|Henry Gray (18251861). Anatomy of the Human Body. 1918.|
|distinct as far as the fundus of the bladder. On rare occasions they open separately into the bladder cavity.|
Structure (Fig. 1134).The ureter is composed of three coats: fibrous, muscular, and mucous coats.
| The fibrous coat (tunica adventitia) is continuous at one end with the fibrous tunic of the kidney on the floor of the sinus; while at the other it is lost in the fibrous structure of the bladder.|
| In the renal pelvis the muscular coat (tunica muscularis) consists of two layers, longitudinal and circular: the longitudinal fibers become lost upon the sides of the papillæ at the extremities of the calyces; the circular fibers may be traced surrounding the medullary substance in the same situation. In the ureter proper the muscular fibers are very distinct, and are arranged in three layers: an external longitudinal, a middle circular, and an internal, less distinct than the other two, but having a general longitudinal direction. According to Kölliker this internal layer is found only in the neighborhood of the bladder.|
| The mucous coat (tunica mucosa) is smooth, and presents a few longitudinal folds which become effaced by distension. It is continuous with the mucous membrane of the bladder below, while it is prolonged over the papillæ of the kidney above. Its epithelium is of a transitional character, and resembles that found in the bladder (see Fig. 1141). It consists of several layers of cells, of which the innermostthat is to say, the cells in contact with the urineare somewhat flattened, with concavities on their deep surfaces into which the rounded ends of the cells of the second layer fit. These, the intermediate cells, more or less resemble columnar epithelium, and are pear-shaped, with rounded internal extremities which fit into the concavities of the cells of the first layer, and narrow external extremities which are wedged in between the cells of the third layer. The external or third layer consists of conical or oval cells varying in number in different parts, and presenting processes which extend down into the basement membrane. Beneath the epithelium, and separating it from the muscular coats, is a dense layer of fibrous tissue containing many elastic fibers.|
Vessels and Nerves.The arteries supplying the ureter are branches from the renal, internal spermatic, hypogastric, and inferior vesical.
| The nerves are derived from the inferior mesenteric, spermatic, and pelvic plexuses.|
Variations.The upper portion of the ureter is sometimes double; more rarely it is double the greater part of its extent, or even completely so. In such cases there are two openings into the bladder. Asymmetry in these variations is common.
|3b. 3. The Urinary Bladder|
(Vesica Urinaria; Bladder)
The urinary bladder (Fig. 1135) is a musculomembranous sac which acts as a reservoir for the urine; and as its size, position, and relations vary according to the amount of fluid it contains, it is necessary to study it as it appears (a) when empty, and (b) when distended.) In both conditions the position of the bladder varies with the condition of the rectum, being pushed upward and forward when the rectum is distended.
The Empty Bladder.When hardened in situ, the empty bladder has the form of a flattened tetrahedron, with its vertex tilted forward. It presents a fundus, a vertex, a superior and an inferior surface. The fundus (Fig. 1152) is triangular in shape, and is directed downward and backward toward the rectum, from which it is separated by the rectovesical fascia, the vesiculæ seminales, and the terminal portions of the ductus deferentes. The vertex is directed forward toward the upper part of the symphysis pubis, and from it the middle umbilical ligament is continued upward on the back of the anterior abdominal wall to the umbilicus. The peritoneum is carried by it from the vertex of the bladder on to the abdominal wall to form the middle umbilical fold. The superior surface is triangular, bounded on either side by a lateral border which separates it from the inferior surface, and behind by a posterior border, represented by a line joining the two ureters, which intervenes between it and the fundus. The lateral borders extend from the ureters to the vertex, and from them the peritoneum is carried to the walls of the pelvis. On either side of the bladder the peritoneum shows a depression, named the paravesical fossa (Fig. 1037). The superior surface is directed upward, is covered by peritoneum, and is in relation with the sigmoid colon and some of the coils of the small intestine. When the bladder is empty and firmly contracted, this surface is convex