BLADDER, NORMAL ANATOMY. 



379 



can any exact distinction, or even an approxima- 

 tion to such, be made between these several 

 compartments. A more accurate knowledge of 

 tliis organ may be obtained by examining both 

 internally and externally its several aspects, 

 which are six in number, and which may be 

 regarded as distinct regions ; viz., an anterior 

 and posterior, two lateral, and a superior and 

 inferior. We shall examine each of these ex- 

 ternally, and defer any remarks on their in- 

 ternal aspect until we come to speak of the 

 lining membrane or the mucous coat of the 

 bladder. 



The anterior region, in consequence of the 

 obliquity of the pelvis, looks also downwards. 

 When the bladder is contracted, this region is 

 behind and in contact (cellular tissue only in- 

 tervening) with the lower half or three fourths 

 of the symphysis pubis, and with the pubic and 

 triangular or mterosseous ligaments ; when dis- 



o O ' 



tended, it rises above the bone, and is connected 

 by an abundance of cellular and adipose tissue 

 to the lower portion of the recti and transversi 

 muscles; and as no peritoneum is there inter- 

 posed, this part can be punctured with safety 

 during life. At the lower border of this region 

 is the neck of the bladder, the upper surface of 

 which is firmly attached to the lower edge of 

 the symphysis pubis by two horizontally placed 

 fibrous cords, which are named the anterior 

 ligaments of the bladder, and which will be 

 more particularly noticed presently. Between 

 and beneath these, some veins also run upon 

 this surface of the bladder. The whole of this 

 region is deprived of any peritoneal or serous 

 covering. 



The posterior region has an aspect upwards 

 also ; it is smooth and covered throughout with 

 peritoneum. When the bladder is contracted, 

 this small region in the male pelvis is in con- 

 tact with the fore-part of the rectum, or with 

 such of the floating abdominal viscera as may 

 chance to intervene ; in the female with the 

 fore-part of the uterus. When this region is 

 distended, it presents a broad smooth convex 

 surface, which presses more against the rectum 

 and supports the convolutions of the small in- 

 testines. 



The lateral regions, when the bladder is 

 contracted, are little more than margins or 

 edges, and present nothing worthy of notice; 

 but when distended, each becomes a broad 

 surface, somewhat triangular, the base below 

 and the apex above, the posterior portion, nearly 

 the half, is covered by peritoneum, the anterior 

 portion is connected by cellular tissue to the 

 parietes of the pelvis : the obliterated umbilical 

 artery ascends along its superior posterior por- 

 tion, and the vas deferens, which crosses to the 

 inside of the latter, runs along this region in an 

 oblique direction downwards and backwards, 

 and marks the anterior limit of the peritoneum. 

 From this region the broad lateral fold of this 

 membrane extends to the iliac fossa, and at its 

 inferior border is that reflection of the vesical 

 fascia which is named the true lateral ligament 

 of the bladder. 



The superior region, by some called the 

 superior fundus, is, when the bladder is empty, 



little more than a point prolonged into the 

 urachus; but when distended, it presents its 

 large and convex surface upwards and forwards ; 

 to it is attached the superior ligament of the 

 bladder, which consists of three fibrous cords, 

 the urachus and the obliterated umbilical arte- 

 ries ; behind these this region is covered by 

 peritoneum, but anterior to them it is not. 

 The former portion is in contact witli the con- 

 volutions of the small intestines, the latter with 

 the recti muscles. 



The inferior region, or the inferior fundus, 

 or the base of some authors, always exists 

 as a distinct surface, whether this organ be 

 contracted or distended, but of course larger in 

 the latter condition. It is rather more exten- 

 size in a transverse direction than from before 

 backwards, and is larger and more distinct in 

 the male than in the female: its lateral por- 

 tions in each sex are in contact with the leva- 

 tores ani muscles, and correspond to the spaces 

 between the anus and the tuberosities of the 

 ischium. In the female its middle portion is 

 in contact with the vagina, in the male with the 

 rectum in the middle line, and with the vasa 

 deferentia and vesiculre seminales on either side; 

 to the latter it is closely connected. The cel- 

 lular and adipose tissue on and around this 

 region in the adult is very abundant, and con- 

 tains numerous veins. This region is covered 

 posteriorly by peritoneum, which extends to a 

 transverse line connecting the centre of each 

 vesicula serninalis. This line corresponds to 

 the convexity of the cul-de-sac formed by the 

 reflection of this membrane from the bladder to 

 the rectum. In front of this line this region 

 is covered in the middle only by a fascia and 

 by some cellular tissue as far as the base of the 

 prostate gland, which extends for some dis- 

 tance along its anterior portion, and on either 

 side are the vasa deferentia and the anterior 

 terminations of the vesiculae seminales. When 

 the bladder is distended in the adult, this surface 

 is enlarged, not only in superficial extent, but it 

 also swells backwards and downwards towards 

 the rectum, and even presses against and into 

 that intestine, so as in some rare cases to admit 

 of being felt by the finger introduced per anum. 

 To this portion the name of 'bas fond' is com- 

 monly applied. In the adult this bas fond, that 

 is, the posterior part of this region, is the lowest 

 portion of the bladder, and hence cannot be 

 evacuated except by the contraction of the 

 organ or by surrounding pressure. In man, in 

 advanced life, it is often found dilated into a 

 sort of pouch, which is behind and quite below 

 the level of the anterior part of this region, as 

 well as of the neck of the bladder, forming in 

 some instances of debility a sort of permanent 

 reservoir, and one in which calculi are not un- 

 frequently contained. In the fcetus this pouch 

 or fundus does not at all exist, the cervix or the 

 urethral opening being then the most depend- 

 ing part, which circumstance offers another 

 reason for the power of retention of urine being 

 less at that age than at a later period of life. Some 

 writers limit the inferior region to so much of 

 this aspect of the bladder as is uncovered by 

 peritoneum, and therefore consider the posterior 



