Urinary bladder

The bladder is a hollow muscular organ that serves to accumulate coming through the ureters urine and highlight it on the urethra.


Fig. 1. Sagittal section of the male pelvis: 1 ampoule VAS duct; 2 - seminal vesicle; 3 - rectum; 4 - prostate; 5 - semyavyvodyaschih duct; 6 - anal hole; 7 - the urethra; 8 - seed tubercle; 9 - the mucous membrane of the urinary bladder; 10 - muscular layer of the bladder; 11 - the peritoneum.

Fig. 2. Sagittal section female Tala:
1 - uterus; 2 - vagina;
3 - rectum;
4 - penis hole;
5 - the eve of the vagina;
6 - the urethra;
7 - the bladder.

Anatomy. The bladder is located in the pelvis for pubic joint (Fig. 1 and 2). Form bladder varies depending on its content and provisions of the adjacent organs. Physiological capacity of the bladder adult - 250-300 ml
In the bladder distinguish the bottom, the top, the body, the neck. The bladder is composed of muscle membrane, submucosal layer and mucous membranes. The mucous membrane forms folds and no sharp borders enters submucosa. The peritoneum covers back and partly side walls of the bladder. On the back surface, in the middle of the bottom of the bubble in the lower segment is gallbladder (Lyadov) triangle. He is limited in front of the inner opening of the urethra and behind the mouths of both ureters.
Blood flow to the bladder is the top and bottom of the cystic arteries and partially branches private parts and locking of the arteries. Venous plexus are situated around the front to the lower part of the bladder. The outflow of blood is in the gallbladder veins. Lymph flowing in and sacral iliac lymph nodes. Innervation at the expense of the upper and lower hypogastric plexus.

vessels and nerves in the bladder
Fig. 1 and 2. Vessels and nerves in the bladder: Fig. 1 - front view, a part of the pubic bone cut, the front wall of the bladder and the urethra is removed, the right nerves in the bladder removed, left removed lymph vessels and nodes; Fig. 2-sagittal section 1-aorta abdominalis; 2-n. praesacralis (plexus hypogastricus sup.); 3-a. iliaca communis; 4-vena iliaca communis; 5-ureter; 6-a., v. et plexus testlculares; 7-rectum; 8-plexus pelvlnus (plexus hypogastrics inf.); 9 - a. iliaca int.; 10-ductus deferens; 11-a. umbilicalis; 12-a. iliaca ext.; 13-a. et v. vesicales superiores; 14-v. iliaca ext.; 15-nerve plexus in the bladder wall; 16-vesica urinaria; 17-trigonum vesicae; 18-prostata; 19-colliculus seminalis; 20-pars spongiosa urethrae; 21 - membrana obturatoria; 22-plica interureterica; 23-ostium ureteris; 24-plexus blood and lymph vessels in the wall of the urinary bladder; 25-nodi lymphatici iliacl int.; 26-a. et v. vesicales inf.; 27-ostium urethrae int.; 28-vesicula seminalis; 29-utriculus prostaticus; 30-pars prostatica urethrae; 31 pars membranacea urethrae; 32-fossa navicularis; 33-symphysis pubica; 34-lig. umbilicale medianum; 35-v. iliaca int.
anatomy of the urinary bladder

The bladder (vesica urinaria) is located in the pelvic cavity and borders on the front, with pubic joint; behind him above the prostate are seminal vesicles and capsules VAS deferens.
Below the bladder is adjacent to the fascia of the pelvis and perineum muscles.
Empty the bladder above all covered parietal piece of peritoneum. During the filling of the bladder urine, abdominal fold goes up, resulting in part of the front wall is not covered by the peritoneum, except knit with it the top of the bubble.
In the wall of the bladder, there are three shell: outer connective tissue, medium - muscle and internal mucous. The most powerful is a muscular layer of smooth muscles, in which there are three layers: the outer (longitudinal), medium (circular) and internal (longitudinal-slash), operating as a single unit and bearing the name of the detrusor.
Circular muscle fibers middle layer move on to the neck of the bladder and surrounding it form a pulp, closing the output of urine (internal sphincter). At the bottom of the bladder is leotiev triangle whose peak corresponds to the inner opening of the urethra and the base is the line connecting holes (mouth) both ureters. Muscle fibers between the mouths of the ureters well defined (mioclonia link - ligamentum interuretericum). The mucous membrane of the urinary bladder covered by the transitional epithelium, except for the area of a triangle, covered by a cylindrical epithelium. Submucosal layer consists of loose fibrous connective tissue. Intact mucosa of the bladder has a weak absorption capacity.
Blood flow to the bladder is top, middle and bottom of the cystic arteries, extending from the front of the trunk hypogastric artery. Small branches go to the bladder from locking and lower gluteal artery. Women in the blood flow to the bladder and take part in vessels coming from the uterus and vagina.
Vienna bladder form three plexus, which flows into the lower Vienna. There are anastomoses with CNC system.
Lymph outflow from the wall of the bladder is in the hypogastric and iliac lymph nodes.
Bladder innerviruetsya three pairs of nerves: nn. hypogastrici, nn. pelvici and nn. pudendi. Nn. hypogastric! refer to the sympathetic system, a nn. pelvici - to the parasympathetic. They depart from the II-IV of the sacral segments and together with nn. hypogastrici form the posterior inferior surface of the bubble so-called cystic plexus (plexus vesicalis)which control how detrusor and the sphincter. Irritation nn. hypogastrici causes relaxation of the detrusor and the contraction of the sphincter, and irritation nn. pelvici, on the contrary, the detrusor contraction and relaxation of the sphincter. The third pair of nerves - nn. pudendi which control the outer striated sphincter, departs from the sacral spinal cord.
In addition, in the thickness of the wall of the bladder has a multitude of nerve ganglia, thanks to which the bladder, isolated from the Central nervous system, capable of automatic urinate.
In the cerebral cortex has a center striated external sphincter. Arbitrary reduction of the latter causes the termination of urination, and he revealed at the beginning of urination reflex because of intensive reduction of the detrusor.

Research methods. From an anamnesis it is possible to learn localization and character of pain, urinary frequency. Frequent and painful urination during the day is typical for bladder stone and cervical cystitis, at night - for adenoma of the prostate. On examination, the patient can be identified filled bladder in suprapubic region, the bladder extrophy (eversion out of his and other Inspection newly urine allows to determine the admixture of pus - Juriy, blood - hematuria, pieces of tissue and blood clots when bladder tumors. Research through the rectum and bimanual palpation of the bladder (the study of two hands: one arm above the pubic area through the wall of the abdomen and the other through the rectum) under anesthesia with relaxation allows to determine the size of infiltrates or tumors. Percussion define the boundaries of the speaker of the sprawling bladder. Catheterization of the bladder after urination allows to determine the amount of residual urine. About the function of the detrusor and sphincter of the bladder can be judged from the nature of the urine stream, but rather - by cystometry using special apparatus, measuring contractility of muscles detruzora. In diseases of the urinary bladder for further diagnosis and treatment apply the cystography (see), phlebography, pelvic angiography, the outflow (see Angiography).