422 TUB BLADDER. 



base of the bladder is destitute of peritoneum, and adherent to the rectum 

 by dense fibro-areolar tissue over the extent of a triangular area bounded 

 at the sides by the rasa deferentia and vesiculce seminales (fig". 305, s, s), 

 whilst its apex in front reaches the prostate gland (p). It is in this 

 space, which in the natural state of the parts is by no means so large as 

 it appears after they are disturbed in dissection, that the bladder may be 

 punctured from the rectum without injury to the peritoneum. In the 

 female, the base of the bladder is of less extent, and does not reach so 

 far bach in the pelvis as in the male : for it rests against the front 

 of the neck of the uterus and the anterior wall of the vagina, both of 

 which organs intervene between it and the rectum. This part of the 

 bladder adheres to the vagina, and above that adhesion the peritoneum 

 form^s a pouch between it and the uterus, much shallower than the recto- 

 vesical pouch of the male. 



The cerr/.r or nceJc of the bladder is a term commonly applied to the 

 j)art of the bladder at which the cavity terminates in the uretln-a, and 

 is often indefinitely used, so as to include a considerable portion either 

 of the bladder or uretlira. It may be conveniently retained to denote 

 the region of the immediate neighbourhood of the urethral orifice. It 

 is the most strongly muscular part of the bladder, and in the male it is 

 closely connected Avith the base of the prostate gland, by which it is 

 supported. It was formerly described as an infundibular projection, 

 but, as pointed out by Kohlrausch, no such arrangement exists. The 

 urethral orifice is in both sexes the part of the bladder which in the 

 erect posture is lowest ; it lies at the angle of meeting of the base and 

 the anterior surface. 



It was formerly believed that the base was tlie loAvest part of the Ijladder in 

 the adiilt male, and hence the origin of the term. The inferior position of the 

 urethral orifice was supposed to be peculiar to -women and children. The more 

 correct views, however, now entertained with respect to the inclination of the 

 pelvis have led to altered notions of the relative elevation of the pelvic 

 viscera. A consideration of the following- circumstances will contribute to 

 an accui-ate conception of the position of the vesical outlet. The sj-mphysis 

 pubis is placed very obliquely ; the ischial tuberosities are little lower than the 

 inferior margin of the symphysis pubis, and the triangular ligament is therefore 

 almost horizontal ; the lower part of the sacrum and the coccyx are nearly 

 vertical, being only slightly cmved forwards, and the tip of the coccyx is on a 

 somewhat higher level than the inferior margin of the symphysis pubis ; the curve 

 and position of the rectum are determined by those of the sacrum and coccyx 

 until it passes in front of the coccyx, when it turns vertically downwards ; the 

 prostate gland, situated entirely on the upper or interior side of the triangular 

 Hgament, rests on the last turn of the rectum, and the base of the bladder is in 

 contact with the rectum above that place. 



Ligaments of the bladder. — The fn/e lifiamenfs of the bladder, 

 four in number, two anterior and two lateral, all derived from the 

 vesical portion of the recto-vesical fascia, have been already noticed. 



T\\Q false ligamenis or per if oneal folds are described as five in number. 

 Two of them, named posferior false ligaments or recto-vesical folds, run 

 forwards in the male along the sides of the rectum to the posterior and 

 lateral aspect of the bladder, and bound the sides of the recto-vesical 

 cul-de-sac. In the female these posterior folds pass forwards from the 

 sides of the uterus, and are comparatively small. The two lateral false 

 ligaments extend from the iliac fossae to the sides of the bladder, each 

 separated from the corresponding posterior ligament by a prominent 



i 



