ANATOMY OF THE URINARY SYSTEM

PAGE 1 of 13
ARSON

Grays Anatomy 40th Edition by Susan Standring

THE KIDNEYS
Basic Functions of the Kidneys

Excrete the end products of metabolism and

excess water

Essential for the control of concentrations of

various

Maintains the water and electrolyte balance

Endocrine functions by producing and

releasing erythropoietin and renin
Gross Appearance of the Kidneys

In the fresh state, the kidneys are reddish

brown in color
Location of the Kidneys

Retropertioneal - situated posteriorly behind

the peritoneum behind each side of the
vertebral column

Surrounded by adipose tissue

Superiorly, level with the upper border of

the 12th thoracic vertebrae

Inferiorly, with the third lumbar vertebrae

The right kidney is usually slightly inferior to

the left, reflecting its relationship to the liver

The left kidney is a little longer and

narrower than the right and lies nearer to
the median plane

The long axis of each kidney is directed

inferolaterally

The
transverse
axis
is
directed
posteromedially
Size, Shape and Weight of the Kidneys

Each kidney is typically:

Length of 11 cm

Breadth of 6 cm

Anteroposterior dimension of 3 cm

Average weight of 150 g in men

and 135 g in women

The left kidney may be 1.5 cm longer than

the right

It is rare for the right kidney to be more

than 1 cm longer than the left

In thin individuals with a lax abdominal wall,

the lower pole of the lower right kidney may
be felt in full inspiration by bimanual lumbar
examination, but this is unusual
The Fetal Kidney

In the fetus and newborns, the kidney

normally has 12 lobules

In adults, these are fused to present a

smooth
surface,
although
traces
of
lobulation may remain
The Perirenal Fascia

Dense, elastic connective tissue sheath that

envelops each kidney and suprarenal gland

The kidneys, together with its vessels are

embedded in perirenal fat

Thickest at the renal border

Extends into the renal sinus at the

hilum

Perirenal fascia was originally described as

being made of separate entitites:

Posterior fascia of Zuckerkandl

Anterior fascia of Gerota

Lateral Conal Fascia

Fusion of the two fascias

laterally

Now, the fascia is not made of distinct fused

fascia, but rather a single multilaminar
structure that fused posteromedially with
the muscular fascia of the the psoas major
and quadrates lumborum

Extends anteriorly behind the kidney as a

bilaminated sheet

At variable points, divide into a thin anterior

lamina, passing around the front of the
kidney as the anterior perirenal fascia

A thicker posterior lamina that continues

anterolaterally as the lateral conal fascia,
fusing with the parietal peritoneum

A simple neprectomy for benign diseases

removes the kidney from within perirenal
fascia

A radical nephrectomy for cancer removes

the entire contents of the perirenal space
including the perirenal fascia

In order to give adequate clearance

around the tumor
Relations of the Kidney

Superior poles of the kidneys

Thick and round

Each is related to its suprarenal

gland

Inferior poles of the kidneys

Thinner

Extend to within 2.5 cm of the iliac

crests

Lateral borders are convex

Medial borders

Convex adjacent to the poles

Concave between them and slope

inferiorly

A Hilum opens anteromedially as a deep

vertical fissure

Bounded by anterior and posterior

lips

Contains the renal vessels, nerves

and the renal pelvis

Relative positions of the hilar

structures:

Anterior renal vein

Intermediate renal artery

Posterior renal pelvis

Usually an arterial branch

from the main renal artery
runs over the superior
margin of the renal pelvis
to enter the hilum

A renal venous tributary

often leaves the hilum in
the same plane

Above the hilum, the medial border

is related to the suprarenal gland
and below to the origin of the
ureter

Convex anterior surface

Faces anterolaterally

Relations differs on the right and

left

Posterior surface

Faces posteromedially

Relations are similar on both sides

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Grays Anatomy 40th Edition by Susan Standring

