Trigone of urinary bladder - Wikipedia
trigone of bladder a triangular region of the wall of the urinary bladder, an area in which the muscle fibers are closely adherent to the mucosa; its three angles. The trigone is a triangular area on the internal face of the posterior wall of the bladder. The posterior vertices are the ureteric orifices and the anterior vertex is the. Urethra · Bladder · Ureters the greater sciatic notch (boundaries are the sacrum , ilium, and ischial spine). Anatomic relationships of the distal third of the pelvic ureter, trigone, and urethra in unembalmed female cadavers.
Another limitation of the present study is that no prospective or retrospective data on LN sparing in the internal iliac region are yet available. Nevertheless, the possible functional benefits are a logical conclusion based on anatomical and functional studies.
The branches of the pelvic plexus comprised of sympathetic and parasympathetic fibres [ 21 ] are in close proximity to the medial internal iliac region. Omission of LN dissection in this internal iliac region on the side contralateral to the tumor should minimize damage to the fragile autonomic nerves which appear to be important for innervation of the proximal urethra continence [ 22, 23 ]; such nerve sparing may have a beneficial impact on continence after radical cystoprostatectomy and ileal orthotopic bladder substitution [ 8, 24, 25 ] although there is no direct evidence for this yet.
These clinical data accord with intraoperative electrophysiological findings and animal studies [ 12, 26 ]. Moreover, nerve sparing also appears to safeguard erectile function by preserving parasympathetic fibres passing through the plexus pelvicus [ 6—8, 11, 27—29 ].
It is, however, not only the preservation of the neurovascular bundle that makes the omission of LN dissection in the medial internal iliac region appealing for the improvement of postoperative functional results, but also the potential further decrease in devascularization damage to internal iliac vessel branches in this region with concomitant less ischemia and necrosis [ 11 ].
Nerve sparing is of utmost importance not only in terms of better functional results of subsequent orthotopic bladder substitution or better recovery of sexual function, but also as a means to avert potential problems of defecation [ 30 ]. As the present results indicate, this may be done without compromising oncological radicality.
Prospective evaluation preferably multi-centerhowever, has to confirm this hypothesis. Another limitation of this study is the difficulty with assigning tumor location in a retrospective study. We did, however, look not only at pathology reports but also at preoperative cystoscopy reports. Furthermore, imaging data were all re-reviewed. In conclusion, our pathoanatomical validation study corroborates the data of a dynamic mapping study showing a lack of lymphatic drainage to the contralateral internal iliac region in patients with strictly unilateral BC.
If these results can be confirmed in a prospective evaluation —preferably a multi-center study - contralateral pelvic lymph node dissection could then be limited to the obturator fossa and the external and common iliac regions in this highly selected group of patients with strictly unilateral tumor growth.
This would better preserve the contralateral autonomic nerves situated close and medial to the internal iliac vessels. Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1, patients. Journal of Clinical Oncology: Management of invasive bladder cancer: A meticulous pelvic node dissection can make a difference.
The Journal of Urology ; 1: Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: The Journal of Urology ; 4: A new multimodality technique accurately maps the primary lymphatic landing sites of the bladder.
European Urology ;57 2: The Journal of Urology ;87, — Neurovascular preservation in orthotopic cystectomy: Impact on female sexual function. Recoverability of erectile function in post-radical cystectomy patients: Subjective and objective evaluations.
European Urology ;55 2: Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. The Journal of Urology ; 4 Pt 1: Contemporary cystectomy and urinary diversion. World Journal of Urology ;20 3: Pelvic lymph node metastases from bladder cancer: Outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy. Pelvic neuroanatomy and recovery of potency.
Anatomic and functional studies of the male and female urethral sphincter. World Journal of Urology ;18 5: Is bilateral extended pelvic lymphadenectomy necessary for strictly unilateral invasive bladder cancer?
The Journal of Urology ; 5: Experience in patients with an ileal low pressure bladder substitute combined with an afferent tubular isoperistaltic segment. Outcome after radical cystectomy with limited or extended pelvic lymph node dissection. The Journal of Urology ; 3: Treatment of muscle-invasive and metastatic bladder cancer: Update of the EAU guidelines.
European Urology ;59 6: Prognostic value of tumor location of urothelial tumors of the bladder, after total cystectomy.
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Association of intravesical tumor location with metastases to the pelvic lymph nodes in transitional cell cancer of the bladder. The American Journal of the Medical Sciences ; 4: Intravesical tumor involvement of the trigone is associated with nodal metastasis in patients undergoing radical cystectomy. Extended radical lymphadenectomy in patients with urothelial bladder cancer: Results of a prospective multicenter study.
Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis. Clin Anat ;16 2: Division of autonomic nerves within the neurovascular bundles distally into corpora cavernosa and corpus spongiosum components: Immunohistochemical confirmation with three-dimensional reconstruction.
Nerves at the ventral prostatic capsule contribute to erectile function: Initial electrophysiological assessment in humans. European Urology ;55 1: Ileal conduit to neobladder.
bladder trigone inferred: Topics by thebluetones.info
The effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. The Journal of Urology ; 6: Intraoperative nerve stimulation with measurement of urethral sphincter pressure changes during radical retropubic prostatectomy: Nerve distribution along the prostatic capsule.
The Latin phrase for "urinary bladder" is vesica urinaria, and the term vesical or prefix vesico - appear in connection with associated structures such as vesical veins. The modern Latin word for "bladder" - cystis - appears in associated terms such as cystitis inflammation of the bladder. Microanatomy[ edit ] The outside of the bladder is protected by a serous membrane. Layers of the urinary bladder wall and cross section of the detrusor muscle. Anatomy of the male bladder, showing transitional epithelium and part of the wall in a histological cut-out.
Detrusor muscle[ edit ] The detrusor muscle is a layer of the urinary bladder wall made of smooth muscle fibers arranged in spiral, longitudinal, and circular bundles. Stretch receptors in the bladder signal the parasympathetic nervous system to stimulate the muscarinic receptors in the detrusor to contract the muscle when the bladder is extended.
The main receptor activated is the M3 receptoralthough M2 receptors are also involved and whilst outnumbering the M3 receptors they are not so responsive. It can also contract for a long time whilst voidingand it stays relaxed whilst the bladder is filling. The lower part of the bladder is supplied by the inferior vesical artery in males and by the vaginal artery in females, both of which are branches of the internal iliac arteries.
These then form three sets of vessels: The majority of these vessels drain into the external iliac lymph nodes.
Urinary bladder - Wikipedia
GVA fibers on the superior surface follow the course of the sympathetic efferent nerves back to the CNS, while GVA fibers on the inferior portion of the bladder follow the course of the parasympathetic efferents. Problems with these muscles can lead to incontinence.
The upper and lower parts of the bladder develop separately and join together around the middle part of development. It is superior to the prostateand separated from the rectum by the recto-vesical pouch. In females, the bladder sits inferior to the uterus and anterior to the vagina; thus its maximum capacity is lower than in males.