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Embryology, Anatomy, and Physiology of the Bladder
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Allan Johnston, Tarik Amer, Omar Aboumarzouk, Hashim Hashim
Wolffian duct (mesonephric duct) (Figure 10.2):Fuses with the cloaca during embryonic folding.Follows the development of the UGS.The common excretory ducts are the portion of the Wolffian duct:Lie distal to the developing ureteric bud.Ducts dilate by ~day 33 and insert into the UGS.Duct orifices move caudally and away from the ureteral orifices.Apoptosis allows the ureters to disconnect from the Wolffian duct.Ureters are incorporated into the bladder at the trigone.Migrate cranially and laterally within the floor of the bladder.
The urinary bladder
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Under the influence of chronic inflammation the surface epithelium sends down buds, resulting in minute cysts filled with clear fluid, most abundant on the trigone. This is frequently found in patients with recurrent frequency and dysuria.
Urinary and sexual problems
Published in Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley, Symptom Relief in Palliative Care, 2018
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley
Trigone pain: The trigone is at the base of the bladder, surrounding the urethral opening. Irritation of this area can cause pain that radiates to the tip of the distal urethra. Catheter balloons are a common cause and reducing the balloon volume can help as well as avoiding tension on the catheter itself. Intermittent catheterization is an alternative (see p. 155).
A single-blind randomized control trial of trigonal versus nontrigonal Botulinum toxin-A injections for patients with urinary incontinence and poor bladder compliance secondary to spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2021
Hui Chen, Keji Xie, Chonghe Jiang
At present, the location of BTX-A injection, especially injection with or without bladder trigone is still a challenging area for the urologist on the technical details. According to European consensus report recommendations, urologists typically injected BTX-A into the detrusor muscle and spared the trigone to avoid the theoretical risk of inducing VUR.6 However, to our knowledge, the grade C recommendation is relatively low and weak due to lack of directly applicable clinical studies of good quality. Studies have demonstrated that the bladder trigone is rich in adrenergic and muscarinic innervation compared to the other area of the bladder.7–11 Its smooth muscles are more sensitive to small pressure changes. Therefore, an advantage of trigonal BTX-A injection is that it may improve clinical efficacy. Until now, many studies showed that the risk of VUR after trigonal BTX-A injection is a nonexistent risk.12–19 Furthermore, Abdel-Meguid TA reported trigone-including injections are superior to trigone-sparing injections for the treatment of pharmacologically refractory idiopathic detrusor overactivity.20 A recent review revealed most data for studies on detrusor overactivity with very little data on poor BC.
Induction of bacterial cystitis in female rabbits by uropathogenic Escherichia coli and the differences between the bladder dome and trigone
Published in Ultrastructural Pathology, 2021
Manal A. Othman, Hicham M. Ezzat, Diaa E.E. Rizk, Amer H. Kamal, Ali E. Al-Mahameed, Ammar M. Marwani, Khalid M. Bindyna, Stefano Salvatore
Despite the physiological and anatomical importance of the trigone of the urinary bladder, there is very scarce literature about its histological structure.15,16 Functional differences between the bladder dome, and trigone is currently receiving more attention in the pathogenesis of the overactive bladder syndrome.17,18 The trigonal detrusor muscle has more spontaneous activity than that of the dome and is thought to initiate contractions of the whole urinary bladder. Furthermore, several studies have suggested that infections located within the trigone may be associated with a higher risk of recurrence than those affecting the rest of the urinary bladder.19 Histological differences between the trigone and the dome may be responsible as the former has smaller muscle cells and distinct gap junction proteins that are likely to be responsible for recurrence of infection.20
Hyperuricosuria, hematuria, and novel bladder images with IgA nephropathy
Published in Baylor University Medical Center Proceedings, 2021
Krista L. Birkemeier, Ronald J. Hogg, Darshan B. Patel, Alisa A. Acosta, Jeffrey A. Waxman
Why do patients with IgAN and hyperuricosuria develop MH? Some authors have proposed that hyperuricosuria causes “microcalculi” that injure the tubular epithelium.9 Alternatively, the ultrasound and cystoscopic findings in our patient suggest that the reaction of the bladder mucosa to a high concentration of uric acid may also be a viable possibility, explaining the hyperemia and irritation on imaging. Visible toxic effects of uric acid on the urinary bladder were first described by Etheridge in the late 19th century10 and subsequently reinforced by Ravogli in 1906.11 Our patient had trigone thickening during her episodes with intervening normal ultrasounds, supporting bladder irritation as the source of macroscopic hematuria. Isolated trigone thickening, as in this case, also raises the question of why this irritation self-isolates to this region alone. One plausible consideration may stem from embryological development of the bladder. When the bladder is forming, the trigone is derived from mesodermal tissue. The remainder of the bladder is derived from the ectoderm. It can be speculated that the different properties of these various layers could lead to different responses to irritation.