Posteromedial surface of the kidneys

Embedded in fat

Devoid of peritoneum

The right and left kidneys are related to

similar structures

Superior

Diaphragm

Medial and lateral arcuate

ligaments

Inferior in a medial to lateral

direction

Psoas major

Quadratus lumborum

Aponeurotic tendon of the

transversus abdominis

Subcostal vessels

Subcostal, iliohypogastric
and ilioinguinal nerves

Upper pole of the right kidney is in level

with the 12th rib

Upper pole of the left kidney is in level with

11th and 12th rib

The diaphragm separates the kidneys from

the pleura

Descends
to
form
the
costodiaphragmatic recess

The diaphragmatic muscle

Sometimes absent or defective in a

triangle immediately above the
lateral arcuate ligament

Allows perirenal adipose tissue to

contact the diaphragmatic pleura
Internal Macrostructure of the Kidneys

Thin fibrous capsule composed of collagen

rich tissue and some elastic and smooth
muscle fibers

In renal disease, the capsule may become

adherent

The kidneys can be divided into an internal

medulla and external cortex

Renal Medulla

Composed of Renal Pyramids

Pale, striated and conical

Bases peripheral

Apices converging to the

renal sinus

At the renal sinus, they

project into calyces as
papillae

Renal Cortex

Subcapsular

Arching over the bases of the

pyramids

Extending between them towards

the renal sinus as renal columns

Peripheral regions are termed

cortical arches

Traversed by radial, lighter colored

medullary rays

Separated by darker tissue, the

convoluted part

Rays taper towards the renal

capsule
are
peripheral
prolongations from the bases of the
renal pyramids

Renal Pelvis and Calyces of the Kidneys

Hilum of the kidneys lead into a central

renal sinus

Lined by renal capsule

Almost filled by the renal pelvis and vessels

The remaining space being filled by fat

Within the Renal Sinus

Collecting tubules of the nephrons

open onto the summits of the renal
papillae to drain into minor calyces

Minor Calyx

Funnel shaped expansions

of the upper urinary tract

Renal capsule covers the

external surface of the
kidney
and
continues
through the hilum to fuse
with
the
adventitial
coverings of the minor
calyces

Each
minor
calyx
surrounds either a single
papilla or more rarely,
groups of two or three
papillae

Unite
to
with
their
neighbors to form two or
three large chambers, the
major calyx

Major Calyx

Results
from
the
unification of the minor
calyx
Infundibulum

Calyces drain into this

structure

The
renal
pelvis
is
normally formed from the
junction of two infundibula

One from the

upper and one
from the lower
pole calyces

There may a third

which drains the
calyces in the
mid-portion
of
the kidneys

The calyces are usually

grouped so that:

three pairs drain

into the upper
pole
infundibulum

four pairs drain

into the lower
infundibulum

If there is a middle
infundibulum,
the
distribution becomes:

three pairs at the

upper pole

two in the middle

pole

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Grays Anatomy 40th Edition by Susan Standring

two at the lower

pole

There is considerable variation in the

arrangement of the infundibulum and in the
extent to which the pelvis is intrarenal or
extrarenal

The renal pelvis tapers as it passes

inferomedially

It traverses the renal hilum to become

continuous with the ureters

It is rarely possible to determine where the

renal pelvis ceases and where the ureters
begin

The region is usually extrahilar

Normally lies adjacent to the lower

part of the medial border of the
kidney
Vascular Supply, Lymphatic Drainage and
Innervation of the Kidneys

ARTERIAL SUPPLY

Renal Arteries

Paired

Takes 20% of the cardiac

output

Branches laterally from

the aorta just below the
origin of the superior
mesenteric artery

Cross at the corresponding

crus of the diaphragm at
right angles to the aorta

Right renal artery

is
usually longer and often
higher

Left renal artery is a little

lower

Near the hilum, they

branch
anteriorly
and
posteriorly
to
form
segmental arteries

Accessory renal arteries

are common

Subdivisions of the renal

arteries
are
described
sequentially as segmental,
lobar, interlobar, acuate
and interlobular arteries

