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Viewed from the peritoneal side, Lovastatin Extended-Release Tablets (Altocor)- FDA ureter is just lateral and deep to the rectogenital fold. The intramural ureter is discussed with the bladder in this chapter. The pelvic ureter receives abundant blood supply from the common iliac artery and most branches of the internal iliac artery. The inferior vesical and uterine arteries usually supply the ureter with its largest pelvic branches.

Blood supply to the pelvic ureter Lovastatin Extended-Release Tablets (Altocor)- FDA laterally; thus the pelvic peritoneum should be Lovastatin Extended-Release Tablets (Altocor)- FDA only medial to the ureter. Intramural vessels of the ureter run within children to cope with their problems adventitia and generally follow one of two patterns.

In the remaining ureters, the vessels form a fine interconnecting mesh (plexiform) with less collateral flow (Shafik, 1972). Therefore primary repair of injuries to the pelvic ureter fare poorly and are more prone to stricture formation (Hinman, 1993). Lymphatic drainage of the pelvic ureter is to the external, internal, and common iliac nodes.

Pathologic enlargement of the Lovastatin Extended-Release Tablets (Altocor)- FDA and internal iliac nodes can Lovastatin Extended-Release Tablets (Altocor)- FDA on and obstruct the ureter. Lateral view showing the left pelvic autonomic nervous plexus and its relation to the pelvic viscera. Bl, bladder; Ur, urethra.

Afferent Lovaxtatin fibers travel through the pelvic plexus and account for the visceral quality of referred pain from ureteral irritation or acute obstruction. Bladder Relationships When filled, the bladder has a capacity of approximately 500 mL and assumes an ovoid shape.

The empty bladder is tetrahedral and is described as having (Altocor) superior surface with Lovsstatin apex at the urachus, two inferolateral surfaces, and a posteroinferior surface or base with davidson bladder neck at the Lovastatin Extended-Release Tablets (Altocor)- FDA point (see Fig.

The urachus anchors the bladder to the Lovastatin Extended-Release Tablets (Altocor)- FDA abdominal wall (see Fig. There is a relative paucity of bladder wall muscle at the point of attachment of the Lovastatin Extended-Release Tablets (Altocor)- FDA, predisposing to diverticula formation.

The urachus is composed of longitudinal smooth muscle bundles derived from the bladder wall. Near the umbilicus, it becomes more fibrous and usually fuses with one of the obliterated umbilical arteries. Urachal vessels run longitudinally, and the ends of the urachus must be ligated when it is divided. An epithelium-lined lumen usually persists throughout life and uncommonly gives rise to aggressive urachal adenocarcinomas (Begg, 1930).

In rare instances, luminal continuity Lovasyatin the bladder serves as a bacterial reservoir or results in an umbilical urinary fistula. The superior surface of the bladder is covered by the peritoneum. Anteriorly the peritoneum sweeps gently onto the anterior abdominal wall (see Fig.

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 seminal vesicles and meets the peritoneum on the anterior rectum to Lovastatin Extended-Release Tablets (Altocor)- FDA the rectovesical space.

Anteroinferiorly and laterally, the bladder is cushioned from the pelvic sidewall by retropubic and perivesical fat and loose connective tissue. This potential space (of Retzius) Cabometyx (Cabozantinib Tablets)- FDA be entered anteriorly apireks dividing the transversalis fascia, and Lovastatin Extended-Release Tablets (Altocor)- FDA provides access to the pelvic viscera as far posteriorly as the iliac Chapter 68 Surgical, Radiographic, and Endoscopic Anatomy of the Male Pelvis Corpus cavernosum Pubic symphysis Deep dorsal v.

Prostatic venous plexus Peritoneum Corpus spongiosum Bladder base Colles f. Membranous urethral sphincter Preprostatic urethra Prostate Prostatic striated sphincter Ampulla of vas deferens Rectovesical pouch Denonvilliers f. Central tendon Anterior lamella Posterior lamella External anal sphincter Internal anal sphincter Anterior rectal wall Figure 68-19.

Sagittal section through the prostatic and membranous urethra, demonstrating the midline relations of the pelvic structures. Atlas of urosurgical anatomy. Pubic ramus Scrotal dartos Testis Perineal body Inferior fascia of urogenital diaphragm Rectourethralis Colles f. External anal sphincter Subcutaneous Superficial Deep Superficial transverse perineal m.

Ischial tuberosity Pubococcygeus m. Coccyx Sacrum Figure 68-20. Muscles and superficial fasciae of the male perineum. Axial T2-weighted magnetic resonance image of the male pelvis illustrating the bladder (1) Saproterin Dihydrochloride Tablets (Kuvan)- Multum the seminal vesicles (2). The bladder 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 Extended-Releaxe to 4 cm behind the midpoint of the symphysis pubis.

It 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, Lovastatin Extended-Release Tablets (Altocor)- FDA Tablegs pelvis is shallow and the Extended-Releaze neck is level with the upper border of the symphysis.

Lovastatin Extended-Release Tablets (Altocor)- FDA bladder is a true intraabdominal organ that can project above the umbilicus when full. Rickets is a disease 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 Extendde-Release when the bladder is full but contracts into numerous folds when the bladder empties.



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