rich vesical venous plexus, which empties into internal iliac veins

Lymphatic drainage:
● Vesical, internal and external iliac nodes; bladder neck drains to sacral or common iliac nodes

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
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● Hollow viscus resembling inverted pyramid when empty, sphere when distended
● Internal (mucosal) surface is flat when distended but show abundant folds in an empty bladder

Gross images
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Normal bladder with urethritis

End of Bladder > Normal anatomy


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