Segmental Arteries

5 arterial segments

Superior
(Anterior)
Segment

Includes the rest

of the superior
pole
and
the
central
anterosuperior region

Inferior Segment

Encompasses the
whole lower pole

Middle
(Anterior)
Segment

Lies between the

anterior
and
inferior segments

Posterior Segment

Includes
the
whole
posterior
region
between
the apical and
inferior segments

These are the common

patterns seen, but there
may be variations

Whatever the pattern, it

must be emphasized that
vascular segments are
supplied by virtual end
arteries

Larger intrarenal veins

have
no
segmental
organization,
and
anastomose freely

Bloodless
Line
of
Brodel

Avascular
longitudinal zone

Along the convex

renal border

Many
vessels
cross this zone,
and is far from
bloodless
Lobar Arteries

Initial branches of the

segmental arteries

Usually
one
to
each
pyramid
Interlobar Arteries

Formed before reaching

the pyramid

2 or 3 in number

Extending towards the

cortex
around
each
pyramid
Arcuate Arteries

Dichotomize
at
the
junction of the of the
cortex and the medulla

Diverge at right angles

Terminations of adjacent
arcuate arteries do not
anastomose but end in the
cortex
as
additional
interlobular arteries
Interlobular Arteries

Formed as the arcuate

arteries arch between the
cortex and the medulla

Diverge radially into the

cortex

Most come from arcuate

branches,
some
arise
directly from arcuate or
even terminal interlobar
arteries

Ascend
towards
the
superficial cortex
Afferent Glomerular Arterioles

Mainly lateral rami of

interlobular arteries

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Grays Anatomy 40th Edition by Susan Standring

Few arise from the arcuate

and interlobar arteries

Deeper
ones
incline
obliquely back towards
the medulla

Intermediate
pass
horizontally

More
superficial
ones
approach the renal surface
obliquely before ending in
a glomerulus
Efferent Glomerular Arterioles

From glomeruli

Divide to form a dense

peritubular
capillary
plexus
around
the
proximal
and
distal
convoluted tubules

There are two sets of

capillaries:

Glomerular
capillaries

Peritubular
capillaries

These
capillaries
are
linked
by
efferent
glomerular arterioles

The efferent glomerular

arterieslargely supply the
renal medulla
Vasa Recta

Arterioles that pass into

medulla
are
relatively
long, wide and contribute
side
branches
to
neighboring plexuses

Before
entering
the
medulla divide into 12-25
Descending Vasa Recta

Run straight to
varying depths in
the renal medulla

Venous
ends
of
the
capillaries converge to
form Ascending Vasa
Recta

Drain
into
arcuate
or
interlobular veins

Essential feature is that

both
ascending
and
descending vessels are
grouped
into
vascular
bundles

External aspects
of both types are
closely apposed

The
close
proximity of both
descending and
ascending
vessels provides
the
structural
basis for counterexchange
mechanism

VENOUS DRAINAGE

Interlobular Veins

Formed
from
the
convergence
of
free
radicles from the venous
ends of the peritubular
plexuses

One with each interlobular

artery

Begin beneath the fibrous

renal capsule by the
convergence of several
stellate veins, that drain
the most superical zone of
the renal cortex

Arcuate Veins

Formed when interlobular

veins
pass
to
the
corticomedullary junctions

Anastomose
with
neighboring veins

Interlobar Veins

Formed
from
the
anastomoses
of
neighboring arcuate veins

Renal Veins

Large veins lie anterior to

renal arteries

Drain into the inferior

vena cava at right angles

The left renal vein is three

times longer than the right

This is the basis

for the reason
that
the
left
kidney
is
the
preferred side for
live
donor
nephrectomy

The right renal vein is

behind the descending
duodenum
and
is
extremely short

Safe
nephrectomy
requires excision
of a cuff of the
inferior
vena
cava

The left renal vein may be

double, and is sometimes
referred to as persistence
of the Renal Collar

The left renal vein may be

ligated during surgery for
aortic aneurysm because
it has a close relationship
with the aorta

The right renal vein has no

significant
collateral
drainage and can be
ligated
LYMPHATIC DRAINAGE

Begin in three plexuses

Around the renal tubules

Under the renal capsule

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Grays Anatomy 40th Edition by Susan Standring

Perirenal fat
Collecting
vessels
from
the
intrarenal plexus form four or five
trunks
These follow the renal vein to end
in the lateral aortic nodes
The subcapsular collecting vessels
join them as they leave the hilum
The perirenal plexus drains directly
into the same nodes

INNERVATION

Dense plexus of autonomic nerves

around the renal artery formed
from:

