Pelvic Viscera Superficial Features of the Back

Gross Anatomy


Male Pelvic Cavity and Urinary Bladder, Female Pelvic Cavity and Urinary Bladder


Anatomy Tables for Today's Topic

Muscles
Nerves
Arteries
Veins
Lymphatics
Viscera

Muscles

Muscle Origin Insertion Action Innervation Artery Notes
detruser of bladder smooth muscle in the wall of the urinary bladder fascicles are arranged roughly in three layers compresses the urinary bladder parasympathetic nerve fibers from the pelvic splanchnic nerves (S2-S4 spinal cord levels) superior and inferior vesical aa. muscles in the neck of bladder must contract and cause the internal urethral orifice to open before the detruser muscle can void the bladder
sphincter urethrae, in female encircles the urethra encircles urethra and vagina; extends superiorly along the urethra as far as the inferior surface of the bladder compresses urethra and vagina deep branch of perineal nerve from pudendal nerve internal pudendal a. skeletal muscle
sphincter urethrae, in male encircles the urethra encircles urethra, reaches lateral surface of prostate and inferior bladder compresses urethra deep branch of perineal nerve from pudendal nerve internal pudendal a. skeletal muscle

Nerves

NerveSourceBranchesMotorSensoryNotes
vesical plexus inferior hypogastric plexus continuous with the prostatic plexus sympathetic: vascular smooth muscle of the pelvic viscera, especially the urinary bladder, seminal vesicle, ductus deferens and ejaculatory duct; parasympathetic: smooth muscle and glands of the pelvic viscera, especially the urinary bladder, seminal vesicle, ductus deferens and ejaculatory duct pain and general sensation from the bladder, seminal vesicle and ductus deferens vesical plexus is continuous with the other autonomic nerve plexuses in the pelvis and cannot be distinguished from them

Arteries

Artery Source Branches Supply to Notes
internal iliac common iliac a. anterior division gives rise to the : umbilical a., obturator a., uterine a., vaginal a., inferior vesical a., middle rectal a., internal pudendal a., inferior gluteal a.; posterior division gives rise to the: iliolumbar a., lateral sacral a., superior gluteal a. pelvic viscera, gluteal region, hip, medial thigh common iliac artery bifurcates anterior to the sacroiliac articulation to form the internal iliac a. and the external iliac a.
ovarian abdominal aorta tubal brs., uterine brs. ovary, uterine tube ovarian a. anastomoses with the uterine a.
testicular abdominal aorta ureteric brs. testis, epididymis, lower part of the ductus deferens, ureter near its midpoint testicular a. is one of the contents of the spermatic cord; the origin of the testicular a. from the aorta at the L2 vertebral level indicates the embryonic level of origin of the testis prior to its descent
uterine internal iliac a., anterior division tubal br., vaginal br. uterus, uterine tube uterine a. anastomoses with the ovarian a. and the vaginal a.; it passes superior to the ureter in the pelvis; remember the saying "water under the bridge"
vaginal internal iliac a., anterior division; occasionally it arises from uterine a. numerous unnamed branches vagina anastomoses with the uterine a.; participates in the formation of the azygos arteries along the lateral surface of the vagina
vesical, inferior internal iliac a., anterior division or it may arise from the middle rectal a. no named branches lower part of the urinary bladder, prostate/vagina inferior vesical a. anastomoses with the middle rectal a.
vesical, superior umbilical a. no named branches superior aspect of the bladder superior vesical aa.arise from the umbilical a. proximal to where its lumen becomes obliterated

Veins

Vein Tributaries Drains Into Regions Drained Notes
ovarian v. no named tributaries right: inferior vena cava; left: left renal v. ovary and the distal part of the uterine tube; ureter connects with the uterine v.; a pampiniform plexus occurs, but is not as well developed as that seen in the male
pampiniform venous plexus no named tributaries becomes the testicular vein at the deep inguinal ring testis, epididymis, ductus deferens pampiniform venous plexus surrounds the testicular a. to cool arterial blood before it reaches the testis
prostatic venous plexus deep dorsal v. of the penis internal iliac v. penis and the prostate gland prostatic venous plexus is connected with the vesical venous plexus
testicular v. pampiniform plexus left: left renal v.; right: inferior vena cava testis, ureter left testicular v. is longer than the right testicular v.
uterine venous plexus multiple tributaries from the uterus; deep dorsal v. of the clitoris uterine vv. to the internal iliac v. uterus & uterine tubes connects with the ovarian v. and the vaginal venous plexus
vaginal venous plexus multiple tributaries from the vagina vaginal v. to the internal iliac v. or uterine v. vagina connects with the uterine venous plexus, the vesical venous plexus and the rectal venous plexus
vesical venous plexus multiple tributaries from the bladder in both sexes superior and inferior vesical vv. to the internal iliac v. urinary bladder in the male - connects with the prostatic venous plexus and the rectal venous plexus; in the female - connects with the rectal venous plexus, uterine venous plexus and vaginal venous plexus

