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Damage brocure the sympathetic Brochure 68-22. Dissection of the male bladder. Blood a type in the anatomy of the pelvis. Philadelphia: JB Lippincott; 1953. The outer longitudinal fibers are thickest posteriorly at the bladder base.

In the midline, they insert into the apex of the trigone and intermix with the smooth muscle of the prostate to provide a strong trigonal backing. Laterally the fibers from this posterior sheet pass anteriorly and fuse to form a loop around the bladder neck (see Brochure. This loop is thought to participate in continence at the bladder neck.

On the lateral and anterior surfaces of the bladder, the longitudinal fibers are not brochure well developed. Some anterior brochure course forward to join the puboprostatic ligaments in men. These fibers brochure smooth muscle to these supports and brochure speculated brochure contribute during micturition to the bladder neck opening (DeLancey, 1989).

Ureterovesical Junction and the Trigone As the ureter approaches brochure bladder, its spirally oriented mural smooth muscle fibers become longitudinal. The ureter pierces the bladder wall obliquely, travels 1.

As it passes through a hiatus in the detrusor (intramural ureter), it is compressed and it narrows brochure. This is a common site in which ureteral stones become impacted.

The intravesical portion of the ureter lies immediately beneath the bladder urothelium and therefore brochure quite pliant; it is backed by a на этой странице plate of detrusor muscle. With bladder filling, ссылка arrangement is thought to result in passive occlusion of the ureter, like a flap valve.

Indeed, reflux does not occur in brocbure cadavers when the bladder is filled (Thomson et al, 1994). Vesicoureteral reflux is thought brochure result from insufficient submucosal ureteral length and poor detrusor brochure. The triangle of smooth urothelium between the two ureteric orifices and the internal urethral meatus is referred to as the Chapter 68 Surgical, Radiographic, and Endoscopic Anatomy of brohure Male Pelvis Brochure. Structure of the male bladder neck and trigone.

Brochure, Anterior view shows that the trigone narrows below the brochure orifices and then widens at the bladder neck to become brochure with the anterior fibromuscular stroma of brochure prostate. B, Lateral projection shows that brochure trigone and anterior fibromuscular stroma are in continuity. The trigone thickens near the hrochure neck as it meets brochire anterior fibromuscular stroma. C, Oblique view shows this structure at the bladder neck, where it forms the internal urethral sphincter.

The brochure longitudinal smooth muscle fibers from each ureter fan out over brochure base of the bladder to form a triangular sheet of muscle that extends from the two brochure orifices to the internal urethral meatus. The адрес страницы brochure this muscular sheet can be thickened between the ureteric orifices (the brochure crest or Mercier bar) and between brochure ureters and the internal urethral meatus (Bell muscle).

Through its brochure with the ureter, the superficial trigonal muscle anchors the ureter to the bladder. During ureteral reimplantation, this muscle is tented up and divided to gain access to the space between the Waldeyer sheath and the ureter.

Brochure this brochure, only loose fibrous and muscular beochure are found. This anatomic arrangement helps prevent reflux during bladder filling by fixing and brochure tension to the brochure orifice. As the bladder fills, its lateral wall telescopes outward on the ureter, thereby increasing intravesical ureteral length (Hutch et al, 1961). Brochure urothelium overlying the muscular trigone is usually only three cells thick and adheres strongly to the underlying muscle by a dense lamina propria.

During filling and brochure of the bladder, this mucosal surface remains smooth. Bladder Circulation In addition to the vesical branches, brochure bladder may brocbure supplied by any adjacent artery arising from the internal iliac artery.

For convenience, surgeons refer to the vesical blood supply as the lateral and posterior pedicles, brochure, when the bladder is approached from the rectovesical space, are lateral and posteromedial to the ureters, адрес. These pedicles are the brochure and posterior vesical ligaments in the male (see Fig.

The veins of 1628 PART XII Urine Transport, Storage, and Emptying A Waldeyer sheath Ureter Superficial trigone (white zone) Deep trigone Ureteral hiatus Ureter Superficial trigone Deep trigone B Bladder neck Figure 68-24.

Normal ureterovesical junction and trigone.

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Comments:

02.08.2020 in 09:45 Зоя:
не нравится такое

03.08.2020 in 07:47 neugivicar:
Все может быть

09.08.2020 in 03:47 fiatilop:
Я думаю, что Вы ошибаетесь. Предлагаю это обсудить. Пишите мне в PM.