Rami from the celiac

ganglion

Aorticorenal ganglion

Lowest thoracic sphlancic

nerve

First
lumbar
sphlancic
nerve

Aortic plexus

Small ganglia occur in the renal

plexus

The largest is usually

behind the origin of the
renal artery

Plexus continues into the kidney

around the arterial branches and
supplies the vessels and renal
glomeruli
and
especially
the
cortical tubules

Axons from the plexuses around

the arcuate arteries innervate
juxtamedullary efferent arterioes
and vasa recta

Control
blood
flow
between the cortex and
medulla without affecting
the glomerular circulation

Axons from the renal plexus

contribute to the ureteric and
gonadal plexus
Gross Abnormalities of the Kidneys

Absent Kidneys

Seen in 1 of 1200 individuals

Results from failure of metanephric

blastema to join with a ureteric bud
on the affected side

Associated
with
absence
of
ipsilateral vas deferens and/or
epididymis

Associated with other congential

anomalies such as:

Imperforate anus

Cardiac
valvular
anomalies

Esophageal atresia

A single kidney often shows

compensatory hypertrophy

Life expectancy is the same as

those with two kidneys

Ectopic Kidneys

Failure of the kidneys to ascend

into the renal fossa in utero

Kidneys are commonly found in the

pelvis

1 in 2500 live births

Associated
with
malrotation
anomalies

Have marked fetal lobulation

Frequently become hydronephrotic

as a result of anterior placed ureter
and an anomalous arterial supply

Associated pelvic-ureteric junction

obstruction is often present
Rarely, two renal masses may be
on the same side and termed
Crossed Renal Ectopia

Fused
under
this
circumstances

Solitary Crossed Renal Ectopia

May be associated with

skeletal
and
other
genitourinary anomalies
Horseshoe Kidney

Found in 1 in 400 individuals

Transverse bridge of renal tissue,

the
isthmus,
that
sometimes
contains renal tissue, connects the
two kidneys

The isthmus lies between the

inferior poles, most commonly
anterior to the great vessels

Ureters have high insertion into the

renal pelvis

Have an increased incidence of

stone disease, due to areas of
inefficient drainage

THE URETERS
Gross Characteristics of the Ureters

Two muscular tubes

Peristaltic contractions of the tubes convey

urine from the kidneys to the urinary
bladder

Measures 25 -30 cm in length

Thick walled and narrow

Continuous superiorly with renal pelvis

Descends slightly medially, anterior to the

psoas major, and enters the pelvic cavity

Curves laterally initially and then medially to

open into the base of the urinary bladder

Diameter is normally 3 mm

It is slightly less at:

The junction with the renal

pelvis

Brim of the lesser pelvis

near the medial border of
the psoas major

It is narrowest at the point:

Where it runs within the

wall of the urinary bladder

All these are common sites for

renal stone impactions
Relations of the Ureters

In the abdomen, descends posterior to the

peritoneum

ANATOMY OF THE URINARY SYSTEM

Grays Anatomy 40th Edition by Susan Standring

Gross

At the origin of the right ureter, it is usually

overlapped by the descending part of the
duodenum
In
the
pelvis,
the
ureters
lie
in
extraperitoneal areolar tissue
Progressively crosses to become medial to
the umbilical
In males, the pelvic ureters hook under the
vas deferens
In females, anterior to the internal iliac
artery is it immediately behind the ovary
The distal 1-2 cm of each ureter is
surrounded is surrounded by an incompete
collar of non-striated muscle, which forms a
Sheath of Waldeyer
Pierce the posterior aspect of the bladder
Runs obliquely through its walls for a
distance of 1.5-2.0 cm before terminating at
ureteric orifices

This arrangement is believed to

assist in the prevention of reflux of
urine into the ureter

It is due to intramural ureters being

occluded
during
increases
in
bladder pressure at the time of
micturition
There is no evidence of classic ureteral
sphincter mechanism in man
In the distended bladder, ureteric opening
are usually 5 cm apart
Ureteric openings are 2.5 cm apart when
the bladder is empty
Abnormalities of the Ureters
Duplex Ureters