Lymphatics

Structure Location Afferents from Efferents to Regions drained Notes
iliac nodes, common along the common iliac vessels; over the sacral promontory external iliac nodes, internal iliac nodes lumbar (lateral aortic) chain of nodes lower limb; pelvic organs, perineum, lower part of the anterior abdominal wall common iliac nodes are approximately 6 in number
iliac nodes, external along the external iliac vessels superficial inguinal nodes; deep inguinal nodes; inferior epigastric nodes common iliac nodes lower limb; external genitalia; lower part of the anterior abdominal wall external iliac nodes are 8 to 10 in number
iliac nodes, internal along the internal iliac vessels lymphatic vessels from the pelvic viscera common iliac nodes, external iliac nodes pelvis, perineum and gluteal region internal iliac nodes are 4 to 8 in number
inguinal nodes, deep along the medial side of the femoral v. deep to the fascia lata and inguinal ligament superficial inguinal nodes, popliteal nodes external iliac nodes lower limb, external genitalia, lower part of the anterior abdominal wall the deep inguinal node in the femoral canal is called the node (or gland) of Cloquet
lateral aortic nodes along the inferior vena cava and abdominal aorta from the aortic bifurcation to the aortic hiatus of the diaphragm common iliac nodes; lymphatic vessels from the posterior abdominal wall and viscera efferents form one lumbar trunk on each side lower limb; pelvic organs; perineum; anterior and posterior abdominal wall; kidney; suprarenal gland; respiratory diaphragm also known as: lumbar nodes; the intestinal trunk drains into to the left lumbar trunk; the lumbar trunks unite to form the thoracic duct/cisterna chyli
lumbar nodes along the inferior vena cava and abdominal aorta from the aortic bifurcation to the aortic hiatus of the diaphragm common iliac nodes; lymphatic vessels from the posterior abdominal wall and viscera efferents form one lumbar trunk on each side lower limb; pelvic organs; perineum; anterior and posterior abdominal wall; kidney; suprarenal gland; respiratory diaphragm also known as: lateral aortic nodes; the intestinal trunk drains into to the left lumbar trunk; the lumbar trunks unite to form the thoracic duct/cisterna chyli
lumbar trunk between the lumbar vertebral bodies and inferior vena cava (right) or aorta (left) at the upper end of the lumbar chain of nodes lumbar (lateral aortic) nodes; the intestinal trunk joins the left lumbar trunk thoracic duct/cisterna chyli left lumbar trunk - left side of the body below the respiratory diaphragm, gut; right lumbar trunk - right side of body below the diaphragm lumbar trunks unite to form the lower end of the thoracic duct; an enlargement of the lower end of the thoracic duct (called the cisterna chyli) occurs in about 25% of individuals, and when it is present, the lumbar trunks drain into it

