Anatomy of the kidney &

ureter
 Anatomy of the kidney & ureter

Ureter
Shape &size
 thick- walled retroperitoneal muscular tube
 25- 30cm long& 6mm in diameter
 Anatomy of the kidney & ureter

Ureter
Beginning
 inferior continuation of the renal pelvis

 in front of tr. Process of L2

Termination
into posterosuperior angle of urinary bladder
 Anatomy of the kidney & ureter

Ureter
parts
1) Abdominal part
 upper 1/ 2
 on post. Abd. Wall
2) Pelvic part
 lower 1/ 2
 on lat. Wall of pelvis
 Anatomy of the kidney & ureter

Ureter
parts
1) Abdominal part
• descends retroperitoneally on anterior
surface of the psoas muscle

• at its midpoint is crossed anteriorly by

gonadal arteries (testicular/ovarian).

• It crosses pelvic brim in the region of

bifurcation of common iliac art.

• it underlies the apex of mesosigmoid usually

run over ext. iliac art
 Anatomy of the kidney & ureter

Ureter
parts
2)Pelvic part
 After entering the pelvis,
 ureter passes inferoposteriorly, on the side
wall of pelvis
 anterior to the internal iliac vessels
 behind ovary
 When reach level of the ischial spines,
 it turn anteromedially above pelvic floor to
enter the base of the bladder at its upper
corner
anatomical course of the ureters is of surgical importance, as they are situated close to many other structures in the pelvis. They mus

Anatomy of the kidney & ureter

Ureter
parts
Intramural part
 ureters enter the bladder 5 cm apart
externally

 pierce its lateral aspect in an oblique manner.

 their internal openings are but 2.5 cm apart

 This creates a one way valve, where high

intramural pressure collapses the ureters,
preventing the back-flow of urine
 Anatomy of the kidney & ureter

Constrictions of the ureter

• anatomically narrowed in 3
locations:

• Renal stones may lodge at these

narrowed points.
 Anatomy of the kidney & ureter
Skeletal Relations of Ureter
• ureter starts at the tip of the transverse process
of L2
• then follows the line of the tips of the
transverse processes of the remaining lumbar
vertebrae.
• crosses in front of the sacroiliac joint.
• till reaches the ischial spine.
• Then it turns medially to enter the urinary
bladder.

N.B
Knowing the course of the ureter in relation to bony landmarks is useful in identifying the course
of the ureter in a plain X-ray of the abdomen and pelvis and in locating tiny stones in the ureter
 Anatomy of the kidney & ureter
Skeletal Relations of Ureter
• ureter starts at the tip of the transverse process
of L2
• then follows the line of the tips of the
transverse processes of the remaining lumbar
vertebrae.
• crosses in front of the sacroiliac joint.
• till reaches the ischial spine.
• Then it turns medially to enter the urinary
bladder.

N.B
Knowing the course of the ureter in relation to bony landmarks is useful in identifying the course
of the ureter in a plain X-ray of the abdomen and pelvis and in locating tiny stones in the ureter
 Anatomy of the kidney & ureter

• Arterial blood supply : no specific artery

 From any nearby artery,
 its chief supply is derived from ureteral
branches from
• renal, gonadal a.
• Aorta
• common and internal iliac aa.
• vesical a.
• uterine a.
 Ureteric branches reach the ureters from their
medial side
 divide into ascending and descending branches.
 All these vessels make a fairly good anastomosis
forming longitudinal channels
 Anatomy of the kidney & ureter

The ureter is identified at operation by

1) Its appearance as thick whitish, non-
pulsatile muscular tube
2) Shows longitudinal blood vessels
along its wall
3) shows peristaltic activity when gently
pinched with forceps
Anatomy of the kidney & ureter

KIDNEY
General functions of Kidney
 Regulating blood volume
Anatomy and pressure
of the kidney & ureter

 Regulating plasma electrolyte concentrations such

as sodium, potassium, chloride…

 Stabilizing blood pH by controlling the loss of

hydrogen ions and bicarbonate

 Conserving nutrients

 Eliminate organic waste products


General functions of Kidney
Endocrine Function:
Anatomy of the kidney & ureter
 Erythropoetin(EPO)

 RENIN

 1,25- dihyroxy vitamin D

 Anatomy of the kidney & ureter

Kidney
Shape & size
  bilateral bean shaped

 retroperitoneal organs.

 reddish-brown in colour

 12cm long, 6cm wide & 3 cm thick

 130 to 170 g in weight
 Anatomy of the kidney & ureter

Kidney
general features :
Has:
2 ends:
 upper end: broader& 1 inch from median
plane
 Lower end: rounded & 2 inches from
median plane
2 borders:
 med: concave& presenting the hilum
 Lat: convex
2 surface:
 ant.: irregular & related to abd. Organs
 Post. : flat& applied to post. Abd. Wall
 Anatomy of the kidney & ureter

Kidney
Hilum:
• lies in the middle of med. Border
• Leads to a wide space inside the kidney
called sinus
• Gives passage to the following structures
• arranged from before backwards
 Renal vein most anteriorly
 Renal artery in the middle
 Pelvis of the ureter most posteriorly
 T12
KIDNEY 11 rib 12 rib
L1
Lt kidney
L2

Rt kidney
L3
The kidney extends from
T12-L3 vertebrae.

