Male Bladder 



407 



sides and summit are intestinal coils. The base of the bladder is 

 fixed, and is close in front of the rectum. For further remarks upon 

 the relative position of the bladder and rectum reference may be made 

 to p. 385. 



The bladder may be emptied by manual compression in those cases 

 in which retention is due to paralysis, provided there is no inflamma- 

 tion or other disease of the bladder, and no urethral obstruction. 



Structure. A partial serous coat. The peritoneum passes from 

 the middle of the front of the rectum on to the back of the bladder, 

 just above the vesiculae seminales and the entrance of the ureters ; 



Arrows showing rectal and supra-pubic puncture of distended bladder. (HOLDEN.) 



thence it ascends over the postero-lateral surface, and, reaching the 

 hypogastric arteries and the urachus, is reflected on to the abdominal 

 wall. When the bladder is empty the recto-vesical pouch may come 

 within two inches of the anus, but when it is distended the pouch 

 stands at about four inches from the perineum. Thus, the base of 

 the bladder, the antero-lateral aspects, and the whole front surface 

 are destitute of serous investment, and puncture for the relief of 

 retention may be practised through the rectum (between the vesiculae 

 seminales) and above the pubes without risk of setting up peritonitis. 

 At the latter situation the instrument should be thrust boldly back- 