Viscera

Organ/Part of Organ Location/Description Notes
ampulla of the ductus deferens dilated part of the ductus deferens located posterior to the bladder ampulla of the ductus deferens joins with the duct of the seminal vesical to form the ejaculatory duct
ampulla of the uterine tube widest and longest part of the uterine tube ampulla of the uterine tube arches over the ovary and ends laterally in the infundibulum
bladder, urinary hollow muscular organ posterior to the pubic symphysis and body of the pubis that acts as a reservoir for urine urinary bladder is held in place by the pubovesical/puboprostatic ligaments; ureters enter the posterolateral surface of the bladder at the posterior two angles of the vesical trigone
body of the uterus part of the uterus between the fundus and the isthmus the uterine cavity is thin anteroposteriorly and wide in the transverse plane
broad ligament peritoneal fold extending from the pelvic walls to the uterus and uterine tubes broad ligament has three named parts: mesovarium, mesosalpinx, mesometrium
cardinal ligament condensations of endopelvic (extraperitoneal) connective tissue surrounding the uterine vessels within the base of the broad ligament cardinal ligament helps in support of the uterus by attaching the uterine isthmus to the lateral pelvic wall
cervix narrowed inferior end of the uterus cervix is inferior to the isthmus of the uterus and projects into the vagina; it is surrounded by the vaginal fornices (anterior, posterior and lateral)
ductus deferens duct of the testis ductus deferens is continuous with the tail of the epididymis; it passes through the superficial inguinal ring, inguinal canal and deep inguinal ring to reach the posteroinferior surface of the bladder where it joins with the duct of the seminal vesicle to form the ejaculatory duct
ejaculatory duct duct formed by the union of the duct of the seminal vesicle and the ampulla of the ductus deferens ejaculatory duct passes through the prostate gland to empty onto the seminal colliculus along the urethral crest in the prostatic urethra
fimbria of the uterine tube finger-like projections surrounding the opening into the uterine tube fimbria spread over the medial surface of the ovary; the ovarian fimbria is an extra long fimbria that attaches to the ovary
fundus of the uterus the rounded anterosuperior part of the uterus fundus of the uterus is defined as that portion of the uterus located superior to an imaginary line joining the points of entry of the uterine tubes; the uterus is normally anteverted and anteflexed, so the fundus normally points anterosuperiorly
infundibulum of the uterine tube funnel-shaped distal end of the uterine tube fimbria are attached to the margin of the infundibulum
interureteric ridge mucosal fold on the inner posterior wall of the bladder connecting the paired ureteric orifices interureteric ridge is the superior boundary of the vesical trigone
isthmus of the uterine tube constricted part of the uterine tube that is adjacent to the uterus isthmus of the uterine tube is the narrowest part
isthmus of the uterus constricted part of the uterus between the body and the cervix isthmus of the uterus is about 1 cm in length and its cavity enters into the internal cervical os
mesometrium part of the broad ligament below the junction of the mesosalpinx and the mesovarium mesometrium attaches the body of the uterus to the pelvic wall
mesosalpinx part of broad ligament that supports the uterine tube mesosalpinx extends inferiorly to meet the root of the mesovarium; it attaches the uterine tube to the mesometrium
mesovarium part of broad ligament that forms a shelf-like fold supporting the ovary mesovarium is located perpendicular to the plane of the mesosalpinx and mesometrium; it attaches the ovary to the mesometrium and mesosalpinx
ovarian ligament a band of connective tissue that connects the ovary to the lateral surface of the uterus a remnant of the gubernaculum; it is continuous with the round ligament of the uterus at the lateral surface of the uterus; ovarian ligament lies within the mesovarium; also known as: proper ovarian ligament
ovary female gonad that lies in the ovarian fossa within the true pelvis in contact with the fimbria of the uterine tube ovary is both an endocrine and an exocrine gland; it is held in place by the ovarian ligament, mesovarium, and suspensory ligament of the ovary
posterior fornix of the vagina space within the vaginal canal posterior to the cervix an incision made superiorly through posterior fornix will enter the rectouterine pouch of the peritoneal cavity
prostate exocrine gland located inferior to the urinary bladder and superior to the urogenital diaphragm multiple small ducts drain into the prostatic urethra as it passes through the prostate; subject to benign and malignant enlargement, which may compromise micturition due to projection of the uvula into the bladder
prostatic utricle a small blind diverticulum in the posterior wall of the prostatic urethra on the summit of the seminal colliculus prostatic utricle is a remnant of the fused lower ends of the paramesonephric ducts - the fused paramesonephric ducts form the uterine canal in the female
rectouterine ligament a condensation of extraperitoneal connective tissue & smooth muscle (rectouterine muscle) connecting the isthmus of the uterus to the sacrum rectouterine ligament is important for support of the uterus
round ligament of the uterus a connective tissue band that attaches to the inner aspect of the labium majus and the uterus round ligament of the uterus traverses the superficial inguinal ring, inguinal canal and deep inguinal ring to reach the lateral surface of the uterus below the uterine tube; it is a remnant of the gubernaculum; it is continuous with the ovarian ligament; it holds the fundus of the uterus forward; also known as: ligamentum teres uteri
