Ovaries The ovaries are paired gonadal structures that lie suspended between the pelvic wall and the uterus by the infundibulopelvic ligament laterally and the utero-ovarian ligament medially. Inferiorly, the hilar surface of each ovary is attached to the broad ligament by its mesentery (mesovarium), which is dorsal to the mesosalpinx and fallopian tube. Primary neurovascular structures reach the ovary through the infundibulopelvic ligament and enter through the mesovarium. The normal ovary varies in size, with measurements up to 5 × 3 × 3 cm. Variation in dimension results from endogenous hormonal production, which varies with age and with each menstrual cycle. Exogenous substances, including oral contraceptives, gonadotropin-releasing hormone agonists, or ovulation-inducing medication, may either stimulate or suppress ovarian activity and, therefore, affect size.
Each ovary consists of a cortex and medulla and is covered by a single layer of ﬂattened cuboidal to low columnar epithelium that is continuous with the peritoneum at the mesovarium. The cortex is composed of a specialized stroma and follicles in various stages of development or attrition. The medulla occupies a small portion of the ovary in its hilar region and is composed primarily of fibromuscular tissue and blood vessels.
Blood Supply The blood supply to the ovary is the ovarian artery, which anastomoses with the uterine artery.
Innervation The innervation to the ovary is the ovarian plexus and the uterovaginal plexus.
The ureter is the urinary conduit leading from the kidney to the bladder; it measures about 25 cm in length and is totally retroperitoneal in location.
The lower half of each ureter traverses the pelvis after crossing the common iliac vessels at their bifurcation, just medial to the ovarian vessels. It descends into the pelvis adherent to the peritoneum of the lateral pelvic wall and the medial leaf of the broad ligament and enters the bladder base anterior to the upper vagina, traveling obliquely through the bladder wall to terminate in the bladder trigone.
The ureteral mucosa is a transitional epithelium. The muscularis consists of an inner longitudinal and outer circular layer of smooth muscle. A protective connective tissue sheath, which is adherent to the peritoneum, encloses the ureter.
Blood Supply The blood supply is variable, with contributions from the renal, ovarian, common iliac, internal iliac, uterine, and vesical arteries.
Innervation The innervation is through the ovarian plexus and the vesical plexus.
The bladder is a hollow organ, spherically shaped when full, that stores urine. Its size varies with urine volume, normally reaching a maximum volume of at least 300 mL. The bladder is often divided into two areas, which are of physiologic significance: 1.
The base of the bladder consists of the urinary trigone posteriorly and a thickened area of detrusor anteriorly. The three corners of the trigone are formed by the two ureteral orifices and the opening of the urethra into the bladder. The bladder base receives α-adrenergic sympathetic innervation and is the area responsible for maintaining continence.
2.
The dome of the bladder is the remaining bladder area above the bladder base. It has parasympathetic innervation and is responsible for micturition.
The bladder is positioned posterior to the pubis and lower abdominal wall and anterior to the cervix, upper vagina, and part of the cardinal ligament. Laterally, it is bounded by the pelvic diaphragm and obturator internus muscle.
The bladder mucosa is transitional cell epithelium and the muscle wall (detrusor). Rather than being arranged in layers, it is composed of intermeshing muscle fibers.