NECK OF THE BLADDER. LIGAMENTS. 947 



over the extent of a triangular area bounded at the sides by the vasa defer - 

 eutia and vesiculae seminales, whilst its apex in front reaches the prostate 

 gland. 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 peri- 

 toneum. In the female, the base of the bladder is of less extent, and does 

 not reach so far back in the pelvis as in the male ; for it rests agaiust 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 

 forms a pouch between it and the uterus, much shallower than the recto- 

 vesical pouch of the male. 



The cervix or neck of the bladder is a term commonly applied to the part 

 of the bladder at which the cavity terminates in the urethra, and is often 

 indefinitely used, so as to include a considerable portion either of the 

 bladder or urethra. 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 con- 

 nected with 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 the lowest part of the bladder in the 

 adult 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 (p. 98), have led 

 to altered notions of the relative elevation of the pelvic viscera. A consideration of the 

 following circumstances will aid the formation of an accurate conception of the position 

 of the vesical outlet. The symphysis 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 curved 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 deep side of the triangular liga- 

 ment, 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 true ligaments of the bladder, four in 

 number, two anterior and two lateral, all derived from the vesicai portion 

 of the recto-vesical fascia, have been already described (p. 260). 



The false ligaments or peritoneal folds are described as five in number. 

 Two of them, named posterior 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 fossse to the sides of the bladder, each separated from 

 the corresponding posterior ligament by a prominent angle in which the 

 obliterated hypogastric artery lies. The superior false ligament (ligamentum 

 suspeusorium) is the portion of peritoneum between the ascending parts of 

 the epigastric arteries, and reaches from the summit of the bladder to the 

 umbilicus. 



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