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Anatomy and Physiology of the Bladder, Trigone, and Urethra

Saul Boyarsky, MD
JAMA. 1972;221(13):1522. doi:10.1001/jama.1972.03200260056035.
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Already recognized as a pioneer surgeon and scientist in vesicoureteral reflux, Hutch now clarifies bladder and urethral function by his baseplate theory. Clinically, this theory has been slow in achieving acceptance, possibly due to its piecemeal presentation in the urological literature. Now, this well-illustrated monograph allows the reader to study and evaluate it.

Briefly, the author presents evidence to show that the three smooth muscle layers of the bladder are fashioned for specific functions. From the middle layer, the circular fibers terminate at the bladder neck, fuse with the trigone to form a fundus ring as part of the baseplate. The middle outer longitudinal layer inserts loops of muscle into the transverse precervical arc anteriorally and into the apex of the deep trigone posteriorally, as well as sending a third component around the bladder neck anteriorally as a detrusor loop. The trigone tissues pass uninterruptedly as a middle layer of


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