Psoas shadow

Anteriorly the hilum of the

kidney lies approximately
on the transpyloric plane 5 L1
cm from the midline.
 KIDNEY 11 rib

Posteriorly, T12
12 rib
superior parts of the
kidneys lie deep to the LT
L1
11th and 12th ribs.

right kidney normally RT

extends about 2 cm
lower than the left.

Each kidney moves 3

cm in a vertical
direction during deep
breathing.
 Anatomy of the kidney & ureter

Kidney
Capsules (covering ) of kidney (3F)
 They are arranged as follows (deep to superficial):
1) Renal capsule (Fibrous capsule)
Tough fibrous capsule.
2) Perirenal fat (Fatty capsule)
  Collection of extraperitoneal fat.
 continuous with the fat within the renal sinus
3) Renal fascia (false capsule)
  Encloses the kidneys and the suprarenal glands.
4) Pararenal fat – Mainly located on the posterolateral
aspect of the kidney

perinephric abscess,
 pus collects in the space between the true and fascial
capsules.
 It tends to descend along the periureteral sheath
downwards andmay reach pelvic cavity
 Anatomy of the kidney & ureter

Kidney
Capsules (covering ) of kidney (3F)
Supports of Kidney
(factors maintain kidney in position)
1) fatty capsule
2) fascial capsule
3) renal vessels.

N.B
nephroptosis (floating kidney).
 Anatomy of the kidney & ureter

Kidney
Renal Angle
Definition
 angle between the lower margin of 12th rib and lateral
margin of erector spinae muscle.
 At this angle, the kidney lies close to the body surface.
 Anatomy of the kidney & ureter

Kidney
Renal Angle
Definition
 angle between the lower margin of 12th rib and lateral
margin of erector spinae muscle.
 At this angle, thekidney lies close to the body surface.
Importance
1) Renal pain:
usually felt at the renal angle as a dull ache.
2) perinephric abscess:
causes swelling and tenderness at the renal angle.
3) lower border of pleura:
 runs horizontally, crossing 12th rib at the lateral margin of
erector spinae muscle
 in approaching the kidney (lumbar route)
upper end of the skin incision should begin below renal angle
Gross appearance of kidney in coronal section

kidney is composed of
 cortex
 dark, outer region
 is composed million
NEPHRONS per kidney

 Medulla
 light, inner region
• consists of 6 to 12 pyramids,
• number is variable.
.
Gross appearance of kidney in coronal section
 Medullary pyramid
 consist of
 base of each pyramid faces the cortex
and forms corticomedullary boundary.
 round apex of pyramid extends
downward to the renal pelvis to form
renal papilla

 renal columns
cortical tissue that extends in between
the adjacent pyramids in the medulla
 Medullary rays
• consist of
 collecting ducts,
 blood vessels,
 straight portions of a number of nephrons
 That penetrate the cortex from the base
of pyramids.
Gross appearance of kidney in coronal section
 renal sinus
 space within the hilus that surrounds the renal pelvis
 filled with loose adipose connective tissue.
 renal papilla
• Apex of each medullary pyramid
• through which collecting ducts open into a calyx
 area cribosa
• tip of each papilla, perforated by the openings of collecting ducts
 calyx
• space into which one medullary pyramid drains
• renal calyces are of two orders,
 minor calyx
o One minor calyx may receive one papilla or more than one.
 major calyx
o are less in number
o usually two to three and are formed by fusion of minor calyces.
o major calyces unite to form the pelvis of kidney.
o combined volume of the pelvis and calyces is nearly 8 ml.
Gross appearance of kidney in coronal section
 Renal lobe
consists of one medullary pyramid

together with the associated cortex .

 Renal lobule
region of cortex surrounding and
drained by a single bundle of
collecting ducts
 Functional Histology of Kidney
 Nephron
 Structural & functional units
of the kidney.


Consist of 4 parts
 renal corpuscles
 filter the blood

 other components of the nephrons

 involved in selective resorption
from the glomerular filtrate.
 Functional Histology of Kidney
 Blood Supply of Kidney
Each kidney is supplied by
renal artery
• arises from aorta
• near L2.
• Rt. one longer
• both lie posterior to renal veins when
entering the hilum
• pattern of branching may vary, but there are
always 5 segments with no collateral
circulation between them
renal veins
• drain into the IVC.
• Lt. one receives
1) inferior phrenic v
2) Suprarenal v
3) gonadal vein
 Functional Histology of Kidney
 Blood Supply of Kidney
 Functional Histology of Kidney
 Blood Supply of Kidney
Anatomy of bladder
 Anatomy of the bladder
 hollow muscular organ,, highly distensible
 situated anteriorly in the pelvic cavity.

