406 The Vagina 



shortness and capacity of the urethra and of its immunity from gleet. 

 The signs of retention are inability to pass urine ; dribbling from over- 

 flow ; the presence of a rounded tumour which may be made out 

 by palpation and percussion above the pubes and 1))' examination 

 per iHigimun. In a lady with every one of these signs it \\ as discovered 

 that an ovarian tumour grou-'mg centrally had compressed the bladder 

 until it could contain no urine, the 'overflow' bein^ the constant 

 escaping of the urine directly after its exit from the ureters. 



Development. Early in foetal life a hollow growth, like the finger 

 of a glove, starting from the hinder end of the rudimentary intestinal 

 canal, extends through a wide gap in the front wall of the abdomen. 

 On the closing in of the abdomen, the part of the diverticulum be- 

 tween the intestine and the umbilicus persists as the bladder ; a 

 small portion only (just behind the umbilicus) becomes obliterated, 

 and constitutes the superior ligament the remains of the tirachits. 

 Then a partition grows downwards and forwards, and converts the 

 existing cloaca into two passages the rectum and the urethra. Thus, 

 at birth the fusiform bladder is found in the abdomen rather than in 

 the pelvis ; it becomes rounded, and settles down, as the pelvis grows 

 capable of receiving it. In perineal lithotomy in young children the 

 knife must be thrust well upwards in order to open the bladder. 



(For scheme of development see p. 383.) 



In rare instances the obliteration of the urachus is delayed, so 

 that, after birth, urine, or even vesical calculi, may escape through the 

 opening at the umbilicus. Owing to an arrest of development the ab- 

 dominal walls may fail to meet in front, and, there being at the same 

 time an absence of the anterior wall of the bladder, the posterior wall 

 and base of that viscus bulge out as a bright vascular tumour. On it 

 may be seen the openings of the ureters and the trickling urine. The 

 term congenital hiatus better describes the deformity than does the 

 one more generally applied to it extroversion of tlic bladder. It is 

 associated with absence of the pubic symphysis, the urethra being 

 represented by an open channel on the dorsum of an ill-developed 

 penis (epispadias). The front of the bladder being deficient, its 

 posterior wall and base are thrust forwards as a convex tumour by the 

 subjacent viscera. 



THE MALE BLADDER 



Relations. When empty, the bladder lies deeply behind the pro- 

 state, triangular ligament, and body of pubes. When distended, it 

 mounts behind the recti abdominis and even to the umbilicus. Pos- 

 teriorly are the rectum and recto-vesical pouch ; into the pouch coils 

 of small intestine are falling ; lower down are the vesiculas seminales 

 and vasa differentia. Laterally are the pelvic walls, and around its 



