Urinary bladder

Last revised by Dr. Reuben Schmidt on 27 Feb 2022

The urinary bladder (more commonly just called the bladder) is a distal part of the urinary tract and is an extraperitoneal structure located in the true pelvis. Its primary function is as a reservoir for urine

The bladder has a triangular shape with a posterior base (a.k.a. fundus), an anterior apex and an inferior neck with two inferolateral surfaces. It is lined with a rough, trabeculated transitional cell epithelium except at the trigone.

The apex of the bladder is directed to the top of the symphysis pubis and it is connected to the anterior abdominal wall and umbilicus through the median umbilical fold (remnant of the urachus which is an embryological structure that contributes to the formation of the bladder) 

The trigone is a triangular area of smooth mucosa found on the internal surface of the base. The superolateral angles are formed by the ureteric orifices and the inferior angle is formed by the internal urethral orifice.

As men age, the trigone overlying the mid-portion of the central zone of the prostate may start to protrude as the prostate enlarges forming a mild hemispherical elevation proximal to the internal urinary sphincter, which is called the uvula of the bladder 5.

The urethra arises from the neck of the bladder and is surrounded by the internal urethral sphincter.

As the bladder fills with urine it becomes ovoid and extends superiorly into the abdominal cavity. Contraction is facilitated by the detrusor muscle.

 All of which are branches from the anterior division of the internal iliac artery 4.

  • autonomic innervation from the vesical nerve plexus (composed of sympathetic and parasympathetic nerve fibers)
    • sympathetic: reach the pelvic and subsequently the vesical plexus via hypogastric nerves (from the inferior mesenteric ganglion which in turn is supplied by the lumbar splanchnic nerves from the sympathetic lumbar outflow)
    • parasympathetic: reach the pelvic and subsequently the vesical plexus via pelvic splanchnic nerves (from the parasympathetic sacral outflow)
  • somatic innervation is via the pudendal nerves 
  • the hypogastric, pelvic splanchnic and pudendal nerves all have afferent components

For an account of the functional anatomy of micturition, refer to bladder neuroanatomy. 2,3.

  • double bladder: receives ipsilateral ureter and has a separate urethra
  • septation: septum may divide the bladder internally into two or more compartments
  • agenesis: persistence of the cloaca
  • ureterocele: dilation of the intravesical part of the ureter

The bladder is usually easier to evaluate when full, and it is sometimes difficult to identify when empty.

The bladder may be seen as a rounded soft tissue mass 1.

Cystography can be performed where the bladder is filled with contrast either via an antegrade or retrograde technique.

The bladder wall is best assessed with this modality - it should not exceed 3-5 mm in thickness. Ureteric jets can be assessed using color Doppler ultrasound 1.

  • T1: bladder wall and contents are homogeneous low signal
  • T2: bladder wall is of low signal and urine of high signal, allowing for a contrast between the two 1

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Cases and figures

  • Figure 1: lymphatics of the bladder (Gray's illustration)
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  • Case 1: normal bladder on cystography
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  • Case 2: ureteric jet
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