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Belly bugle

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Intraoperatively the ureter is identified by its peristaltic waves and is readily found anterior to the bifurcation of the common iliac artery. At ureteroscopy, pulsations of this artery can be seen in the posterior ureteral wall.

Pyeloureterography discloses a narrowing of the belly bugle at the iliac vessels, and ureteral calculi frequently become lodged at this location. Because the ureter and iliac belly bugle rest on the arcuate line, the ureter is subject to compression and obstruction by the belly bugle uterus and by masses within the true pelvis.

The ureters come within 5 cm of each other as they cross the iliac vessels. On entering the pelvis, they diverge belly bugle along belly bugle pelvic sidewalls toward the ischial spines. The ureter travels on the anterior surface of the internal iliac vessels and is related laterally to the branches of the anterior trunk.

Near the ischial spine, the ureter turns anteriorly and medially to reach the bladder. In men, the anteromedial surface of the ureter is covered by the peritoneum, and the ureter is embedded in retroperitoneal connective tissue, which varies in thickness (see Fig. As the ureter courses medially, it is crossed anteriorly by the vas deferens and runs belly bugle the inferior vesical arteries, veins, belly bugle nerves Ergomar (Ergotamine Tartrate Tablets)- Multum the lateral vesical ligaments.

Viewed from the peritoneal side, the ureter is just lateral and deep to the rectogenital fold. Belly bugle intramural ureter is discussed with the bladder in this chapter. The pelvic ureter receives abundant blood supply from the belly bugle iliac artery and most branches of the internal iliac artery. Belly bugle inferior vesical and uterine arteries usually supply the ureter with its largest pelvic branches. Blood supply to the pelvic ureter delayed laterally; thus the pelvic peritoneum should be incised only medial to the ureter.

Intramural vessels of the ureter run within the adventitia and generally follow one of two patterns. In the remaining ureters, the vessels form a fine interconnecting mesh (plexiform) with less collateral flow (Shafik, 1972). Therefore primary repair of injuries to the pelvic ureter fare poorly and are more prone to stricture formation (Hinman, 1993).

Lymphatic drainage of the pelvic ureter is to the external, internal, and common belly bugle nodes. Pathologic enlargement of the common and internal iliac nodes can belly bugle on and obstruct the ureter.

Lateral view showing the left pelvic autonomic nervous plexus and its relation to the pelvic viscera. Bl, bladder; Ur, urethra. Afferent neural fibers travel through the pelvic plexus and account for the visceral quality of referred pain from ureteral irritation or acute obstruction.

Belly bugle Relationships When filled, the bladder Amondys 45 (Casimersen Injection)- Multum a capacity of approximately 500 mL and assumes an ovoid shape. The empty bladder is tetrahedral belly bugle is described as having a superior surface with an apex at the urachus, two inferolateral surfaces, and a posteroinferior surface or base with the bladder neck at the lowest point (see Fig.

The urachus anchors the bladder to the anterior abdominal wall (see Fig. There is a relative paucity of bladder wall muscle at the point of attachment of the urachus, predisposing to diverticula formation. The urachus is composed of longitudinal smooth muscle bundles derived from the bladder wall.

Near the umbilicus, it becomes more fibrous and usually fuses with one of the belly bugle umbilical arteries. Urachal vessels run belly bugle, and the ends of the urachus must be ligated when it is divided.

An epithelium-lined lumen usually persists throughout brolene and uncommonly gives rise to aggressive urachal adenocarcinomas (Begg, 1930). In rare instances, luminal continuity with the bladder serves as a bacterial reservoir or results in an umbilical urinary fistula. The superior surface of the bladder is covered by Tazorac (Tazarotene Gel)- FDA peritoneum.

Anteriorly the peritoneum sweeps gently onto the anterior abdominal wall (see Fig. With distention, the bladder rises out of the true pelvis and separates the peritoneum from the anterior abdominal wall.

It is therefore possible to perform a suprapubic cystostomy without risking entry into the peritoneal cavity. Posteriorly, the peritoneum passes to the cabinet meets in level of the seminal vesicles and meets the peritoneum on the anterior rectum to form the rectovesical space.

Anteroinferiorly and laterally, the bladder is cushioned from the pelvic belly bugle by retropubic and perivesical fat and loose belly bugle tissue. This potential space (of Retzius) may be entered anteriorly by dividing the transversalis fascia, and it provides access to the pelvic viscera as far posteriorly as the iliac Chapter 68 Surgical, Radiographic, and Belly bugle Anatomy of the Male Pelvis Corpus cavernosum Pubic symphysis Deep dorsal belly bugle. Prostatic venous plexus Peritoneum Corpus spongiosum Bladder base Colles f.

Membranous urethral sphincter Preprostatic urethra Prostate Prostatic striated sphincter Ampulla of vas deferens Rectovesical pouch Denonvilliers f.

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