Inferior Vesical Research Articles

Venous drainage of the urinary bladder.

The venous drainage of the urinary bladder was studied in 20 pelvic halves (14 males and 6 females). Vesical and prostatic plexuses draining the bladder (vesical only in females) were found in 16 cases; they supplied blood to the internal iliac vein--usually by two to five veins--the most common number being three. One vein always drained the prostatic plexus. The vesical and prostatic plexuses were absent in 4 male cases, where the vesical veins issuing from the bladder wall drained directly the internal iliac vein. Their number in such cases was minimal: between one and two only, on each side. The union of a vesical vein issuing from any of the two mentioned plexuses (when found) with the obturator, prostatic or vaginal vein was common. A shunt from a common trunk of united obturator and vesical veins to the external iliac vein was noticed in some cases. Occasionally, an inferior vesical vein ending in the obturator vein accompanied an inferior vesical artery initiating from the obturator artery.

Clinical significance of preservation of the superior and inferior vesical arteries in the recovery of bladder function after radical operation for uterine cervical cancer

In order to increase the 5 year survival rate, lessening the incidence of urogenital complication by facilitating the recovery of bladder function is one of the important factors. For this purpose, two techniques—preservation of the pelvic splanchnic nerves and of the superior and inferior vesical arteries—were devised. Both were proved satisfactorily effective in facilitating the recovery of bladder function. We rather prefer the latter to the former because the arteries are strong enough to tolerate cleansing of the attached parametrial or areolar tissues possibly harboring more or less cancer cells, particularly because of the frequent permeation of cancer cells alongside the perineural tissue. The clinical significance should be evaluated on the basis of the 5 year survival rate. Our clinical experiences indicate that not only the pelvic splanchnic nerves but also the plexus uterovaginalis, the plexus vesicalis, the balance of the tonus between the detrusor and the internal sphincter, pelvic infection, and the blood circulation of the bladder are related to the recovery of bladder function.

Hemostasis and prevention of osteitis pubis in retropubic prostatectomy.

• Prostatectomy by the retropubic procedure has the advantage that the patient usually recovers more quickly than when other approaches are used, but surgeons have been reluctant to use it because of reports of excessive bleeding and subsquent osteitis pubis. The hemorrhage can be reduced by attention to the vessels coming from the prostaticovesical junction above and the penis below. The latter include branches from the internal pudendal arteries and sinuses related to the deep penile veins; most of these are controlled by 20 minutes of pressure on the perineum under the pubic arch. Hemmorrhage from branches of the inferior vesical artery can be checked by placing a forceps astride the prostatic capsule at the prostaticovesical junction during the dissection and by certain precautions as to ligatures and sutures after all the hyperplastic tissue has been removed. Osteitis pubis is probably related to the accumulation of pent-up serum in the retropubic space. As much as 200 cc. has been obtained by aspiration in one case. Careful drainage is now used to prevent this, with the result that no evidence of osteitis pubis has been seen after 410 retropubic prostatectomies.