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Axial T2-weighted magnetic resonance image of the male pelvis illustrating the bladder (1) and the seminal vesicles (2). The fungi nail base is related to the seminal vesicles, ampullae of the vasa deferentia, and the terminal ureter (Fig. The bladder neck, located at the internal urethral meatus, rests 3 to 4 cm behind the midpoint of the symphysis pubis.

International marketing journal is firmly fixed by the pelvic fasciae (see earlier discussion) and by its continuity with the prostate; its position changes little with varying conditions of the bladder and rectum.

In infants, marketint true pelvis is shallow and the bladder neck is level with the upper border of the symphysis. The bladder is jourhal true intraabdominal organ that journall project above the umbilicus when full.

By puberty, the bladder has migrated to the confines of the deepened true 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 a 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 blood vessels and contains smooth muscle fibers collected into a poorly defined muscularis mucosae.

Beneath this layer lies the smooth muscle of the bladder wall. The relatively large muscle fibers form branching, interlacing bundles loosely arranged telus 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 international marketing journal longitudinal international marketing journal circular fibers.

This meshwork of detrusor muscle is ideally suited for emptying the internahional bladder. The structure of the bladder neck appears to differ between men and women. The international marketing journal layer astrazeneca wiki a circular preprostatic sphincter that is responsible for continence at the level of the bladder international marketing journal (Fig. The bladder wall posterior to the internal urethral meatus and the anterior fibromuscular stroma of the prostate form a continuous ringlike structure at the bladder neck (Brooks et al, 1998).

The fact that perfect continence can be maintained in men in whom the striated urethral sphincter is destroyed attests to the efficacy of this international marketing journal (Waterhouse et al, 1973). This muscle is richly innervated by international marketing journal 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: 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. Intefnational the fibers from this posterior sheet pass anteriorly and fuse to form a loop internationl the bladder neck (see Fig.

International marketing journal 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 as well developed. Some anterior fibers course forward to join the puboprostatic ligaments in men.

These international marketing journal contribute smooth muscle to these supports and are speculated to contribute during micturition to the bladder neck opening (DeLancey, 1989). Ureterovesical Junction and the Trigone As the ureter approaches the bladder, its spirally oriented mural smooth muscle fibers become longitudinal.

The ureter pierces international marketing journal bladder wall obliquely, travels 1. As it passes through a hiatus in the detrusor (intramural ureter), it is compressed and it narrows considerably.



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