Now let's turn to the bladder and on
the screen we can see two hemisections
of the pelvis which is being
cut down in the sagittal plane.
And here we can see
we have the male pelvis
and we can see we
have the female pelvis.
And what we can see is anteriorly
over here and posteriorly here
for the male. Anterior here and
posterior here for the female.
We can see that directly behind the
pubic symphysis in both the male
and the female we have the bladder
which we can make out here.
So both in the male and
the female we have the bladder
directly posterior to
the pubic symphysis.
Now the bladder is a hollow
organ. Its a hollow organ
that has strong muscular walls
and these walls are distensible.
That means that the bladder can alter
in shape much in size; much like the stomach did.
The position is found
within the lesser pelvis.
So it's found beneath the pelvic brim and
it is posterior to the pubic symphysis.
It is inferior to the peritoneum.
So we have a layer of
the peritoneum coming down
from the anterior abdominal wall
in both the male and the female.
And then the peritoneum lies over the
top of the bladder we can see it here.
See the peritoneum lying
over the top of the bladder.
Now, the overlying peritoneum
can form pouches
as it covers the pelvic
viscera that project up
into the pelvic cavity. That
project into the pelvic cavity.
So in the male we can have a pouch
where we have got the bladder
and then we here we
have got the rectum.
So here in the male we can
see directly posterior to the
bladder we find the rectum.
And we can follow the peritoneum as it
comes from the anterior abdominal wall
over the bladder and then up
the rectum up here and then follows the
various contours of the gastrointestinal tract.
We can see that the bladder
is inferior to the peritoneum.
But this space that's
located in between the bladder
and the rectum which
is lined by peritoneum
this in the male known
as the rectovesical pouch.
The rectovesical pouch and its in
between the rectum and the bladder.
In the female a similar
but you have the vagina and the uterus
positioned between the bladder
and the rectum. But we can
still follow this peritoneum.
So the peritoneum goes over the bladder and
then it can actually go over the uterus
which we see here, positioned
on top of the bladder.
So the peritoneum comes over the
superior surface of the bladder.
It may creep in between
the bladder and the uterus.
And then it runs over
the uterus here
so then form this pouch in between
the uterus and the rectum.
Here we can see the
rectum in the female.
So because the uterus is in between
the bladder and the rectum.
In the female we have two pouches. We
have the pouch that's in between the
bladder and the uterus. The so
called the vesicouterine pouch
and that's what we can see here.
And then between the
uterus and the rectum
we find we have the
And this rectouterine pouch is
really important in the female.
In the female this pouch can
collect a free fluid or pus.
Free fluid or pus that's accumulative
within the peritoneal cavity
can migrate to this deep pouch
via the various paracolic
gutter. And this pus
needs to be drained and the easiest way to access
this pouch is to pass through the vagina.
So transvaginal approach will
allow access to this pouch
and the passing free fluid
can be drained away.
That prevents any interference to the rectum
introducing feces into the peritoneal cavity.
And passing through this way will
prevent the abdominal cavity
being opened up to the outside
environment. So tranvaginally
can then enter through this
small fibro muscular
wall and enter into the
rectouterine pouch to
withdraw free fluid or pus.