Surgical Anatomy of the Bladder

Advancing from open to endoscopic surgery and continuing to robotic-assisted endoscopic surgery does not change the anatomical facts, but visual perspective changes literally. Both the angle of view of topographic relations between anatomical structures and the attention to details have been modified and enhanced by the technical development. Magnification and stereoscopic view along with the possibility of reduced tremor and precise preparation opened up these real-time insights into human pelvic anatomy. The following chapter addresses the macroscopic and microscopic anatomy of the urinary bladder with regard to special needs of a surgeon working endoscopically. In addition to basic anatomical knowledge, this chapter emphasizes the topographic female and male anatomy of the pelvis, the urethral sphincter mechanisms, and the continuously evolving field of genitourinary tract innervation. Whereas gross anatomy is substantially investigated and well known, microscopic anatomy, especially the complex pelvic neural network and the ultra structure of the rhabdosphincter, is still in the spotlight of scientific interest. Knowledge of periprostatetic nerve courses facilitates nerve-sparing during pelvic surgery. But data regarding perivesical neural anatomy above the level of the bladder neck is still sparse. The combination of new findings with traditional anatomical knowledge into urological practice will improve the treatment success for our patients after robotic pelvic surgery.