The Urinary System

Muh.Iqbal Basri Anatomy Department Hasanuddin University

The Urinary System

1. REN 2. URETER 3. VESICA URINARIA 4. URETHRA

CAVUM PELVICUM

Composition Two kidneyform urine Two ureterconduct urine from kidneys to bladder Bladderreceives and stores urine Urethraconducts urine from bladder to exterior of body (discharged)

The Pelvic Cavity

Bony Pelvis Pelvic Organs Reproductive System

Kidney
General features Bean shaped, reddishbrown organs Superior extremitybroad and thin Inferior extremitynarrow and thick Anterior surfaceconvex Posterior surfaceflat Lateral borderconvex

Medial borderconcave

Renal hilum a vertical slit on the medial border of kidney, the structures which enter and leave the renal hilum is called renal pedicle, including the renal vein, renal artery, renal pelvis, lymphatic vessels and nerves Order of structures in the renal pedicle from anterior to posteriorV. A. P.; from superior to inferiorA. V. P.

Renal sinus which is the renal hilum leads into a space within the kidney, the renal sinus is occupied by the renal vessels, minor renal calices, major renal calices, renal pelvis and some adipose tissue

Structure of the kidney

Renal cortex renal columns Renal medulla

Renal pyramids : 1520 Renal papilla Papillary foramina

Minor renal calices (78) Major real calices (23) Renal pelvis

Polus cranialis (=superior) Fascia renalis

Margo lateralis

Enter and leave :vasa renalis, ureter and saraf

HILUM RENALE

Polus caudalis (=inferior)

About 12-20 pyramidales Consist of BASIS and APEX PYRAMID

Cortex renalis
Papilla renalis

Pyramis renalis Calyx major Columna renalis Bertini

Calyx minor Pelvis renalis c.o. 23 calyx major and calyx major is divided to be 7-14 calyx minor

Sinus renalis

Pelvis renalis
ureter

Urine collection
Ducts within each renal papilla release urine into

minor calyx

major calyx

renal pelvis

ureter

Coverings

Fibrous capsule
a strong fibrous capsule which strips easily from a normal kidney surface but adheres firmly to an organ that has been inflamed

Position

Lie behind peritoneum one on each side of the vertebral column high up on the post abdominal wall, upper pole nearer to media plan than lower pole

Kidney Location

Lateral to vertebral column high on body wall, under floating ribs in retro-peritoneal position

Fatty renal capsule a thick adipose connective tissue capsule, surrounds the fibrous capsule. It acts as a shock absorber to protect the kidney from jolting and jarring Renal fascia on outside, surrounds both the kidney and suprarenal gland, holding these organs in place

Left kidney lies at the level from the lower border of T11 to L2; the 12th rib is behind its middle part of the post surface Right kidney lies slightly lower than the left kidney, at the level from the lower border of T12 to L3; the 12th rib is behind its upper part of the post surface Renal hilum at the level of L1, is about 5cm from the posterior median line Renal regionthe area between 12th rib and the lateral margin of erector spinae

Relationships of kidneys

Superiorlysuprarenal gland Posteriorly

Three muscles Diaphragm (pleural cavity), Psoas major Quadratus lumborum Three nerves Subcostal Iliohypogastric Ilioinguinal Left kidneyabdominal aorta Right kidneyinferior ceva vana

Medial

Anteriorly

Left kidney

Stomach (superior), Pancreas (middle), Loops of intestine and left colic flexure (inferiorly)
Right lobe of liver (superior) Right colic flexure (inferior) Descending part of duodenum (medially)

Right kidney

Renal segments

The kidney is divided into five vascular segments and each is supplied by a branch of the renal artery; between the segments there is no anastomosis. The segments are

Superior segment Superior anterior segment Inferior anterior segment Inferior segment Posterior segment

Ureters

Muscular tube, about 25cm long Three parts

Abdominal partdescend on the psoas major behind the peritoneum Pelvic partin females, passes 2cm lateral to the neck of uterus and lies below the uterine artery Intramural partpasses obliquely through the bladder wall for 2cm long

URETER

Formed by smooth muscle, 25-30 cm Like a tube, two PARS ABDOMINALIS & PARS PELVICA Continued fromPELVIS RENALIS Empty to VESICA URINARIA