Seen in 1 of 125 individuals

Two ureters drain the renal pelvis

on one side

Bilateral duplex systems may occur

in 1 in 800 cases

Derive from two ureteric buds

arising from the mesonephric duct

Contained in a single fascial sheath

Fuse at any point along their

course or maybe separate until
they insert through the urinary
bladder

Ureter from the upper pole (the

longer
ureter)
inserts
more
medially and caudally in the
bladder than the ureter from the
lower pole (shorter ureter)

The shorter ureter is more prone

to reflux
Ectopic Ureters

Single ureters, and more commonly

from the longer ureter of a duplex
system can insert more caudally
and medially than normal

In males, can insert at the bladder

neck, posterior urethra or rarely in
the seminal vesicle

Always inserts cranial to the

external urethral sphincter

In females, can be distal to the

external urethral sphincter or into

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ARSON

the vagina, resulting in persistent

childhood incontinence

Ureteroceles

Cystic dilatation of the lower end of

the ureters

Ureteric orifice is covered by a

membrane which expands as it is
filled with urine and then deflates
as it empties

Vary in size, and have no influence

of ureteric drainage

In adults, they tend to be bilateral

Radiologically, they result in a

Cobra-head Halo around the
ureteric
orifice
following
administration of contrast

Retrocaval Ureters

Persistence
of
the
posterior
cardinal vein

Associated with high confluence of

the right and left common iliac
veins of a double inferior vena cava

Ureters pass behind the inferior

vena cava usually at the level of
the third part of the duodenum

1 in 1500 individuals

Can result in upper ureteric

obstruction
Vascular Supply, Lymphatic Drainage and
Innervation of the Ureters

ARTERIAL SUPPLY

Branches of the:

Renal artery

Gonadal artery

Common iliac artery

Internal iliac artery

Vesical artery

Uterine arteries

Abdominal aorta

Abdominal ureters are supplied by

vessels
originating
medial
to
ureters

Pelvic ureters is supplied by vessels

lateral to the ureters

VENOUS DRAINAGE

Generally follow the arterial supply

LYMPHATIC DRAINAGE

Lymph
vessels
begin
in
submucosal, intramuscular and
adventitial plexuses

Collecting
from
the
upper
abdominal ureter may join the
renal collecting vessels

Those from the lower abdominal

ureters drain to the common iliac
nodes

Those from the pelvic ureters drain

to common, external, or internal
iliac nodes

INNERVATION

Supplied by:

Renal plexus

Aortic plexus

Superior
hypogastric
plexus

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Inferior hypogastric plexus

Ureteric nerves consist of relatively
large bundles of axons

Density
of
the
innervations
increases gradually from the renal
pelvis and upper ureter to a
maximum
density
in
the
juxtavesical segment
Pathologic Conditions Associated with the
Ureters

Renal and Ureteric Calculi

Ureteric calculi tend to be arrested

in their descent in either the pelviureteric region, or in the veiscoureteric region

The vesico-ureteric region is the

narrowest of the areas, and can be
responsible
for
arresting
the
passage of stones as little as 2-3
mm

The kidney and upper ureter move

with respiration within the the
perirenal fascia

Affects visualization and

tracking of a stone

THE URINARY BLADDER

Gross Characteristics of the Urinary Bladder

Serves as a reservoir for urine

Size, shape, position and relations vary

according to its content and state of
neighboring viscera

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When empty, it lies entirely in the lesser

pelvis

As it distends, it expands anterosuperiorly

into the abdominal cavity

An empty bladder is somewhat tetrahedral

It has a base (fundus), neck, apex, superior

and two inferolateral surfaces
Relations of the Urinary Bladder

The base is triangular and located

posteroinferiorly

In females, it is closely related to the

anterior vaginal wall

In males, it is related to the rectum, but

separated from it above by the rectovesical
pouch and below by the seminal vesicle and
vas deferens on each side and Denonvilliers
fascia

The neck is most fixed, lies most inferiorly,

3-4 cm behind the lower part of the
symphysis pubis

The neck is essentially the internal urethral

orifice, and lies in a constant position, and is
independent on the various positions of the
bladder

Anterior surface of the bladder is separated

from the transversalis fascia by fat in the
potential Retropubic Space of Retzius

