148 TOPOGRAPHIC AND APPLIED ANATOMY. 



PLATE 21. 

 A median sagittal section of the male pelvic region. From a Leipzig model from nature (His). 



FiG. 71. The bladder, the ureters, and the seminal vesicles exposed from behind by a frontal section of the pelvis. 

 Upon the left side there is an external inguinal hernia; upon the right side the peritoneum has been almost entirely 

 removed. 



supravesical space (cavum Retzii), which is situated above the symphysis and also is filled with 

 loose connective tissue. The superior surface is directed upward and backward and borders 

 upon the small intestine and the sigmoid colon. In contrast to the anterior surface, it possesses 

 a peritoneal reflection (see Fig. 71, in which a part of this reflection is still present) which passes 

 above the symphysis to reach the inner surface of the abdominal wall. Since the height of 

 the bladder above the symphysis is inconstant and varies with the degree of distention of the 

 viscus, it follows that the line of reflection of the peritoneum from the abdominal wall to the 

 bladder is also inconstant, and is higher or lower according to whether the bladder is full or 

 empty. If the peritoneum is irritated by an inflammation, peritoneal pains will be produced 

 by the displacement of the peritoneum during urination. The larger portion of the lateral 

 surfaces is also covered by peritoneum, which extends downward over the ligamentum um- 

 bilicale laterale (see page 123). The posterior and inferior surfaces rest upon the sacral curve 

 of the rectum (see page 150). The posterior surface, at least in its upper portion, possesses 

 a peritoneal reflection. For this reason a rupture of the posterior wall of the bladder is a more 

 serious injury than one of the anterior wall, since the former may at once involve the peritoneum 

 and almost surely produce a fatal peritonitis unless the surgeon interferes in time. Between the 

 bladder and the rectum the peritoneum forms the excavatio rectovesicalis. Below the line of 

 the reflection of the peritoneum from the bladder to the rectum the posterior wall of the bladder 

 is separated from the anterior wall of the rectum by a loose connective tissue, and the rectovesical 

 fascia, which also passes to the inferior surface of the bladder (in the region of the fundus). 

 The seminal vesicles (Plate 21 and Fig. 71) are imbedded in this tissue and, when well developed, 

 may extend upward as far as the line of reflection of the peritoneum from the bladder to the 

 rectum. Between the seminal vesicles are the ends or ampullas of the vasa deferentia which 

 unite with the ducts of the seminal vesicles to form the ejaculatory ducts. These parts as well 

 as the fundus of the bladder (and occasionally vesical calculi), from their relation to the anterior 

 rectal wall, are accessible to digital examination from the rectum. This is also most valuable 

 in the examination of the bladder, of the prostate (particularly when hypertrophied), and of 

 the seminal vesicles, the contents of which may, under certain circumstances, be emptied 

 through the urethra by pressure upon the anterior rectal wall. 



The relation o] the rectum to the bladder may be utilized in practice by filling the rectum 

 with water, or by tamponade, in order to force the distended bladder forward and upward 

 toward the anterior abdominal wall and thus render it more accessible to operative procedures 

 above the symphysis. [The reflections of peritoneum from the bladder to the anterior walls 

 of the pelvis and abdomen and to the lateral walls of the pelvis rise higher and higher according 

 to the degree of distention. As pointed out by the author, the reflection from the bladder to 

 the rectum posterior however, changes but little. This reflection takes place at the level 

 of about one inch above the prostate or a finger's length from the anus. A knowledge of this 