seminal colliculus elevation on the posterior wall of the prostatic urethra the seminal colliculus is a mound in the posterior wall of the prostatic urethra; on its summit is found the opening of the prostatic utricle
seminal vesicle blind sac located on the posterior surface of the bladder lateral to the ampulla of the ductus deferens seminal vesicle produces seminal fluid; its duct joins with the ampulla of the ductus deferens to form the ejaculatory duct
suspensory ligament of the penis/clitoris a specialization of deep fascia connecting the proximal end of the penis/clitoris to the pubis and pubic symphysis the fundiform ligament is a specialization of superficial fascia that lies superficial to the suspensory ligament
testis an endocrine and exocrine gland contained within the scrotum testis is the male gonad; its exocrine product is sperm which drain to the head of the epididymis via efferent ductules; its endocrine product is testosterone; the testis migrates into the scrotum shortly before birth; it is tethered to the scrotum inferiorly by the scrotal ligament (a remnant of the gubernaculum)
tunica albuginea, testis outer white fibrous covering of the testis tunica albuginea is a dense connective tissue capsule that is covered on its external surface by the visceral layer of the tunica vaginalis testis
tunica vaginalis testis a peritoneal sac located anterolateral to the testis tunica vaginalis testis has two layers: visceral and parietal; the visceral layer lies on the anterolateral surface of the testis and epididymis; the parietal layer lines the inner surface of the scrotal sac; the word "vaginalis" is derived from the Latin word for sheath
urethra duct that drains the urinary bladder urethra has three parts in the male: prostatic, membranous & penile/spongy; female urethra is much shorter than the male urethra, consisting of the membranous part only
urethra, membranous part of the urethra that passes through the urogenital diaphragm (sphincter urethrae muscle and perineal membrane) female: membranous urethra connects the urinary bladder to the external urethral orifice at the vestibule of the vagina; male: membranous urethra connects the prostatic urethra with the spongy/penile urethra
urethra, penile part of the urethra contained within the bulb and the corpus spongiosum of the penis longest part of male urethra; penile urethra has a dilation in the region of the glans called the navicular fossa; also known as: spongy urethra
urethra, prostatic part of the male urethra passing through the prostate gland prostatic urethra begins at the internal urethral orifice at the anteroinferior angle of the vesical trigone; posterior wall of the urethra has an elevated ridge called the urethral crest with a prominence called the seminal colliculus (veru montanum); seminal colliculus has a blind diverticulum called the prostatic utricle with orifices of ejaculatory ducts located below it
urethra, spongy part of the urethra contained within the bulb and the corpus spongiosum of the penis longest part of male urethra; spongy urethra has a dilation in the region of the glans called the navicular fossa; also known as: penile urethra
ureter muscular tube that serves as the duct of the kidney to carry urine to the bladder ureter is continuous proximally with the renal pelvis; it passes over the pelvic brim medial to the testicular/ovarian vessels; it passes obliquely through the posterior wall of the urinary bladder and drains at the posterolateral angle of the vesical trigone
uterine tube the duct of the ovary; it extends from the ovary to the uterus uterine tube has four named parts: infundibulum is the funnel shaped opening - fimbria encircle this opening; ampulla is a dilated region that connects the infundibulum with the isthmus; isthmus is the constricted part nearest the uterus; intramural part is within the uterine wall
uterus hollow muscular organ within which the fertilized ovum develops; normally lies anteverted posterosuperior to the bladder uterus is anteflexed (curved anteroinferiorly) at the uterine isthmus; the fundus is the part superior to the entrance of the uterine tubes and it normally lies anterosuperiorly; the body meets the cervix at a constricted area called the isthmus; the cervix projects into the vagina
uvula of the bladder elevation of the inner bladder wall posterosuperior to the internal urethral orifice uvula is caused by the middle lobe of the prostate gland; if the prostate becomes enlarged (either benin hypertrophy or malignancy) the uvula can constrict the internal urethral orifice and cause difficulty in voiding the bladder; only found in males
vagina part of the female genital canal located between the vestibule and the cervix vaginal fornices surround the cervix; the word "vagina" is derived from the Latin word for sheath
vesical trigone smooth triangular region located on the inner surface of the posterior wall of the urinary bladder vesical trigone is bounded by the openings of the ureters (2) superolaterally, the interureteric ridge between the openings of the ureters and the internal urethral orifice inferiorly
vestibule of the vagina region inferior to the hymen/hymeneal caruncles and between the labia minora vestibule of the vagina contains the external urethral orifice, the opening of the vagina and the openings of the greater vestibular glands

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Some of the material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest and Jaye Schlesinger
Published by ILOC, Inc., New York. Copyright 1995.

Content of these tables has been edited for use in this course by Patrick W. Tank, Ph.D.
Copyright 2005, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences.

Unauthorized use is prohibited.