THE LYMPHATICS OF THE PELVIS. 



985 



Fig. S26. 



Obliterated hypogastric 

 artery 



Umbilicus 



Urachus 



Anterior vesical node 



Lateral vesical node 



and, on account of their intimate relation with these, the superficial lymphatics of 

 the perineal and circumanal regions. 



The Bladder. — It was for a long time a matter for discussion whether or not 

 the mucosa of the bladder was provided with a lymphatic net-work, but the general 

 consensus of recent observers is that it is not. Only the muscular coat possesses a 

 net-work, and from this stems pass to the surface of the viscus to form a superficial 

 net-work beneath the peritoneal or fascial investment. This net-work is continuous 

 at the neck of the bladder with those of the urethra and prostate gland, and, at its 

 base, with the net-works of the ureters and seminal vesicles, and, in the female, of the 

 vagina. The efferent stems which take origin from it may be divided into two 

 groups according as they arise upon the anterior or posterior surface. 



Those passing from the lower part of the anterior surface are directed laterally 

 and those from the upper part pursue a flexuous course downward and laterally to 

 terminate in the nodes of the iliac group situated along the external iliac vessels 

 (Fig. S26). In their course they usually traverse some small nodes situated in 

 close proximity to the bladder 

 and divisible according to their 

 position into two groups. One 

 of these is situated upon the 

 anterior surface of the bladder, 

 and consists of two or three 

 nodes, the anterior vesical 

 nodes, two of which are usually 

 situated near the apex of the vis- 

 cus in the course of the superior 

 vesical artery, while the third 

 occurs lower down in the retro- 

 pubic tissue. The other group 

 consists of from two to four 

 nodes, the lateral vesical 

 nodes, situated on either side 

 of the bladder along the course 

 of the obliterated hypogastric 

 arteries. Both groups are some- 

 what inconstant, but occur in a 

 large percentage of cases. 



The vessels from the upper 

 part of the posterior surface of 

 the bladder pass downward and 

 laterally, often traversing some 

 of the lateral vesical nodes, and terminate in the external iliac nodes which receive 

 the stems from the anterior surface. Others pass to the hypogastric nodes, while 

 others again, arising from the base of the bladder, pass at first directly backward 

 past the lateral surfaces of the rectum and then ascend on the sacrum to terminate 

 in the iliac nodes situated upon the promontory. 



The Prostate Gland. — The lymphatics of the prostate have their origin in 

 net-works surrounding the various acini of the gland. From these net-works stems 

 pass to the surface, where they form a second net-work, and from this the efferent 

 stems pass symmetrically on either side of the median line to somewhat diverse 

 terminations. One or two of the ef^erents on either side ascend in a tortuous course 

 upon the posterior surface of the bladder, and then bend laterally over the obliterated 

 hypogastric arteries to terminate in one of the middle series of the iliac nodes 

 which accompany the external iliac vessels. Another stem passes backward along 

 the prostatic vessels to terminate in one of the hypogastric nodes ; others pass at first 

 backward on either side of the rectum, and then ascend upon the anterior surface 

 of the sacrum to terminate in the lateral sacral nodes or in the iliac nodes situated 

 on the promontory of the sacrum ; and from the anterior surface of the gland a stem 



Subhypogastric 

 node 



-Iliac node 



Anterior 



vesical node 



Lymph-nodes of bladder. (Based on figures of Gerola.*) 



*Archivf. Anatom. u. Physiol., 1S97. 