The inferolateral surfaces are not covered

by perioteneum

In males, the superior surface is completely

covered by peritoneum

In females, the superior surface is largely

covered by peritoneum

As the bladder fills, it becomes ovoid

The distended bladder may be punctured

just above the symphysis pubis without
traversing
the
peritoneum
through
Suprapubic Cystostomy

At birth, the bladder is relatively higher

because the true pelvis is shallow, and thus
is abdominal rather than pelvic

The bladder reaches the adult position

shortly after puberty
Ligaments of the Urinary Bladder

Anchored inferiorly by condensations of the

pelvic fascia attaching it to the:

Pubis

Lateral pelvic side walls

Rectum

Pubovesical Ligaments

Stout bands of fibromuscular tissue

present in both sexes

Extend from the bladder neck to

the inferior aspect of the pubic
bones

Derived from the detrusor muscle,

part of the detrusor apron

In females, they constitute the

superior
extensions
of
the
pubourethral ligaments

In males, the detrusor apron is an

extension of detrusor that extends
over the anterior surface of the
prostate, and condenses distally
and
anteriorly
to
form
the
puboprostatic ligament

The pubovesical ligaments lie on

each side of the median plane,
leaving a midline hiatus through
which numerous small veins pass

There are other ligaments in

regards to the base of the bladder:

Lateral
and
posterior
vesical ligaments in the
male

Cardinal and ureterosacral

ligaments in the female

Reflections of the peritoneum from

the bladder to the side walls of the
pelvis
form
the
Lateral
Ligaments

Sacrogenital folds constitute the

Posterior Ligaments

All are condensations of tissue

around
major
neurovascular
structures
rather
than
true
anatomical ligaments

Median Umbilical Ligament

Apex of the bladder is connected

by the remains of the urachus, the
median umbilical ligament

Composed of longitudinal muscle

fibers derived from detrusor

Becomes more fibrous towards the

umbilicus
Interior of the Urinary Bladder

Vesical Mucosa

Attached loosely by subjacent

muscle

Folds when the bladder is empty

Folds are stretched flat as it fills

Trigone

Smooth muscle consisting of two

distinct layers:

Superficial
Trigonal
Muscle

Represents
a
mor-phologically
distinct
compotent,
continuous with
the
intramural
ureters

Deep Trigonal Detrusor

Muscle

Indistinguishable
from those of the
detrusor

Ureteric Orifices

Placed
at
the
posterolateral
trigonal angles

Approximately 2.5 cm apart and

2.5 cm apart from the internal
urethral orifice

In distentions, these measurements

may be doubled

Internal Urethral Orifice

Sited at the apex of the trigone,

which is the lowest part of the
bladder

Somewhat crescentric in section

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There is often an elevation

immediately behind it in adult
males, particularly those past
middle age, which is caused by the
median prostatic lobe

Bladder Neck

Smooth muscle is histologically,

histochemically
and
pharmacologically distinct from the
detrusor muscle proper

Females

Large diameter fasciculi

characteristic
of
the
detrusor are replaced by
small diameter fasciculi

Sits above the pelvic floor

supported predominantly
by the:

Pubovesical
ligments

Endopelvic fascia

Levator ani

These support the urethra

at rest

The arrangement alters

after parturition and with
increasing age

Bladder neck lies

beneath
the
pelvic floor

Leads to stress
incontinence as a
result of urethral
hypermobility

Males

Completely surrounded by
circular collar of smooth
muscle

Distinct
adrenergic
innervations

Distinct smooth muscle

bundles
surround
the
bladder
neck
and
preprostatic
urethra
forming the Preprostatic
Sphincter

It is a genital sphincter
that
allows
antegrade
ejaculation of semen

Contraction
of
the
sphincter
serves
to
prevent retrograde flow of
ejaculate
Pathologic Conditions Associated with the
Urinary Bladder

Bladder Outflow Obstruction

Progressive chronic obstruction to

micturition as result of:

Prostatic enlargement

Urethral stricture

Hypertrophy
of
the
bladder muscle

Muscle fasciculi increase in size

and
forma
a
thick
walled
Trabeculated Bladder

Mucosa between the fascicles form

diverticuli

Emptying is not complete

Back pressure dilates the ureters

and renal pelvis

Leads
to
progressive
renal
impairment
Vascular Supply, Lymphatic Drainage and
Innervation of the Urinary Bladder

