Blood Supply of the Bladder
Arterial Supply
The bladder receives its arterial blood supply primarily from the superior and inferior vesical arteries, which are branches of the internal iliac artery (also called the hypogastric artery). 1
Primary Arterial Sources
Superior vesical artery: Arises from the umbilical artery (which itself branches from the internal iliac artery) and supplies the superior and anterolateral aspects of the bladder 2
Inferior vesical artery: Originates directly from the internal iliac artery in approximately 73% of males, or from the umbilical artery in 27% of cases 3
In females, the inferior vesical artery is present in only 47% of cases and shows significant anatomical variation—it may arise from a common trunk with the umbilical and uterine arteries (33%), directly from the umbilical artery (33%), from the uterine artery (22%), or from the obturator artery (11%) 3
Additional Arterial Contributors
Middle vesical artery: A fairly constant branch of the umbilical artery that supplies the bladder neck and anterior bladder wall above the neck 2
Urachal artery: Originates from the umbilical artery and contributes to bladder vascularization 2
Vesiculo-deferential artery: A constant vessel in males that contributes to bladder blood supply 2
Clinical Significance of Arterial Supply
The internal iliac artery is the critical vessel for bladder perfusion—bilateral ligation results in significant bladder ischemia with decreased bladder wall oxygen tension, leading to oxidative stress, muscarinic receptor upregulation, and smooth muscle degeneration 1, 4
Even unilateral ligation of the internal iliac artery decreases bladder blood flow and impairs voiding pressure, though blood flow may recover within two weeks 4
During pelvic trauma requiring angioembolization for hemorrhage control, non-selective bilateral embolization of the internal iliac arteries may be necessary for hemodynamically unstable patients with multiple bleeding targets 5
Venous Drainage
The bladder drains venously through the vesical venous plexus (and prostatic plexus in males), which empties into the internal iliac vein. 6
Venous Drainage Pattern
The vesical and prostatic plexuses drain into the internal iliac vein via 2-5 veins (most commonly 3 veins) in approximately 80% of cases 6
In 20% of cases, these plexuses are absent and vesical veins drain directly from the bladder wall into the internal iliac vein via only 1-2 veins 6
Vesical veins frequently unite with obturator, prostatic, or vaginal veins before entering the internal iliac vein 6
Occasional shunts exist from the vesical venous system to the external iliac vein via connections with the obturator vein 6
Clinical Pitfall
Surgeons must recognize the significant anatomical variations in bladder vascularization, particularly in females, to prevent inadvertent bladder devascularization during pelvic surgery or non-selective arterial ligation 3. The rich collateral circulation and anastomoses of pelvic vasculature explain why bilateral embolization may be required even for unilateral pelvic fractures 5.