1096 . UROGENITAL SYSTEM. 
of the syinphysis pubis (Fig. 738). Thus it is possible, when the organ is distended, 
to puncture, or open into the bladder, through the anterior abdominal wall above 
the symphysis pubis, without at the same time opening into the peritoneal cavity. 
In the same manner the line of reflexion of the peritoneum, from the side wall of 
the pelvis on to the lateral aspect of the bladder, is also raised higher, and may 
come to correspond, in part, to the level of the vas deferens, or to that of the 
obliterated hypogastric artery (Figs. 742 and 743). On the other hand, the level of 
the reflexion of the peritoneum from the rectum towards the basal aspect of the 
bladder does not appear to vary much with the distension or contraction of the organ 
(compare Figs. 737 and 738), and thus the fossa between the bladder and rectum 
becomes relatively very deep when the bladder is full. The bladder in normal 
distension may contain as much as one pint, but in most eases the bladder is 
emptied when its contents reach from six to ten ounces. Under abnormal or patho- 
logical conditions the bladder capacity may be mueh increased. 
Varying STARE according to the degree of Distension of the Bladder. 
—When the bladder is distended the obliterated hypogastric artery may cross 
forwards against its side; when it is empty the obliterated vessel lies, at its nearest 
Pubic spine 
Obliterated hypo- é : ine 
gastric artery—> 3 ve a Bi SW Ne SS 
Deep epigastric artery ———-359 6 
Urachus 
~ Pectineal eminence 
Deep epigastric artery 
Vas deferens 
~— Vas deferens 
Bladder (highest point) 
( lone 
{ A. 
Sacral promontory 
Ureter 
Ureter— 
Common. iliac artery 
Fic. 7438.—VIEW LOOKING INTO THE PELVIS FROM ABOVE AND SOMEWHAT BEHIND. 
The bladder has been artificially distended. 
point, often as much as one and a quarter inches above the lateral border of the 
organ (Figs. 736 and 742). The vas deferens, during a part of its course, is in contact 
with the aa wall of the distended bladder, but when the organ is empty it hes 
above and parallel to the lateral border, only comme into relationship with the 
basal surface of the bladder after it has crossed the ureter. The side wall of the 
distended bladder is closely related to the obturator vessels and nerves. 
Bladder in the Female. —In the female the bladder is related behind to 
the uterus and upper part of the vagina. The anterior surface of the uterus in its 
upper part is separated from the upper surface of the bladder by the shallow utero- 
vesical pouch of peritoneum, but the two organs are nevertheless normally in 
apposition. So close is this relationship that the upper surface of the bladder very 
often shows a slight concavity, due to contact with the convex anterior wall of the 
uterus. The lower part of the uterus and upper part of the vagina are not 
separated by peritoneum from the basal surface of the bladder, but are in actual 
apposition with it (Fig. 744). Thus, below the level of the utero-vesical pouch, the 
female bladder is related in much the same manner to the uterus and anterior wall 
of the vagina as the male bladder is related to the vesiculee seminales and vasa 
deferentia. The apex of the bladder, where the urachus is attached, often lies on a 
lower Jevel than in the male, so that the organ, even when distended, rises less 
wall 
