Bladder & ureters
General
Normal anatomy


Topic Completed: 1 June 2011

Revised: 12 June 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Bladder [title] normal anatomy

Alcides Chaux, M.D.
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Cite this page: Chaux A. Normal anatomy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderanatomy.html. Accessed December 7th, 2019.
Definition / general
  • 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:
  • 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:
  • 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

Ureters:
  • 30 cm long, 5 mm in diameter
  • Areas of ureteral narrowing are at ureteropelvic junction, crossing of external / common iliac artery and where ureters enter bladder; these are common sites of obstruction and stone impaction
  • Ureters enter bladder in oblique manner
  • Bladder muscle contraction mechanically closes off ureteral orifice
  • Defects cause reflux
Diagrams / tables

Images hosted on other servers:

Position of bladder in male pelvis

Position of bladder in female pelvis

Interior

Gross description
  • 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
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