538 A MANUAL OF ANATOMY. 



space may extend two inches above the top of the symphy- 

 sis. As the bladder rises it takes with it the peritoneum ; 

 consequently, the viscus can be opened in this condition 

 without entering the peritoneal cavity. The extent of space 

 is further increased by inflating the rectum, thus crowding 

 the bladder upward and forward. This manoeuvre is util- 

 ized in suprapubic cystotomies. 



The True Ligaments of the Bladder. 



(a) The urachus. This is the fibrous cord that extends 

 from the top of the bladder to the umbilicus, and represents 

 the canal which connected the bladder with the allantois in 

 the fcetus. See Fig. 95. (6) and (c) The obliterated 

 hypogastric arteries. These fibrous cords extend from the 

 sides of the bladder, where they are continuous with the 

 superior vesical arteries, to the umbilicus. In the fcetus 

 they were pervious and carried the foetal blood to the 

 mother, (d} The rectovesical fascia. Parts of this sheet 

 of fascia are designated as the anterior and lateral true liga- 

 ments of the bladder and the ligament of the rectum. See 

 Page 399. 



Relations of the Bladder (when moderately distended). 

 Anteriorly, the inner surface of the pubic bones and 

 anterior portions of the obturator internus muscles. Later- 

 ally, ureters, obliterated hypogastric arteries, vas deferens 

 (in the male, round ligament in the female), anterior 

 branches of the internal iliac artery, levator ani and obtura- 

 tor internus muscles. Posteriorly ; the upper, peritoneal 

 surface, with the omega loop ; the lower, nonperitoneal, 

 with the rectum, seminal vesicles, terminations of ureters, 

 and vasa deferentia. In the female the posterior surface is 

 in relation to the uterus and upper part of the vagina. 



Superiorly, the small intestines and omega loop. Infe- 



