Anatomy of

The Urinary Bladder

&
The urethra

Presented by
Mohammad Ihmeidan PGY2
 The urinary bladder
a hollow distensible muscular
organ
situated in the pelvic cavity
posterior to the symphysis pubis.
In infants and children , it is
situated higher.
Full bladder
Adult capacity
400 -600 cc

• Pediatrics bladder
capacity
= (AGE + 2) *30 in milliliters
Empty bladder
The empty bladder
is shaped like a
threesided
pyramid.
It has an apex, a
base,
a superior surface,
and two
The apex of the bladder
is attached to a structure known as the
median umbilical ligament
(a remnant of the embryologic urachus)
The urachus anchors the bladder to the
anterior abdominal wall
There is a relative paucity of bladder wall
muscle at point of attachment of urachus,
predisposing to diverticula formation
Near umbilicus, becomes more fibrous and
 Superior Surface
 Covered by peritoneum.
 Anteriorly, the peritoneum sweeps gently onto the
anterior abdominal wall
 With distention, the bladder rises out of the true
pelvis and separates the peritoneum from the
anterior abdominal wall.
 It is therefore possible to perform a suprapubic
cystostomy without risking entry into the
peritoneal cavity.
 Posteriorly, the peritoneum passes to the level of
The base of the bladder is shaped like an
inverted triangle and faces posteroinferiorly.
The two ureters enter the bladder at each of
the upper corners of the base and the
urethra drains inferiorly from the lower
• The smooth triangular
area between the
openings of the ureters
and urethra on the inside
of the bladder
Is known as the trigone

The intravesical ureteral

orifices are roughly 2-3
cm apart. The intramural
ureters are each about 1.5
cm in length.
 Inferolateral
Anteroinferiorly and laterally, the
bladder is cushioned from the
pelvic side wall by retropubic and
perivesical fat and loose
connective tissue.
 Base and Neck
In males the bladder base is related to the
seminal vesicles, ampullae of the vas
deferens , and terminal ureter.

The bladder neck, located at the internal

urethral meatus, rests 3-4 cm behind
symphysis pubis
It is firmly fixed by the pelvic fasciae and
by its continuity with the prostate
males ,the vagina and uterus intervene betwe
der and the rectum so that the base of the bl
and urethra rest on the anterior vaginal wall
The mucosa of the urinary bladder is
lined by a multilayered transitional
epithelium (urothelium).
Beneath it ,is a submucosal layer
formed of connective and elastic
tissues.
External to the submucosa is the
detrusor muscle
the detrusor muscle which is made up of
When becomes close to the internal meatus, where
the detrusor muscle assumes 3 definite layers:
Inner longitudinal, middle circular, and outer
longitudinal.
circular smooth muscle fibers form internal urethral
sphincter
circular skeletal muscle fibers form external urethral
sphincter
adventitia layer of loose connective tissue anchors in
place
superior surface has serosal layer (visceral peritoneum)
 Bladder Circulation
The arterial blood supply of the bladder
arrives primarily from superior vesicle
branches,middle vesical and inferior
vesical arteries which arise from the
anterior trunk of the internal iliac
(hypogastric)artery
 The arterial supply of the bladder is also
derived in part from the obturator artery
Venous:
Surrounding the bladder is a rich plexus
of veins
that ultimately empties into the
internal iliac (hypogastric) veins
Lymphatics:
The lymphatic drainage of the bladder
is into the obturator, external iliac,
internal iliac (hypogastric), and
 The urethra
The urethra is a fibromuscular tube that
conducts urine from the bladder (and
semen from the ductus deferens) to the
exterior. It begins at the neck of the bladder
and ends at the external urethral orifice.
Differs significantly in males and females.
 In females
 The urethra is short, being about 4 cm long.
 It travels a slightly curved course as it passes inferiorly
through the pelvic floor into the perineum, where it
passes through the deep perineal pouch
and perineal membrane before opening in the
vestibule that lies
between the labia minora ;
between the clitoris
and the vagina.
 In males
 The urethra is longer than females, about 16-20
cm
 Beginning at the base of the bladder
 passing inferiorly through the prostate,
it passes through the deep
perineal pouch and perineal
membrane and enters the root
of the penis.
 The urethra exits the deep perineal
pouch, it bends forward to course anteriorly
in the root of the penis.
When the penis is flaccid, the urethra
makes another bend, this time
inferiorly, when passing from the root
to the body of the penis.

During erection, the bend between

the root and body of the penis
disappears
The urethra in men is divided into:
prostatic,
mwmbranous
bulbar
spongy (penile) parts.
The prostatic part of the urethra begins at
the vesical neck and internal sphincter,
courses through the prostatic gland and
ends at the urogenital diaphragm.
It is approximately 3-4cm long
The membranous urethra lies specifically
between two landmarks: the distal end of
the verumontanum (proximally) and the
conical end of the bulbar urethra (distally)
Membranous urethra Beginning from the
apex of the prostate gland, the
membranous urethra traverses the
urogenital diaphragm, which contains the
external urethral sphincter and pair of
Cowper's glands on each side.
It is the shortest (1-2cm) part of the male
urethra
The anterior urethra composed of bulbous
and penile urethra
The bulbous urethra extends from the
inferior margin of the urogenital diaphragm
to the penoscrotal junction
The penile urethra extends from
penoscrotal junction to the external
urethral meatus
 The spongy urethra is
enlarged to form a bulb at the
base of the penis and again
at the end of the penis to
form the navicular fossa).

 The external urethral orifice is

the sagittal slit at the end of
the penis.
Thank you