THE URINARY BLADDER 



1229 



summit. The postero-superior surface is directed upward and backward, and is cov- 

 ered by peritoneum: behind, it is separated from the rectum by the rectovesical 

 excavation, while its anterior part is in contact with the coils of the small intestine. 

 The antero-inferior surface is devoid of peritoneum, and rests, below, against the 

 pubic bones, above which it is in contact with the back of the anterior abdominal 

 wall. The lower parts of the lateral surfaces are destitute of peritoneum, and are 

 in contact with the lateral walls of the pelvis. The line of peritoneal reflection 

 froLd the lateral surface is raised to the level of the obliterated hypogastric artery. 

 The fundus undergoes little alteration in position, being only slightly lowered. 

 It exhibits, however, a narrow triangular area, which is separated from the rectum 

 merely by the rectovesical fascia. This area is bounded below by the prostate, 

 above by the rectovesical fold of peritoneum, and laterally by the ductus deferentes. 



CORPUS 

 CAVCRIMOSUM 



COWPER'S 

 GLAND 



BULBO- 



CAVERNOSUS 



MUSCLE 



FIG. 1136. Male pelvic organs seen from right side. Bladder and rectum distended; relations of peritoneum to the 

 bladder and rectum shown in blue. The arrow points to the rectovesical pouch. 



The ductus deferentes frequently come in contact with each other above the pros- 

 tate, and under such circumstances the lower part of the triangular area is obliter- 

 ated. The line of reflection of the peritoneum from the rectum to the bladder 

 appears to undergo little or no change when the latter is distended; it is situated 

 about 10 cm. from the anus. The summit is directed upward and forward above 

 the point of attachment of the middle umbilical ligament, and hence the peritoneum 

 which follows the ligament, forms a pouch of varying depth between the summit 

 of the bladder, and the anterior abdominal wall. 



The Bladder in the Child (Figs. 1137, 1138). In the newborn child the internal 

 urethral orifice is at the level of the upper border of the symphysis pubis; the 

 bladder therefore lies relatively at a much higher level in the infant than in the 

 adult. Its anterior surface "is in contact with about the lower two-thirds of that 



CV\* IU V . J 



