388 



BLADDER, NORMAL ANATOMY. 



The superior fold or ligament extends from 

 the summit of the bladder to the posterior 

 surface of the recti muscles, and is partially 

 reflected over the remains of the urachus and 

 hypogastric arteries. This fold rather consists 

 of three folds which diverge below and con- 

 verge towards the umbilicus; they present a 

 falciform appearance towards the abdomen, 

 particularly when the bladder is contracted. 

 In the foetus these superior folds, particularly 

 the lateral, are very distinct, as they each con- 

 tain the umbilical artery. The urachus, which 

 is in the centre, is also at that age very distinct 

 though shorter; its vesical end is often pervious 

 for about an inch : it is always closed before it 

 arrives at the umbilicus, it then becomes fila- 

 mentous, and is soon lost on the umbilical 

 arteries. 



The second medium of connexion between 

 the bladder and the parietes of the pelvis is 

 the vesical fascia, the reflections of which con- 

 stitute the true ligaments of the bladder. The 

 vesical is the internal lamina of the pelvic 

 fascia reflected from the latter at the upper 

 border of the levatores ani muscles : it covers 

 the internal surface of this muscle on each side, 

 and descends as low as a line drawn from the 

 inferior border of the symphysis pubis to the 

 spinous processes of the ischia. On this level 

 it is reflected on the prostate gland and on 

 the sides of the bladder, and posterior to this 

 organ on the rectum and on several of the 

 pelvic vessels and nerves. The anterior or 

 vesical portion of this fascia is distinct and 

 strong, and forms a pouch on each side of the 

 bladder which assists in closing the pelvis ; 

 posteriorly this fascia is thin and cellular, being 

 perforated by several vessels. Its anterior 

 reflections constitute the true anterior liga- 

 ments of the bladder, which are described as 

 arising from the lower margin of the pubis on 

 either side of the symphysis, then passing back- 

 wards and upwards on the upper surface of 

 the prostate gland, and expanding on the an- 

 terior region of the bladder; many of their 

 iibres become continuous with the muscular 

 fibres of the bladder. A depression exists 

 between these two ligaments, along which the 

 dorsal veins of the penis run from beneath the 

 arch of the pubis to the side of the bladder 

 in their course to the internal iliac veins, in 

 which they terminate. The fascia, however, 

 is not deficient in this depression between these 

 ligaments, but is continued from one to the 

 other so as to line this hollow and to cover the 

 upper surface of these veins. The anterior 

 ligaments present a smooth concavity towards 

 the abdomen or pelvis; their perineal or infe- 

 rior aspect is convex, and has inserted into it 

 the posterior lamina of the inter-osseous or 

 triangular ligament of the urethra. 



The true lateral ligaments of the bladder arc 

 also two in number, one on each side ; each is 

 continuous with the anterior, and is formed by 

 the reflection of the vesical fascia from the 

 internal surface of the levator ani muscle to 

 the side of the prostate gland, and of the 

 bladder immediately above and outside the 



vesiculse seminales. The pelvic and vesical 

 fascia? will be more particularly noticed in the 

 article PELVIS. 



Lastly, the bladder is retained in situ by 

 the attachments of the cervix; these take place 

 not only directly by the ligaments which have 

 been just described, but also indirectly through 

 its connexion to the urethra and of the latter 

 to the pubes through the medium of the trian- 

 gular ligament of the urethra. This ligament, 

 for a fuller description of which we refer to 

 the article PERINEUM, is a strong aponeurosis 

 intimately connected to the rami of the pubes 

 and ischia, and there continuous with the obtu- 

 rator fascia of each side. It is strong, tense, 

 and unyielding, and closes all the anterior 

 portion of the inferior orifice of the pelvis; it 

 is perforated by a small opening, through which 

 the urethra passes about an inch inferior to the 

 bony edge of the pubes; the edges of this 

 opening are continued on the urethra both to- 

 wards the perineum and towards the pelvis. 

 The process which extends in the former or 

 inferior direction is lost on the bulb of the 

 urethra, while that which extends in the pos- 

 terior or superior direction, and which is more 

 distinct and strong, encompasses the mem- 

 branous part of the urethra, (which, while in 

 situ, is very short,) and is then inserted or 

 becomes continued into that reflected portion 

 of the vesical fascia which forms the true 

 anterior and lateral ligaments of the bladder ; 

 thus the commencement of the urethra, the 

 prostate gland, and the neck of the bladder, 

 which must be nearly synonymous with the 

 prostatic portion of the urethra, are all retained 

 in a nearly fixed position, and the continuity 

 of the different aponoreuses in this region 

 serves to afford mutual strength and general 

 security. 



The bladder, notwithstanding the foregoing 

 connexions, is subject to displacement. In the 

 male this occurrence seldom happens, although 

 in some cases of very large inguinal or scrotal 

 hernias this viscus has been gradually drawn 

 into the sac, in consequence, most probably, 

 of adhesion between it and the omentum or 

 some other of the protruded parts. We have 

 already mentioned how a portion of the lining 

 membrane may become protruded between the 

 muscular fasciculi and form a sac which may 

 increase to a considerable size, and extend into 

 some new and even remote situation. In the 

 female the bladder is very liable to partial 

 pressure as well as to displacement, owing to 

 different conditions of the uterus, such as 

 retroversion, inversion, and prolapsus. 



BIBLIOGRAPHY. Mangetiu, Uretemm ct ve- 

 sicas urinarire hist, ex variis in Bib. Anat. v. i. 

 Vogclmunn rcsp. Janson, Diss. sist. fab. &c. rcnum 

 ct vcsica; urinaria-, 4to. Mogunt. 17'>'2. Parsons. 

 Description of the human urinary bladder, &c. 8vo. 

 Lond.1742. Beitrlf, DC f'abrica et usu visccrum urop.o- 

 eticorum, 4to. Lugcl. Bat. 1744 ( Rcc. in Hallrri 

 Disp. Anat. vol. iii.). Walther, Do collo virilis 

 vesicae, 4to. Lips. 1745 (Rec. in Haller, Coll. diss. 

 Anat. vol. v.). Lieutaiirl, Obs. anat. sur la structure 

 de l.i vessie, Mem. df. I'.Acad. de Paris, 1753. 

 Weitbrccht, De figura ct situ vesicae urinariae, Com. 



