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    Related Topics

    From Urinary System

    Median Umbilical Ligament
    Remnant of embryonic urachus.
    Internal Urethral Sphincter
    Involuntary control of urine release.
    Bladder Neck
    Region surrounding internal urethral orifice.
    Renal Cortex
    Outer region of the kidney where filtration begins.
    Bowman’s Capsule
    Surrounds glomerulus; initial urine collection.
    Distal Convoluted Tubule
    Regulates electrolytes and pH.
    Detrusor Muscle
    Smooth muscle for bladder contraction.
    Glomerulus
    Capillary tuft where filtration starts.
    Renal Columns
    Tissue between pyramids extending into medulla.
    Renal Papilla
    Apex of pyramid draining urine into minor calyx.
    Loop of Henle
    Creates osmotic gradient in medulla.
    Urinary Bladder
    Stores urine until micturition.
    Pelvic Floor Muscles
    Support bladder and urethra.
    Arcuate Arteries
    Arch over the base of pyramids.
    Papillary Duct
    Drains urine into minor calyx.
    External Urethral Meatus
    External urethral opening.
    Ureters
    Transport urine to bladder.
    Nephron
    Functional unit of kidney.
    Renal Artery
    Supplies oxygenated blood to kidney.
    Efferent Arteriole
    Drains from glomerulus.
    Kidneys
    Primary organs for filtration, fluid balance, and excretion.
    Vasa Recta
    Capillaries around loop of Henle.
    Trigone
    Triangle between ureteral openings and urethra.
    Renal Pelvis
    Funnel-shaped basin collecting urine into ureter.
    Minor Calyces
    Receive urine from renal papillae.

    Bladder Peritoneum

    Reviewed by our medical team

    Covers superior bladder surface.

    1. Overview

    The bladder peritoneum refers to the portion of the peritoneal lining that covers the superior surface of the urinary bladder. This peritoneal reflection plays an important role in anatomical compartmentalization, surgical access, and the spread of fluid or disease within the pelvic cavity. The bladder is classified as a subperitoneal (extraperitoneal) organ, but its upper surface is in direct contact with the peritoneum, particularly when the bladder is distended.

    2. Location

    The bladder peritoneum is located on the superior surface of the urinary bladder, forming the vesical peritoneal covering. Its anatomical relationships vary slightly between males and females:

    In Males:

    • Covers the superior surface of the bladder and reflects onto the rectum to form the rectovesical pouch.

    • Sits anterior to the seminal vesicles and vas deferens.

    In Females:

    • Reflects from the bladder onto the uterus, forming the vesicouterine pouch.

    • Sits inferior to the uterus and anterior to the vagina.

    The extent of peritoneal coverage changes with bladder filling—when full, the peritoneum is pushed upward, exposing more of the bladder wall anteriorly.

    3. Structure

    The bladder peritoneum consists of the same histological layers found in other peritoneal reflections:

    • Mesothelium: A single layer of simple squamous epithelial cells providing a smooth, frictionless surface.

    • Submesothelial Connective Tissue: Supports the mesothelium and contains blood vessels, lymphatics, and nerves.

    Beneath the peritoneum lies the detrusor muscle of the bladder wall. Unlike peritonealized abdominal organs, the bladder’s peritoneal covering is partial, only on its dome and varies based on bladder distention.

    4. Function

    The bladder peritoneum is not directly involved in urine storage or voiding but serves critical anatomical and functional roles:

    • Allows bladder expansion: The flexible peritoneal covering accommodates the bladder’s changing volume.

    • Reduces friction: Provides a smooth interface with adjacent organs (e.g., uterus or rectum).

    • Forms pelvic pouches: Contributes to the vesicouterine or rectovesical pouch which serve as spaces for fluid collection or surgical access.

    5. Physiological Role(s)

    Although passive in nature, the bladder peritoneum participates in several physiological contexts:

    • Structural compartmentalization: Helps separate pelvic organs within the peritoneal cavity.

    • Fluid dynamics: Participates in peritoneal fluid circulation and may serve as a site for fluid accumulation (e.g., pus, blood, ascitic fluid).

    • Barrier function: Acts as a semi-permeable membrane, influencing diffusion of solutes and immune factors in disease states.

    6. Clinical Significance

    Bladder Rupture and Peritonitis

    In cases of intraperitoneal bladder rupture (e.g., due to trauma), urine can leak into the peritoneal cavity leading to chemical peritonitis. This is a surgical emergency and often requires bladder repair and peritoneal lavage.

    Surgical Access: Suprapubic Approach

    During procedures like suprapubic cystostomy or bladder surgery, the peritoneum may need to be retracted or incised. The bladder peritoneum serves as a landmark to access the bladder dome safely, especially when the bladder is distended and displaces the peritoneum superiorly.

    Spread of Disease

    The peritoneal covering may act as a conduit for the spread of infection, malignancy, or fluid. For example:

    • Ascitic fluid can collect in vesicouterine or rectovesical pouches.

    • Peritoneal carcinomatosis may involve the bladder peritoneum in advanced abdominal cancers.

    Peritoneal Dialysis Consideration

    While not directly targeted, understanding the peritoneal surface of the bladder is important during catheter placement for peritoneal dialysis, as misplaced catheters can irritate or perforate this region.

    Imaging and Interpretation

    The bladder peritoneum is often visualized during:

    • Ultrasound or CT: When evaluating pelvic free fluid or tumors.

    • Cystography: Can reveal intraperitoneal extravasation of contrast in cases of bladder perforation.

    Did you know? Urinary retention occurs when the bladder is unable to fully empty, which can be caused by blockages or nerve issues.