URINARY BLADDER CADAVERIC DISSECTION - Human Anatomy Cadaveric Dissection Videos
Summary
TLDRThis educational video script delves into the anatomy of the urinary bladder, highlighting its structure, ligaments, and relationship with surrounding organs. It explains the median umbilical ligament, medial umbilical ligaments, and the potential hernia sites. The script also covers the bladder's interior, including the detrusor muscle, trigone, and the urethral and ureteral orifices. It discusses conditions like urinary reflux and benign prostatic hyperplasia, providing insights into the bladder's function and potential medical issues.
Takeaways
- 📚 The script discusses the anatomy of the urinary bladder and its surrounding structures in a cadaveric dissection setting.
- 🔍 The median umbilical ligament is identified, which is a remnant of the urachus and attaches to the umbilicus.
- 🔑 The medial umbilical ligaments are remnants of the obliterated umbilical artery, branching from the internal iliac artery.
- 🕳 The presence of the superolateral fossa, a potential site for herniation, is mentioned on either side of the median umbilical ligament.
- 🌐 The prevesical space, also known as the space of Retzius, is described, which contains the endopelvic fascia in life.
- 💡 The bladder's position relative to the pubic bone and the procedure of suprapubic cystoscopy is explained for distended bladders.
- 🌌 The peritoneum covering the bladder and its reflection onto the rectum, known as the rectovesical pouch, is discussed.
- 🌀 The fundus of the bladder, which is extraperitoneal and opposite the apex, is identified along with its relation to the rectum.
- 🚰 The interior of the bladder is described, including the mucosa, the detrusor muscle, and the trigone.
- 🚿 The trigone's role in preventing vesicoureteral reflux and its sensitivity during cystoscopy is highlighted.
- 🌡 The anatomical relationship between the ureters, ductus deferens, and the urethra, including potential sites for constriction and impaction, is explained.
Q & A
What is the median umbilical ligament and what is its embryonic origin?
-The median umbilical ligament is a remnant of the urachus, which is derived from the allantois. It extends from the apex of the bladder to the umbilicus on the inner surface of the abdominal wall.
What are the medial umbilical ligaments and their function in the body?
-The medial umbilical ligaments are the obliterated distal portions of the umbilical artery, which is a branch from the anterior division of the internal iliac artery. They also extend to the umbilicus and are located on the inner surface of the abdominal wall.
What is the clinical significance of the supero-anterior fossa in the abdominal wall?
-The supero-anterior fossa is a depression on either side of the median umbilical ligament and can be a potential site for herniation.
What is the pre-vesical space and its contents in the body?
-The pre-vesical space, also known as the cave of Retzius, is located between the bladder and the pubic symphysis and is filled with the endo-pelvic fascia in life, which becomes continuous with the prostatic venous plexus.
Why is a suprapubic cystoscopy performed and through which route is it done?
-A suprapubic cystoscopy is performed when the bladder is distended and the catheter cannot be passed through the urinary passage. It is done through the pre-vesical space, above the level of the pubic bone.
What is the relationship between the peritoneum covering the bladder and the rectum?
-The peritoneum covering the bladder's surface continues and gets reflected onto the rectum, forming the recto-vesical pouch in females and the recto-prostatic pouch in males.
What are the structures separating the posterior surface of the bladder from the rectum?
-The structures separating the posterior surface of the bladder from the rectum are the ductus deferens, the ureters, and the seminal vesicles, which are contained within the recto-vesical or recto-prostatic septum.
What is the significance of the ampulla of the ductus deferens and its connection to the seminal vesicles?
-The ampulla of the ductus deferens dilates and unites with the duct from the seminal vesicle to form the ejaculatory duct, which passes through the prostate and opens into the urethra.
How does the blood supply to the bladder dome differ from the rest of the bladder?
-The blood supply to the dome of the bladder comes from the vesical arteries, which are branches of the anterior division of the internal iliac artery, whereas the rest of the bladder is supplied by other branches.
What is the detrusor muscle and what is its autonomic nervous system control?
-The detrusor muscle is a smooth muscle that forms the wall of the bladder. It is under parasympathetic control, which causes contraction, and sympathetic control, which causes relaxation, facilitating the process of micturition.
What is the trigone of the bladder and what are its components?
-The trigone is a triangular shaped structure located in the floor of the bladder. It includes the openings of the two ureters and the internal urethral meatus, and is encircled by the internal urethral sphincter.
What is the clinical significance of the inter-ureteric bar and the internal urethral meatus?
-The inter-ureteric bar is a part of the trigone and is important for the anatomy of the bladder. The internal urethral meatus is the opening of the urethra within the bladder and is surrounded by the internal urethral sphincter, which is crucial for controlling the flow of urine.
What is the significance of the relationship between the ureters and the ductus deferens?
-The ureters cross over the ductus deferens on either side because during embryonic life, the testes descend while the kidneys ascend. This anatomical relationship can rarely cause constriction of the ureter where a stone might get impacted.
What is Marion's sign positive and what does it indicate in a patient with benign hypertrophy of the prostate?
