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Additional info for Adult and Pediatric Urology (3-Volume Set)
58). 58. Nerves in a male pelvis, viewed from the right side: Portions of the coxa have been removed. Relations of the Male Bladder to Adjacent Organs The relations of the bladder to adjacent organs correlate closely with its relations to the pelvic connective tissue and peritoneum. Peritoneal Covering of the Bladder The bladder is attached to the peritoneum by loose connective tissue. This enables it to function as an expansile urinary reservoir that is mobile with respect to the peritoneum. Only a greatly distended bladder is fixed by its peritoneal covering (Fig.
Entry into the peritoneal cavity at a more inferior level is established by dissecting the vesicoumbilical plate (medial umbilical fold, median umbilical fold, transversalis fascia, peritoneal fat, and peritoneum) downward en bloc to the lateral umbilical ligaments (Fig. 64). 63. Dissection of the vesicoumbilical plate. 64. The freed vesicoumbilical plate is retracted inferiorly. Dissection of the Lateral Bladder Pedicle (Lateral Bladder Retinaculum) The right-handed surgeon places the fourth and fifth fingers of the left hand on the bladder and medial border of the lateral paracystic connective tissue with the third finger on the internal iliac artery.
The retroperitoneal venous system develops from three paired, longitudinally oriented parallel channels: the caudal cardinal vein, supracardinal vein, and subcardinal vein, which are continuous caudally with the sacrocardinal vein. Further differentiation of the venous system is characterized by a progressive asymmetry in favor of the right side, with anastomoses between the right and left cardinal veins assuming key importance. 19. Development of the vena caval system. Vessels that do not persist are colored light gray.