362 THE ABDOMEN AND PELVIS 



pelvic fascia, which passes forwards and medially to the lateral 

 border of the posterior surface of the bladder and constitutes 

 its posterior pedicle. 



The vesical arteries supply the bladder, the seminal vesicles, 

 the prostate and the terminal parts of the ureters. In addition 

 the superior vesical usually gives off a special branch to the 

 ductus deferens (p. 257). 



The vesical veins join the pudendal (prostatic) plexus (p. 366), 

 from which two or three large veins issue in the posterior pedicle 

 of the bladder to join the hypogastric vein. 



The nerve-supply of the bladder is derived entirely through 

 the sympathetic. Some of the fibres come from the twelfth 

 thoracic and first lumbar segments ; the others arise from the 

 second and third, or third and fourth sacral segments, and are 

 restricted to the basal surface and the trigone. On account 

 of the different segments involved, pain referred from the 

 bladder is felt in two different regions. A vesical calculus 

 irritates the trigone, and the pain is referred to the perineum 

 and the penis (S. 2, 3, and 4). On the other hand, pain due to 

 over-distension or caused by strong contraction of the muscular 

 wall, such as occurs at the end of micturition in cases of vesical 

 calculus, is usually referred to the lower part of the anterior 

 abdominal wall (T. 12, L. i). 



In the presence of vesical calculi or ulcers of the bladder 

 wall, the centres for micturition in the spinal medulla become 

 hypersensitive, and frequency of micturition results. 



The Pelvic Part of the Ureter is closely related to the 

 peritoneum. It crosses the brim of the pelvis in front of, or a 

 little lateral to, the bifurcation of the common iliac artery, and 

 descends in front of the hypogastric (internal iliac) artery, which 

 separates it from the posterior wall of the pelvis and the great 

 nerve trunks. As it approaches the base of the bladder, it 

 curves medially and enters the posterior pedicle. Here it is 

 related to the superior vesical artery, which lies above it, and 

 the other vesical arteries and veins, which lie below it. Just 

 before entering the bladder (p. 358), the ureter is crossed 

 latero-medially and on its superior aspect by the ductus deferens, 

 which intervenes between it and the peritoneum. 



This part of the ureter is supplied by the vesical arteries. 



Impacted calculi in the pelvic part of the ureter are usually 

 found (i) at the pelvic brim, on a level with the first sacral 

 vertebra, or (2) at the point of entrance into the bladder, on a 