-Marion's sign positive refers to a condition where all three orifices (the two ureteral openings and the internal urethral meatus) are visible simultaneously during a cystoscopic examination. This indicates that the internal urethral orifice is pushed up by the enlarged median lobe of the prostate, causing a depression known as the uvula of the bladder.
What is the post-prostatic pouch and its clinical significance?
-The post-prostatic pouch is a depression behind the median lobe of the prostate. Irritation of this pouch by residual urine when the patient lies down can produce nocturia and frequency in patients with benign hypertrophy of the prostate.
Outlines
📚 Anatomy of the Pelvic Region and Bladder
This paragraph delves into the anatomical structures of the pelvic region, focusing on the urinary bladder. It describes the bladder's position relative to the pelvis, the median umbilical ligament, and the medial umbilical ligaments. The speaker explains the concept of the prevesical space, also known as the 'cave of Retzius,' which is significant in medical procedures like suprapubic cystoscopy. The script also covers the peritoneum's reflection on the bladder and rectum, the rectovesical pouch, and the structures related to the bladder's posterior surface, such as the ureters and ductus deferens. Additionally, it touches on the blood supply to the bladder from the umbilical artery and the internal structure of the bladder, including the detrusor muscle and the trigone.
🩺 Urinary System Pathologies and Surgical Considerations
The second paragraph discusses various pathologies and surgical considerations related to the urinary system. It explains the mechanism of the ureteric orifices in the bladder, which helps prevent vesicoureteral reflux, and the potential complications that can arise when this mechanism fails. The paragraph also addresses the possibility of ureteric constriction due to stones and the associated conditions like hydroureter and hydronephrosis, illustrated with an axial CT scan example. Furthermore, it describes the internal urethral sphincter, its control by the sympathetic and parasympathetic nervous systems, and the implications of an enlarged prostate on the bladder's trigone. The summary concludes with the unique anatomical relationship between the ductus deferens and the ureters, and how this can sometimes lead to ureteric constriction.
Mindmap
Keywords
💡Urinary bladder
💡Median umbilical ligament
💡Medial umbilical ligaments
💡Superficial inguinal fossa
💡Prevesical space
💡Detrusor muscle
💡Trigone
💡Urethral orifices
💡Internal urethral sphincter
💡Ductus deferens
💡Benign prostatic hyperplasia
Highlights
Introduction to the spring cadaver and the structures of the pelvis.
Identification of the urinary bladder and the median umbilical ligament.
Explanation of the median umbilical ligament's connection to the umbilicus.
Description of the medial umbilical ligaments and their origin from the umbilical artery.
Mention of the super of a cynical fossa as potential sites of herniation.
Discussion on the prevesical space and its contents, the endo pelvic fissure.
Clarification on the bladder's position relative to the pubic bone and the procedure of suprapubic cystoscopy.
Examination of the peritoneum covering the bladder and its reflection onto the rectum.
Introduction to the rectovesical pouch and its significance in females.
Differentiation between the fundus and apex of the bladder and their anatomical relations.
Identification of the structures related to the posterior surface of the bladder: the ductus deferens, ureters, and seminal vesicles.
Demonstration of the relationship between the ductus deferens and the ureters.
Explanation of the blood supply to the bladder from the umbilical artery.
Interior examination of the bladder, focusing on the bladder mucosa and detrusor muscle.
Description of the trigone of the bladder and its role in preventing vesicoureteral reflux.
Importance of the internal urethral sphincter in the process of micturition.
Discussion on the impact of benign hypertrophy of the prostate on the bladder and urethra.
Identification of the post-prostatic pouch and its role in nocturia and frequency.
Conclusion summarizing the key points about the bladder and related structures in the pelvis.
