dome of urinary bladder

The dome of the urinary bladder is the anterosuperior surface of the bladder, representing the uppermost rounded portion. It is bounded inferiorly by the apex anteriorly and the fundus posteriorly, and it is the most mobile part of the bladder, rising as the bladder fills.

The median umbilical ligament attaches to the dome of the urinary bladder at the apex. This ligament is the fibrous remnant of the urachus, which connected the bladder to the umbilicus during fetal development. In adults it runs from the apex of the bladder to the umbilicus within the space of Retzius.

The dome is the safest site for intentional cystotomy (surgical opening of the bladder) because it is covered by peritoneum and is relatively avascular compared to the bladder base. It is the preferred site for suprapubic catheter placement and for opening the bladder during transurethral procedures when intraperitoneal access is needed.

The dome of the urinary bladder is covered by peritoneum on its superior surface. As the bladder fills and rises, it lifts the peritoneum off the anterior abdominal wall, creating the retropubic space. This allows suprapubic catheter insertion below the peritoneum when the bladder is distended, reducing the risk of peritoneal injury.

Yes, urothelial carcinoma can arise anywhere in the bladder including the dome. Tumors at the dome may be harder to visualize and resect during cystoscopy due to their location at the top of the bladder. Urachal carcinoma, a rare and aggressive cancer, specifically arises at the dome in relation to the urachal remnant.