Lateral rotation of the thigh PELVIS & PERINEUM I Srre: Apex: . At birth: it lies in the abdominal cavity (Pelviabdominal organ) . ln adult: it occupies the anterior part of the pelvis (Pelvic organ), when it is full it expand upward into the abdominal cavity. 4 ANGLES: attached to median umbilical ligament.

support the

prostate in male &

acts as a sphincter

for vagina in the

female

I PELVIS & PERINEUM

Coccyceus:

Tip of the ischeal

spine

Sides of last sacral

segment & 1't

Supports the pelvic

cavity & the coccyx

PlnlFoRMls see tower rimb musctes,

OeruReron rNreRi.rus

Pelvic wall &

obturator membrane

Medial surface of

the greater

trochanter

Lateral rotation of

the thigh

PELVIS & PERINEUM I

Srre:

Apex:

. At birth: it lies in the abdominal cavity (Pelviabdominal organ)

. ln adult: it occupies the anterior part of the pelvis (Pelvic organ), when it is

full it expand upward into the abdominal cavity.

4 ANGLES:

attached to median umbilical ligament.

lf remains patent, it may cause:

. Urachal (sinus, fistula, cyst)

. Congenitaldiverticulum

Neck: Lying on prostate (d) or pelvic fascia (?), it gives the urethra

Surrounded by smooth muscle fibers constituting the sphincter vesicae

2 oosterosuperior angles: receiving the 2 ureters

4 SURFAcES: A

TligtrE

Supg'lotmrfaoe

ille(Irr

urnbl[cal

lEffr€rlt

tp6x

ll{erolsttsrd

srdaces

Superior, posterior & 2 inferolateral

I PELVIS & PERINEUM

#P=-,r"-=^t c"rr-,

Utethra

Corptr

Corpus

Ghnr pinil

Exlrrnel urathral orificr'

. Male: superior surface & upper of base._Female: superior surface ONLY.

RrlanoNS

1. Anterior:

1. They fix bladder in pelvis.

2. They are present in Cave Of Retzius @ "

2. Inferolateral surface: pubis, retropubic fat, obturator internus &

levator ani muscles.

4. Posterior surface:

iliac arlery and vein

Comrnon llec v*h and art8ry

tjreler

Erlofid illecen€ryand Eclallc nonrc

cut €dgd ot

of

ilrctue delerens

lnlerkrr utgiesl

REtropubh

Ptbopm$Eli:

Dorsal vsin of psrris

nr€rnbren€

enel gphlncter

PELVIS & PERINEUM I

Cut.d!ol

E,fffla

IL!

Fqnd llgnrlrt

0l

Lln .l!.

Ap.n ol

fnt nal 9rfial

Rtorrwlod

Erbrn luilhrfl

V.rlhraol

olluhr

dbldlr

rnl

Iralt0hlncll

enll t9linollr

CevrrY oF

llfta.Guar

THE BLADDER

Pdnrrlmnbr*r.

!hddlr

Urs0c

oilIlco

otluffir

hBmir

Lcurtrul

G CrunttrOon mrmUuo

-Trigone:

- Triangular part of the base between the 2 openings of the ureter & the

opening of the urethra

- Gharacters:

1. No rugae

2. Pink (rich blood supply)

Surgical lmportance (if stone ) hematuria)

3. No submucosa

Surgical lmportance; ) No bitharziasis )No Egyptian cancer

4. lt is richly supplied by nerves

Surqical lmportance: lt is more sensitive to pain.

I PELVIS & PERINEUM

Utmryilrftr

Ptt[Eqm$Hs

In[ununil

pffi

mfiilh

UrhnfiodhLp6!t

(nEGtmu$

0mttr{hfiruE

finrumof *Et$ftdbrfia

SffiilH&nd

Ehruhhrydtd

mcffilpflHr

Hh.rl mamDmne

Blooo

BrIbdpsrB

LfdnEccilqr

-Ureteric orificer:

- They lie at the posterolateral angles of the trigone

- The 2 orifices are separated from each other by a transverse ridge

called the interureteric crest

-Uvulcr of the blcrdder:

- lt is produced by the median lobe of the prostate.

$HSiCAI.lm[.gnLfl.ltEE ln old age, the uvula enlarges leading to difficulty

to pass urine.

-lnternql qrcthrql orifice:

- lt is placed at the lowest part of the bladder.

- lt is surrounded by an involuntary non-striated muscle forming the

sphincter vesicae.

-lntrqmurcrl pqrt of the sreterl

- The lowermost part of the ureter passes obliquely through the wall of

the bladder; this part is called the intramural part.

$.U.fging!.lmp.q.f!flng.F; The oblique course of the intramural part is a

factor in preventing regurgitation of urine into the ureter when the

bladder is distended.

SuppLy:

Vesical artries: From internal iliac a.

Vesical veins: ) internal iliac vein.

It is connected with vasal, ureteric, prostatic & hemorrhoidal plexus of

veins.

