Retention of Urine 409 



The uvula is a small sensitive elevation at the apex of the trigone ; 

 it is situated above the ' middle lobe ' of the prostate. 



Ligaments. The base of the bladder is firmly fixed by four 

 sheets of the recto-vesical fascia, two of which pass on to its side 

 along the upper surface of the levatores ani (p. 363), and two run on to it 

 more (p. 413) anteriorly from the pubes and prostate the lateral and 

 pubo-prostatic ligaments, respectively. The urachus is reckoned as the 

 fifth true ligament. The &\t false ligaments are the various sheets of 

 the peritoneum which pass to or from the bladder. Thus the sides of 

 the recto-vesical pouch make two of them ; the lateral reflections of the 

 peritoneum from the side of the pelvis make two more, and the fifth 

 is that piece of the peritoneum which runs up behind the obliterated 

 hypogastric arteries and the urachus. The reflections of the peri- 

 toneum around the bladder steady it without absolutely fixing it ; 

 they also prevent coils of the intestine falling between the bladder and 

 the pubes. 



Supply. Blood is derived from the internal iliac, and especially 

 from that portion of it which, under the name of the hypogastric 

 artery, passed into the umbilical cord. The part which remains per- 

 vious after birth constitutes the superior vesical artery ; the middle 

 vesical is a branch of it. The inferior vesical branches come independ- 

 ently from the internal iliac, and from other neighbouring vessels, 

 such as the middle haemorrhoidal, sciatic, obturator, pudic, uterine, 

 and vaginal. The veins form an intricate plexus at the base of the 

 bladder with those of the lower part of the rectum, the prostate, and 

 seminal vesicles ; other branches pass at once into the internal iliac 

 trunk. The vesico-prostatic plexus of veins is enclosed within the 

 recto-vesical fascia. 



The lymphatics communicate with the glands by the side of the 

 internal iliac artery. 



The nerves are derived from the hypogastric plexus of the sym- 

 pathetic, and also from the sacral nerves, especially the fourth ; thus, 

 in the case of compression of the spinal cord, the patient may lose 

 not only the power of micturating, but also the consciousness of the 

 bladder being distended. The fact of the non-striated muscular tissue 

 of the bladder receiving filaments from a spinal nerve (fourth sacral) 

 is interesting and suggestive. 



The subject of enlarged prostate sometimes finds that he can pass 

 water better when sitting on a cold seat, as in that way he is able to 

 stimulate the vesical nerves. 



Retention of urine. As the bladder becomes distended it ex- 

 pands laterally and also mounts behind the recti abdominis, lifting 

 the coils of intestine. Bowel cannot intervene between the bladder 

 and the abdominal wall, because of the reflection of the peritoneum 

 behind the urachus (v. p. 385) ; thus, the hypogastric and lower 

 umbilical region is full and rounded and dull on percussion. The 



