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  <head>
    <title>079-02 Pelvic viscera, ureters, bladder, rectum, continence, and pelvic relations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Pelvic viscera, continence, and relations">
      <outline text="Ureters in the pelvis">
        <outline text="Cross brim near iliac bifurcation"/>
        <outline text="Run on lateral wall, then anteromedially"/>
        <outline text="Below uterine artery near cervix"/>
        <outline text="Below ductus deferens before bladder">
          <outline text="Crossings create surgical risk"/>
        </outline>
        <outline text="Oblique intramural course">
          <outline text="Flap valve limits reflux"/>
        </outline>
        <outline text="Narrowings where stones impact">
          <outline text="Pelviureteric, iliac crossing, ureterovesical"/>
        </outline>
        <outline text="Segmental arterial supply">
          <outline text="Medial in abdomen, lateral in pelvis"/>
          <outline text="Wide mobilisation devascularises"/>
        </outline>
      </outline>
      <outline text="Bladder and urethra">
        <outline text="Empty behind symphysis, rises on filling"/>
        <outline text="Apex to umbilicus via urachal remnant"/>
        <outline text="Trigone between ureteric and urethral openings"/>
        <outline text="Detrusor contracts for voiding"/>
        <outline text="Posterior relations differ by anatomy"/>
        <outline text="Short female urethra">
          <outline text="Ascending infection risk"/>
        </outline>
        <outline text="Male urethra in four portions">
          <outline text="Membranous part vulnerable in pelvic trauma"/>
        </outline>
      </outline>
      <outline text="Innervation and voiding">
        <outline text="Parasympathetic: detrusor contraction"/>
        <outline text="Sympathetic supports storage">
          <outline text="Beta relaxes detrusor"/>
          <outline text="Alpha tightens bladder neck"/>
        </outline>
        <outline text="Pudendal controls external sphincter"/>
        <outline text="Stretch afferents to sacral and pontine centres"/>
        <outline text="Pons coordinates micturition"/>
        <outline text="Suprasacral lesion: overactivity, dyssynergia">
          <outline text="High bladder pressures"/>
        </outline>
        <outline text="Sacral or peripheral lesion: weak sensation, contraction"/>
        <outline text="Urodynamics measures actual function"/>
      </outline>
      <outline text="Urinary continence">
        <outline text="Many components must work together">
          <outline text="Bladder, sensation, outlet, support, cognition, access"/>
        </outline>
        <outline text="Female: urethral support closes during cough"/>
        <outline text="Male: prostate, bladder neck, membranous sphincter"/>
        <outline text="Stress: outlet fails under abdominal pressure"/>
        <outline text="Urgency: often detrusor overactivity"/>
        <outline text="Overflow: incomplete emptying"/>
        <outline text="Continuous: fistula or ectopic ureter"/>
      </outline>
      <outline text="Rectum and mesorectum">
        <outline text="Begins near S3, follows sacral curve"/>
        <outline text="Peritoneum: upper front and sides, middle front"/>
        <outline text="Mesorectum: vessels, lymphatics, nodes">
          <outline text="Mesorectal fascia: cancer excision plane"/>
          <outline text="Protect autonomic nerves"/>
        </outline>
        <outline text="Anterior relations differ by organs"/>
        <outline text="Superior, middle, inferior rectal supply"/>
      </outline>
      <outline text="Defecation and faecal continence">
        <outline text="Internal sphincter: much of resting pressure"/>
        <outline text="External sphincter, puborectalis augment"/>
        <outline text="Rectoanal inhibitory reflex samples contents"/>
        <outline text="Defecation straightens anorectal angle"/>
        <outline text="Dyssynergia: outlet fails to relax">
          <outline text="Assess anatomy and physiology"/>
        </outline>
        <outline text="Incontinence: sphincter, nerve, stool, capacity">
          <outline text="Childbirth injures sphincter and pudendal paths"/>
        </outline>
      </outline>
      <outline text="Prolapse, compartments, and imaging">
        <outline text="Anterior, apical, posterior descent">
          <outline text="Continuous supports, defects not independent"/>
        </outline>
        <outline text="Rectal prolapse is full thickness"/>
        <outline text="Mass in one compartment alters another"/>
        <outline text="Read imaging from wall inward">
          <outline text="Fat planes lost by inflammation or tumour"/>
          <outline text="MRI fascia, CT trauma, ultrasound dynamic"/>
          <outline text="Re-establish orientation every study"/>
        </outline>
        <outline text="Describe collections by boundaries"/>
      </outline>
      <outline text="Lymphatics and spread">
        <outline text="Superior bladder: external iliac nodes"/>
        <outline text="Bladder neck: internal iliac, sacral"/>
        <outline text="Prostate: internal iliac, sacral, obturator"/>
        <outline text="Rectum: inferior mesenteric and internal iliac routes">
          <outline text="Anal drainage changes at pectinate line"/>
        </outline>
        <outline text="Tumour also follows fascia, veins, nerves"/>
        <outline text="Localise failure: reservoir, outlet, support, control"/>
      </outline>
    </outline>
  </body>
</opml>