Functions :
serves two functions:
• Temporary store of urine
• Assists in the expulsion of urine –  During
voiding, the musculature of the bladder
contracts, and the sphincters relax.
 Anatomy of the bladder
Position
varies with
 At birth
 It is abdominal organ,
 internal urethral meatus at the level of the
upper border of symphysis pubis.
 shortly after puberty
• becomes a pelvic organ
• internal urethral meatus is just above plane
of the inferior margin of symphysis pubis.
 In adult
 empty bladder is entirely in the pelvic cavity
• distended bladder rises in the abdominal
cavity.
 position of bladder in the adult is described
as:
 lying on the front part of pelvic floor
 below the peritoneum
 behind the pubic symphysis.
 Anatomy of the bladder
Capacity
 varies from 120 to 250 ml.
 Maximum capacity is 500 ml

• Shape:
 vary according to the amount of urine
that it contains
 tetrahedral when empty
 ovoid when distended

External features: has

• Apex.
• Base.
• Neck.
• Three surfaces
 Superior
 two inferolateral
• Four borders
 Anterior
 posterior
 two lateral
 Anatomy of the bladder
Relations
Apex in male
• It provides attachment to the
median umbilical ligament

• lies posterior to the upper margin

of the pubic symphysis.

• median umbilical ligament is

the fibrous remnant of the intra-abdominal part of the
allantois (urachus).

In female
Has same relation
 Anatomy of the bladder
Relations
Base in male
• Its upper ½ inch covered by peritoneum
• Related to rectum but separated from it by:
1) Rectovesical pounch contai coils of ileium(upper part)
2) seminal vesicle and ductus deferens(lower part).
external trigone
• A triangular area of the base
• bounded
 above :line of peritoneal reflection
 on the sides: right and left vasa deferentia
• closely related to the rectum,
• Denonvillier’s fascia : only structure intervening between
the two.
 Anatomy of the bladder
Relations
Base in female
• Is devoid of peritoneum
• Related to upper part of the anterior wall of vagina
 Anatomy of the bladder
Relations
superior surface in male
• triangular in shape
• bounded
 on each side : lateral borders which extend from
ureteric orifices posterolaterally to the apex
anteriorly
 posteriorly : posterior border which joins
the ureteric orifices.
 completely covered by the peritoneums
 related to coils of the ileum, and/or sigmoid colon.
 Anatomy of the bladder
Relations
superior surface in female
• Its greater part covered by peritoneum
& related to Anterior surface of uterus with
shallow uterovesical pouch in between

 Its most posterior part devoid peritoneum

& related to supravaginal part of cervix
 Anatomy of the bladder
Relations
inferolateral surfaces in male
• devoid of peritoneum and
• in both sex are related:
• In front to
– retropubic space,
– pubic symphysis, and
– puboprostatic ligaments.

• Behind to
– obturator internus muscle above
– levator ani muscle below.

In female
Has same relations
 Anatomy of the bladder
Relations
Neck (inferior angle)in male
• lowest and most fixed part of the bladder.
• where inferolateral & posterior surfaces of the
bladder meet.
• It is pierced by the urethra.
• about 3–4cm behind the lower part of pubic
symphysis.
• Rests on the base of prostate gland

In female
 Rest on the pelvic fascia
 Give attachment to pubo-vesical ligament
 Anatomy of the bladder
Blood Supply
1) superior vesical a
.(proximal patent part of obturated umbilical a.
2) inferior vesical a (vaginal a. in female):
from ant. division of internal iliac a.
3) Additional branches are derived from
 obturator
 inferior gluteal arteries.
 in female from uterine arteries.
Venous drainage
• Vesical veins form plexus lying on inferolateral surfaces.
• Then pass along the posterior true ligaments to open into
the internal iliac veins.
• They are in communication with the internal vertebral
venous plexus

Lymphatic drainage
to external iliac L.N
 Anatomy of the bladder
Nerve Supply (inferior hypogastric plexuses)
1) Sympathetic :
 T11,12 &L1,2
 . They synapse in the inferior hypogastric plexus,
 On stimulation cause
 inhibit contraction of the detrusor
 stimulate closure of the sphincter vesicae
So the sympathetic efferent fibers mainly act on the muscle
surrounding the bladder neck.

2) Parasympathetic :
 From pelvic splanchnic (S2,3,4)
 preganglionic parasympathetic fibers
 postganglionic neurons in the bladder wall.
 On stimulation cause
 contraction of detrusor
 relaxation of internal sphincter.
So, parasympathetic is “nerve of emptying or voiding”.
 Anatomy of the bladder
 afferent fibers from the bladder: carry
 pain impulse from the mucosa
 sense of awareness of bladder filling.