Transcripts
[Music]
so this is spring cadaver I'm on the
right side camera person is on the left
side we have completely taken all the
structures of the pelvis and this
structure that we see in front of us
this is the urinary bladder
this is apex of the bladder and we can
see this ligament arising from the apex
this is the median umbilical ligament
which is a remnant of the erectus which
is derived from the allen toy and this
goes and gets attached to the umbilicus
on the inner surface of the a abdominal
wall we see these two ligaments on
either side these are the medial
umbilical ligaments which are the
obliterated distal portions of the
umbilical artery which is a branch from
the anterior division of the internal
iliac these also go to the umbilicus in
life these structures are located on the
inner surface of the a tree abdominal
wall and there's a depression on either
side of the median umbilical ligament
here and here these are called the super
of a cynical fossa which can be a
potential site of herniation to continue
we have opened out the space between the
bladder and the pubic symphysis this is
known as the previous cycle space this
is filled with endo pelvic fissure this
space is also referred to as the cave of
radius in life this is filled with
recycled venous plexus which becomes
continuous with the prosthetic venous
plexus normally the bladder is below the
level of the pubic bone intra pelvic
organ but when the bladder gets
distended and for some reason we cannot
pass the catheter through the urinary
passage we have to do what is known as a
suprapubic cystoscopy
and we do the suprapubic just talk to me
through this route where my instrument
is pointing to continue with the parts
of the bladder this surface of the
bladder was covered by peritoneum and
this is the Dome of the bladder and this
peritoneum which we have removed
continues and gets reflected onto the
rectum which is this structure here the
place where the peritoneum gets
reflected from the bladder to the rectum
that is known as the rec to recycle
pouch in females Sutras is lying on the
Dome of the bladder so therefore there
will be a Vista Co you trained publish
any portion after that is extra pet
oniel and we will come to that in a
little
while we will pick up the better to show
you this portion Knox ocean is known as
the fundus it is extra paid to name the
fundus of the bladder is also called the
pace of the bladder because it is
opposite the apex it is also the
posterior surface of the bladder this is
the structure which is in relation to
the rectum separated by the recto of a
cycle set and it contains three
structures in the main and we can see
the two structures here one of them is
the doctors difference which is going
inside and then we have the ureter which
is also going and there will be a
structure which is not visible but
further lower down and that'll be the
seminal vesicle so this are the three
structures which are separating the
posterior surface or the base of the
bladder from the rectum and the rector
of a cycle septum and to show it more
clearly I will lift up the bladder and
we can see this is the doctors
difference here on this side and the
doctors difference on this side and we
can see the doctors difference here
becomes a little dilated this is known
as the ampule of the doctors difference
which will then unite with the duct from
the seminal blade and form the gamma D
regulatory duct which will go through
the prostate and open as the common
ejaculatory duct into the prostate in
your instrument this is a post-operative
case so therefore this whole area was
highly fibrosis but we can see a few of
the blood vessels which are coming to
the bladder from the proximal portion of
the umbilical artery and these are the
severe recycle arteries on this side and
these are some remnants of the severe
recycle artery on this side they are the
ones we supply the dome of the bladder
the ductus deferens it's supplied by
branch from the inferior recycle artery
and these are known as differential
arteries ninfea recycle artery is also
approached from the anterior division of
the internal iliac now let's take a look
at the interior of the bladder and for
that we have sliced open the bladder on
its anterior surface and I have tilted
the bladder back and we have opened the
letter
this is the interior of the matter we
can see first of all the bladder mucosa
it is sewn into slight folds after that
this is the thickness of the bladder
wall this contains a smooth muscle which
is referred to as the detrusor muscle
this detrusor muscle is under
parasympathetic control parasympathetic
causes contraction and sympathetic
causes relaxation of the bladder and if
we look very closely here we can see a
triangular shaped structure here this is
the Trigon of the bladder this tricone
is located in the floor of the bladder
what are the components of this Trico
you can see this structure which I have
lifted up here and when I pull we can
see it is exerting attraction on the
ureter on this side similarly when I
pull here we can see it is exerting
traction on the ureter on this side so
these are the openings of the two
ureters the ureters went into the
bladder to enter in a bevelled fashion
the purpose being to prevent vistacool
euroleague reflux in normal
circumstances therefore it acts as a
valvular mechanism with this valve Aloma
cancer fails then we get what I
mentioned as the visco urinary reflux
for the same reason this you drove a
cycle Junction is also a potential site
of European constriction where a small
stone more than 0.5 centimeters can get
impacted in which case there will be
hydro ureter and hydronephrosis this is
an axial CT scan at the level of the hip
joint to show a right you Egypt calculus
and right hydro ureter if we look
further closely we will see a rich
joining the two openings of the ureters
this is referred to as the inter
ureteric bar lower down we can see yet
another opening here that is the opening
of the urethra that is the internal
urethral meatus
which is also encircled by smooth muscle
which is the internal urethral sphincter
this is relaxed by the spatter
sympathetic and contracted by the
sympathetic
so therefore parasympathetic is for
micturition purpose this try goal of the
bladder is derived separately from the
rest of the bladder
bladder is derived from inter term of
the urogenital sinus why the tricone is
derived from the me suit
wolffian dumped mucosa of the trigon is
very sensitive when we are doing a you
know trance copy examination of the
bladder and we reach the internal
urethral meatus at that position we
cannot see normally the two openings of
the ureter however when we advance the
urine through scope even further then we
can see these two openings that is the
normal situation however when the
patient has got benign hypertrophy of
the prostate then the internal urethral
orifice is pushed up by means of the
median lobe of the prostate and that is
referred to as the uvula of the bladder
and in which case we get a condition
known as Marion's sine positive
what is this Merion sign positive it
means that in the same system urethral
scopic view we can see all the three
orifices simultaneously so when a
patient has got enlarged prostate the
median lobe is enlarged there is a
depression behind the median lobe of the
prostate and that is known as the post
prostatic pouch
whenever the patient lies down there is
irritation of the post prostatic pouch
the trigana of the bladder by means of
residual urine and that is what produces
nocturia
and frequency in a patient with benign
hypertrophy of the prostate again come
to the posterior surface or the base of
the bladder to show the unique
relationship of the ductus deferens and
the ureter so I have pulled it up to
show you the normal relationship and we
can see that the ureters are crossed
over by the ductus deferens on either
side this is because during embryonic
life the testes descends down and the
kidneys ascent up and so therefore this
is the place where the ductus deferens
crosses the ureter this can rarely be a
site of constriction of the ureter where
again a stone can get impacted so these
are the points that are already
mentioned to you about the better and
the related structures in the pelvis
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