Lynnpx onernece:

. Perivesical LN ) internal & external iliac LNs ) common iliac LNs

) para-aortic LNs,

PELVIS & PERINEUM I

Nenvr SUPPLY

I perurrrtclnoru ouRrrrrc OpenRrroru

. Brownish network of muscles . Fill it with saline ) Balloons.

. Bluish network of venous plexus . Stone

Nef U ne: it is a fibromuscular exocrine glandular organ.

(Senile enlarged prostate is an fibromyoadenoma)

S tf e : present in males, below the bladder neck & is behind symphysis pubis.

SfnUCfUnf : lt is partly glandular consisting of numerous follicles, &

partly muscular consisting of non-striated muscle fibres.

lntmfll rBtlral BDhtEttr

{EltodrilusdB}

m8*flih urrldfi

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ofFmilile

FlbrunussJr

slofia

{enooffimusol*ard

I

Ultrrral*ueee

llblu.e oomecltsst8suel

Optnh#ol

elrulahryil.pts

peilnd poucft

t€riEalfircf,thrfiE

*pnr,ffii*rpl

SnRpe:

>'l res;mfi

:ili'frf$if :":#i#.

- 4 surfaces : posterior, anterior& 2 inferolateral.

) lt weighs 8 gm & measures 4 cm from side to side at the base, & 3

cm from base to apex.

I PELVTS & PERTNEUM

CepsuLES:

F lt has a firm fibrous capsule which is adherent to the prostate substance > lnner ) true fibromuscular capsule.

Y Outer ).f1scia capsule (fascia of Denonvittier),

which delays direct spread of cancer between rectum & prostate.

ftEfus.hf.Is#E

IgamEEI

ot hladdsr

ll**sr?l pBhb tsqch

IFqrhhrydili

Pnosffi E$we$kalseptum

A,rugmrlru lnleflrEdhle lmemhEnousl urehra

Poslnoru:

Iower part of rectum.

palpated by PR examination.

Loses or rHe Pnosrere:

.By means of prostatic urethra to

ejaculatory ducts , the prostate is

divided into 5 lobes .

'1. Anterior lobe (isthmus) : infront of

prostatic urethra , consists of

fibromuscular tissue with litfle

glandular tissue

2. ,3. Right and Left Latral lobes : one

on each side of the prostatic urethra

, they are the usual sites for senile

enlarged prostate

4. Posterior lobe : behind prostatic

urethra but below the 2 ejaculatory

ducts ,

lt is the usual site for cancer

prostate .

5. Median lobe :

- Between the upper part of the

prostatic urethra and the 2

Ehddsr

,Hd(

--

llLdbr

lobe

EFEsHhry drEE

{ rooertor

ejaculatory ducts

- After Middle age ,

it produces " uvula vesicae " in the lower part of

the bladder trigone .

- lt is also a common site for senile enlarged prostate.

PELVIS PERINEUM

.L

NB:

. The median lobe of the prostate contains more glandular material than the

other lobes.

r During P/R: only Posterior parts of lateral lobes & Post lobe can be palpated

RemnoNS:

I

|fitsm., urlltrtl $lrlEfr (snodrmurld

Fmctrb

Eomrlufirralrpfihstrr

{*lcElmu3ol6}

pg{gHartsdrhss.

- Base,'

o

o

- Apexl

Dup prrlnral poucfi

PErln6dlmflnbftffi

glrxl rnd ducl

and bcnd $tfi prti l0 fhoold

tEt beld

Erlefful urs$nrl ullhe

Surrounds the neck of the bladder

Pierced by the urethra,

o Lies on the roof of the deep perineal pouch

o The urethra emerges from the anterior surface of the prostate

just above its apex,

o Lies in direct contact with the lower part of the rectum

o !t can be palpated by PR examination in the living.

Anterior surface:

o lies about 2 cm behind the pubic symphysis

o lt is connected to the pubic bones by

the puboprostatic ligaments.

lnferolateral surtaces (one on each side):

. Rest on the anterior free borders of the 2 levator ani.

o The most anterior fibres of the muEcles sweep backwards on

each side of the prostate to be inserted into the perineal body;

these fibres form what is called the levator prostatae.

EUM

SrnucruREs wtrHtN THE PR TATE:

lrurllhrmuldurllr

Illctlrlarduot

illta.

ailrErplllorlltdhluor

Itrtrlh r$h0[!ffiffrlrnstt

EilmaunftdtDl$fi

Gmrrrr

1) Prostatlc urgthra: traverses the prostate from the base to the apex

along the junction of the anterior %with the posterior Ts of the gland.

2) Elaculatoru ducts: the 2 ducts run downwards & forwards one on

each side of the median plane to open into the back of the prostatic

urethra.

{SO P:r:?*WtIIFg*-:IF1l11 upwards & backwards from the,prostatic

urethra into the median lobe.

PR Exeurrulnoru:

The normal prostate is:

# Smooth

# Soft

# Sulci can be felt

# Slippery rectal mucosa

# Symmetrical

BI.ooD SUPPLY:

Al Arterial) inferior vesical & middle rectal

Exbmdrnrl

rphlnolrr

Somlnal

PlEthilc

Pro6leta

Blgddcr

Publr

#

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