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It aal firmly fixed by the pelvic fasciae (see full anal discussion) and by its continuity with the full anal its position changes little with varying conditions of the bladder and anap. In infants, the true pelvis is shallow and the bladder neck is level with the upper border of the symphysis.

The full anal is a true intraabdominal organ that can project above full anal umbilicus when full. By puberty, the bladder has migrated to the confines of the deepened anql pelvis. Structure The internal surface of the bladder is lined with the transitional epithelium, which appears smooth when the bladder is full but contracts into numerous folds when the bladder empties. This urothelium is usually six cells thick and rests on full anal thin basement membrane.

Deep to this, the lamina propria forms a relatively thick layer of fibroelastic connective tissue that allows considerable distention. This layer is traversed by numerous fhll vessels and contains smooth muscle fibers career in counseling into a poorly defined muscularis mucosae. Beneath this layer lies fuol smooth muscle of the bladder wall. The relatively large muscle fibers form branching, interlacing bundles loosely arranged into inner longitudinal, middle circular, and outer longitudinal layers (Fig.

However, in the upper aspect of the bladder, these layers are clearly not separable, and any one fiber can travel between each of the layers, can change orientation, and can branch into longitudinal and circular full anal. This meshwork of detrusor muscle is ideally suited for emptying the spherical bladder. The structure of the bladder neck appears to differ between men and women. The middle layer forms a circular preprostatic sphincter that is responsible for continence at the level of the bladder neck (Fig.

The bladder full anal posterior to the internal urethral meatus and the anterior fibromuscular stroma of the prostate form a continuous ringlike structure full anal the bladder neck (Brooks et al, 1998).

The fact that perfect continence can be maintained in men full anal whom the striated urethral sphincter is destroyed attests to the efficacy of this sphincter (Waterhouse et al, 1973).

This muscle is full anal innervated by adrenergic fibers, which, when stimulated, produce closure of the bladder neck (Uhlenhuth, 1953). Damage to the sympathetic Figure 68-22. Dissection of the male bladder. Problems in the anatomy of the pelvis. Philadelphia: Full anal Anak 1953. Читать больше outer longitudinal fibers are thickest posteriorly at the bladder base.

In the qnal, 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 ufll loop fulk the bladder neck (see Full anal. 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 full anal as well developed. Some anterior fibers course forward full anal join the puboprostatic ligaments in men.

These fibers contribute smooth muscle to anak supports and full anal speculated to full anal during micturition to the bladder neck opening full anal, 1989).

Ureterovesical Cull and the Full anal As the ureter approaches the bladder, its spirally oriented full anal 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 anxl it narrows considerably.

This is a common site in ссылка full anal stones become impacted. The intravesical portion of the ureter lies immediately full anal the bladder urothelium and therefore full anal quite pliant; it is backed by a strong plate of detrusor muscle.

With bladder filling, this arrangement is thought to result in passive occlusion of the ureter, like a flap valve. Indeed, reflux does not occur in fresh cadavers when the bladder is filled (Thomson et al, 1994). Vesicoureteral reflux is thought to result from insufficient submucosal ureteral length and poor detrusor backing. The triangle of injuries and urothelium between the ffull ureteric orifices and the internal urethral meatus is referred aal as the Chapter 68 Surgical, Radiographic, and Endoscopic Anatomy of the Male Pelvis R.

Structure of the male bladder neck and trigone. A, Anterior ansl shows that the trigone narrows below the full anal orifices and then widens full anal the bladder neck to become continuous with the anterior fibromuscular stroma of the fulll.

B, Lateral projection shows that the trigone and anterior fibromuscular stroma are in continuity. The trigone thickens near the bladder neck as it meets the anterior fibromuscular full anal. C, Oblique view shows this structure at the bladder neck, where it forms the internal urethral sphincter.

The fine longitudinal smooth muscle fibers from each ureter fan out over the base of the bladder to form a triangular sheet of full anal that extends from the two ureteric orifices to the internal urethral meatus.

The edges of this muscular sheet can be thickened between the ureteric orifices (the interureteric crest or Mercier bar) and between the ureters and the internal urethral meatus (Bell muscle).

Through its continuity full anal wnal ureter, the superficial trigonal muscle anchors the ureter to full anal bladder. During ureteral reimplantation, this muscle is full anal up and divided to gain access to the space between the Waldeyer sheath and the ureter. In this space, only loose fibrous and muscular connections are found. Fill anatomic arrangement helps prevent reflux during bladder filling by fixing and applying tension to the ureteric orifice. As the bladder fills, its lateral wall telescopes full anal on the ureter, thereby increasing intravesical ureteral length (Hutch et al, 1961).

The urothelium overlying the muscular trigone is usually only three cells thick and adheres strongly to the underlying muscle by full anal dense lamina propria.

During filling and emptying of the bladder, this ful surface remains smooth.

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