By Jay Y. Gillenwater MD, John T. Grayhack MD, Stuart S. Howards MD, Michael E. Mitchell MD
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Extra resources for Adult and Pediatric Urology (3-Volume Set)
56 and Fig. 57). The veins of the pelvic part of the ureter reach the veins accompanying the arteries either directly or by way of the venous plexuses of the pelvis (vesical, prostatic, uterine, and vaginal plexuses). The lymph vessels of the pelvic ureter drain into the regional lymph nodes on the pelvic wall: the external iliac, internal iliac, interiliac, and common iliac nodes. The nerves of the pelvic ureter form dense networks in the adventitia, muscular wall, and mucosal layer of the ureter.
55). 55. Anatomic approach to the suprahilar lymph node dissection, view from the right side. The superior mesenteric artery is identified at the point where it crosses over the left renal vein (Fig. 55). Care must be taken to prevent excessive tension on this artery and to preclude injury to it by a retractor because it serves as a vascular pedicle for the small and large bowels. Therefore pads are placed on the pancreas and the pedicle of the superior mesenteric artery. Dissection of the crura is started at the base of this pedicle and, on completion of the infrahilar node dissection, should be continued to the suprahilar region.
It binds the prostate and bladder to the anterior pelvic wall. The paracystic connective tissue (bladder retinaculum) passes to the bladder from the lateral pelvic wall. Between the paracystic connective tissue and pararectal connective tissue (rectal retinaculum) is the rectovesical septum, which represents the central portion of the lateral neurovascular sheath. Loose connective tissue occupies the spaces between the condensations of the neurovascular sheaths and visceral fasciae. The prevesical space located between the anterior abdominal wall and bladder is bounded anteriorly by the transversalis fascia and posteriorly by the vesical fascia.
Adult and Pediatric Urology (3-Volume Set) by Jay Y. Gillenwater MD, John T. Grayhack MD, Stuart S. Howards MD, Michael E. Mitchell MD