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URINARY BLADDER,

URETHRA, ADRENALS,
BLOOD VESSELS

URINARY BLADDER

Pyramidal muscular organ when empty


Triangular shaped base posteriorly
Ureters enter the postero-lateral angles and the urethra leaves inferiorly at the
narrow neck (surrounded by the (involuntary) internal urethral sphincter)
1 superior and 2 inferolateral walls, meet at an apex behind the pubic
symphysis
Extraperitoneal structure

URINARY BLADDER
Retropubic fatty space (of Retzius )

Separate urethra from the pubic symphysis


contains a venous plexus, nerves, lymphatics

Perivesical fat surrounds the bladder


Obturator internus muscle is anterolateral, levator ani muscle inferolateral
Superiorly covered by peritoneum (separates from bowels)
Fixed inferiorly via condensations of pelvic fascia, which attach it to the back of the
pubis, lateral walls of the pelvis and the rectum

URINARY BLADDER
trigone

triangular inner wall of the bladder between the ureteric and urethral orifices
wall is smooth (remainder of the bladder wall is coarsely trabeculated by
criss-cross muscle fibres)

Blood supply

internal iliac artery via superior and inferior vesical arteries


drainage is via a venous plexus to the internal iliac vein

Lymph drainage - external iliac and thence to para-aortic nodes

URINARY BLADDER
Female

body of the uterus rests on its posterosuperior surface


cervix and vagina are posterior
rectum behind
bladder neck rests on the pelvic fascia

Male

termination of the vasa and the seminal vesicles are between the posterior
bladder and the rectum
bladder neck fused with the prostate
Puboprostatic ligament make it more immobile inferiorly in male

Pouch of Douglas/ cul de sac

Rectovesical pouch/ cul de sac

URINARY BLADDER
Plain film
Contrast study - intravenous urography or retrogradely via the urethra
US
CT
MRI

MALE URETHRA
runs from the internal urethral sphincter(neck of the bladder) to the external
urethral orifice at the tip of the penis
In radiological terms it may be divided into posterior and anterior parts

posterior - prostatic & membranous urethra


Anterior - bulbous & penile

Widest at prostatic part(3 cm)

MALE URETHRA
has a longitudinal midline ridge known as the prostatic crest
Several prostatic ducts open into the prostatic sinus
verumontanum(seminal colliculus)

prominence in prostatic crest


prostatic utricle opens on to this

Ejaculatory ducts = terminations of the seminal vesicles and the vasa


lower part of the prostatic urethra is relatively immobile as the prostate is fixed
here by the puboprostatic ligaments

MALE URETHRA
Membranous urethra

traverses the membranous urogenital diaphragm (form voluntary external


urethral sphincter(voluntary)
narrowest part of the urethra (2 cm long)
urethra is quite immobile at this point
A gland is present at either side at this point Cowper s gland

MALE URETHRA
bulbous urethra - in the bulb of the penis

has a localized dilatation called the intrabulbar fossa


surrounded by the corpus spongiosum

penile urethra

long and narrow


dilatation at its termination the navicular fossa
surrounded by the corpus spongiosum of the penis

MALE URETHRA
Retrograde urethrography

introduced retrogradely via a soft catheter in the navicular fossa

voiding cystourethrography - contrast in bladder voided


Penile sonourethrography - retrograde instillation of saline into the urethra
MRI

FEMALE URETHRA
4 cm long
from the internal urethral sphincter at the bladder neck through the urogenital
diaphragm
end at the external urethral meatus in the cleft between the labia minora/vestibule
lies on the anterior vaginal wall & posterior to the pubic symphysis
external urethral sphincter opens anterior to the vaginal opening
Multiple tiny urethral glands open into the lower urethra draining via Skene s
tubules

FEMALE URETHRA
no true anatomical sphincters in the female urethra
vesical muscle fibres at the urethrovesical junction acts as the involuntary internal
urethral sphincter/primary continence mechanism
Involuntary muscles of the urethral wall also provide resistance, keeping the
urethra closed except during micturition
There are three muscle

innermost longitudinal smooth muscle


middle layer circular smooth muscle
outermost striated muscle (rhabdosphincter) - most important

FEMALE URETHRA
The external urethral sphincter is at the urogenital diaphragm

Less well developed than that in the male


composed of voluntary muscle fibres arising from the inferior pubic ramus,
which encircle the urethra and allow voluntary arrest of urinary flow
pudendal nerve supplies the external urethral sphincter

FEMALE URETHRA
voiding contrast cystourethrography
US
3D US - perineal transducer
MRI

IVU

Male urethrogram,
oblique

T2w coronal female

T2w sag female

T2w axial female

T2w sag female

Ureteric orifice

trigone

Urethral sphinter

urethra
T2 w coronal female

T2w axial male

T2w coronal male

T2 fat sat sag male

Subtracted pelvic arteriogram

ADRENAL GLAND
retroperitoneally above each kidney
enclosed within the perirenal fascia but in a separate compartment
composed of a body, medial limb, lateral limb
outer cortex derived from mesoderm
inner medulla (10% of the weight of the gland) derived from the neural crest and is
related to the sympathetic nervous system
tends to have a consistent location

ADRENAL GLAND
At birth the adrenal glands are relatively much larger than
in the adult one-third the size of the kidney at birth
size of the gland is somewhat variable
(limbs should not be thicker than the diameter of the adjacent crus of the
diaphragm)

ADRENAL GLAND
adrenals do not develop with the kidneys (develop in the retroperitoneum and
descend, whereas the kidneys develop in the pelvis and ascend)
if kidneys fail to ascend normally, adrenal glands are still found in the expected
position although their shape may be more discoid
Variants = Small masses of adrenal cortical tissue (cortical bodies)

often found near the adrenal glands


attached to other organs early in embryology and migrate with these organs
broad ligament of the uterus/spermatic cord/epididymis

ADRENAL GLAND
Right

posterior to the inferior vena cava


medial to the right lobe of the liver
lateral to the right diaphragmatic crus
cross-section it is triangular or Y-shaped

Left

posterior to the splenic vein


lateral to the diaphragmatic crus
position is less consistent than that of the right side
linear or V-shaped, with a larger medial limb and a smaller lateral limb

ADRENAL GLAND
Plain radiograph - if calcified
CT - contrast help diff if from splenic vessels
MRI - T1 vs T2
US - easily seen in neonates
Adrenal venography - venous sampling in addition to imaging the veins
Arteriography of adrenal gland

Arteriography of adrenal
superior adrenal artery usually consists of several branches from the inferior
phrenic artery (may arise separately from the aorta)
middle adrenal artery arises from the aorta and is multiple in more than 30% of
studies
inferior adrenal artery may arise from the renal artery directly or with the superior
capsular artery
Other arteries to the adrenal gland may arise from the gonadal arteries