Three constrictions

At the pelvoureteric junction Where it crosses the pelvic inlet and iliac vessels Where it pierces the bladder wall obliquely (at intramural part)

Stone in ureter

Relation of abdominal part of ureter

Anterior to left ureter Descending part of duodenum Right colic vesseles Iliocolic vesseles Testicular vesseles Terminal part of ileum Right to left ureter Cecum Vermiform appendix Anterior to left ureter Duodenojejunal flexure Left colic vesseles Testicular vesseles

Bladder
General features Pyramidal in shape when empty, having

Apex, Fundus Body of bladder Neck

VESICA URINARIA

Connective tissue & smooth muscle Morfology vary regard to age, sex & volume There are 3 facies:
1. FACIES SUPERIOR 2. FACIES INFERO-LATERALIS

3. FACIES POSTERIOR (=FUNDUS,=BASIS VESICAE)

Wall of the Bladder

Fibrous adventitia

External Except on superior surface Detrusor Muscle Smooth muscle

Muscular layer

Inner and outer longitudinal layers Middle circular layer Mucosa Distensible transitional epithelium

Interior of bladder

Mucous membrane folded, except for trigone of bladder Trigone of bladder smooth triangular area at inner surface of the funds of bladder, formed by internal urethral orifice anteriorly and two ureteric orifices laerally, in this area absents submucosal layer, where the mucous membrane is firmly adherent to the muscular coat, and is always smooth Interureteric fold muscular elevation, between ureteric orifices.

Location

In the adult, it lies in the lesser pelvis, behind the pubic symphysis, in front of seminal vesicle, ampulla ductus deferentis and rectum in the male, and in front of uterus and vagina in the female. In the young child the empty bladder projects above the pelvic inlet

Urethra
Female urethra Relatively short (about 5cm long), wide and straight Opens into vaginal vestibule

Male versus Female

Urethra

Drains urine from bladder to outside Female = short tube

3-4 cm or 1.5 inches 20 cm or 8 inches Prostatic, Membranous, Spongy (penile) urethra Carries sperm

Males = long tube

Pars membranacea Pars prostatica

Pars spongiosa

Retroperitoneal space and contents

Positionit lies between the parietal peritoneum and transvers fascia of the posterior abdominal wall, from diaphragm to promontory of sacrum, continuation with extraperitoneal fascia. Contentskidney, suprarenal gland, ureter, abdominal aorta, inferior vena cava, nervers and lymphatics, loose connective tissue

Suprarenal gland
Shape and position Right is pyramidal in shape, left one semilunar in shape, consisting of out cortex and inner medulla Located retroperitoneally, superomedial to superior poles of each kidney, enclose with the kidney by the renal fascia Blood supply Arteries

Superior suprarenal a. Middle suprarenal a. Inferior suprarenal a. Right suprarenal v. drains into inferior vena cava Left suprarenal v. joins left renal v.

Venous drainge

Nervers of abdomen
Lumbar plexus Formation: formed by anterior rami of L1-L3, a part of anterior rami of T12and L4 Position: lies within substance of psoas major

Branches

Iliohypogastric n. Supplies lower part of anterior abdominal wall Ilioinguinal n. Passes through inguinal canal to supply skin of the groin and scrotum

Lateral femoral cutaneous Femoral n. Obturator n. Genitofemoral n.

Lumbar sympathetic trunk

Made up of paired chains with four to five lumbar ganglia anterolateral to vertebral column Enters abdomen via the diaphragm and as a continuation of he thoracic part Passes inferiorly behind common iliac vessels and terminations by joining to form unpaired ganglion impar, anterior to sacrum

Relations of abdominal aorta Anteriorly (from above downward)

Pancreas Ascending part of duodenum Radix of mesentery Upper four lumber vertebrae Inferior vena cava Left lumbar sympathetic trunk

Posteriorly

On its right

On its left

Relations of inferior vena cava

Anteriorly (cranially to caudally)

Liver Head of pancreas Horizontal part of duodenum Right testicular (or ovarian) a. Radix of mesentery Right crus of diaphragm Upper four lumber vertebrae Left sympathetic trunk Parietal branches of abdominal aorta Psoas major Right kidney Right suprarenal gland Abdominal aorta

Posteriorly

On its right

On its left