ARTERIAL SUPPLY

Supplied principally by:

Superior vesical arteries

Inferior vesical arteries

Supplemented by:

Obturator arteries

Inferior gluteal arteries

In females, additional branches are

derived from the uterine and
vaginal arteries

Superior Vesical Arteries

Supplies the fundus

Arteries
to
the
vas
deferens often originate
from this artery

Supplies the ureters

Beginning of this artery is

the
proximal
patent
section
of
the
fetal
umbilical artery

Inferior Vesical Artery

Arises from the middle

rectal artery

Supplies the base of the

bladder, prostate, seminal
vesicles and lower ureters

VENOUS DRAINAGE

Veins form a complicated plexus on

its inferolateral surfaces

These pass backwards in the lateral

ligaments of the bladder

It ends in the internal iliac veins

LYMPHATIC DRAINAGE

Begin
in
the
mucosal,
intermuscular and serosal plexuses

Most end in the external iliac nodes

Vessels from the trigone emerge on

the exterior of the bladder

Vessels from the superior surface

of the bladder converge to the
posterolateral angle

Vessels from the inferolateral

surface of the bladder ascend to
join those from the superior surface

INNERVATION

Arise from pelvic plexuses

Mesh of autonomic nerves and

ganglia on the lateral aspects of
the rectum, internal genitalia and
bladder base

Consists of both sympathetic and

parasympathetic components

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Grays Anatomy 40th Edition by Susan Standring

THE MALE URETHRA

Gross Characteristics of the Male Urethra

18-20 cm long

Extends from the internal orifice of the

urinary bladder to the external opening or
Meatus

Considered in two parts

Anterior Urethra

Approximately 16 cm long

Lies within the perineum

proximally
and
penis
distally

Surrounded
by
corpus
spongiosum

Posterior Urethra

4 cm long

Lies in the pelvis proximal

to the corpus spongiosum

Acted
upon
by
the
urogenital
sphincter
mechanisms

Both parts act functionally as a

conduit
Posterior Part of the Male Urethra

Preprostatic Urethra

Approximately 1 cm in length

Extends from the base of the

bladder to the prostate

Small periurethral glands at this

site may contribute to benign
prostatic hyperplasia

Prostatic Urethra

3-4 cm in length

Tunnels through the substance of

the prostate

Closer to the anterior surface

Continuous
above
with
the
preprostatic part
Emerges from the prostate slightly
anterior to its apex
Throughout most of its length,
possesses a midline ridge, the
Urethral Crest

Projects into the lumen

causing it to appear
crescentric in transverse
section
On each side of the crest is a
shallow depression, the Prostatic
Sinus
The prostatic sinus is perforated by
orifices of 15-20 prostatic ducts
An elevation, the Verumontanum
(Seminal Coliculus) is seen about
the middle of the length of the
urethral crest

Surgical landmark for the

urethral sphincter during
TURP
At this point, the urethra turns
anteriorly by 35 degrees and
contains the slit-like orifice of the
Prostatic Utricle

Cul-de-sac 6 mm long

Runs
upwards
and
backwards
in
the
substance of the prostate

Composed
of
fibrous
tissue, muscle fibers and
mucous membranes

Thought to be homologous
from the vagina of the
female

Sometimes called Vagina

Masculina
Lowest part is fixed by the
puboprostatic ligament and is
therefore immobile

Membranous Urethra

Shortest

2-2.5 cm in length

Least dilatable

Narrowest section of the urethra

with exception to the external
orifice

Descends with a slight ventral

concavity from the prostate to the
bulb of the penis

Consists of muscle coat which is

separated from the epithelial lining
by a narrow layer of fibroelastic
connective tissue

Urinary continence at this part is

mediated by radial folds of:

Urethral mucosa

Submucosal
connective
tissue,

Intrinsic urethral smooth

muscle

Striated muscle fibers

ANATOMY OF THE URINARY SYSTEM

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Pubo-urethral component
of the levator ani

Bulbourethral glands are invested

in sphincteric muscle and drain into
the membranous urethra during
sexual excitement
Anterior Part of the Male Urethra

Also known as the spongiose part of the

urethra

Lies within the corpus spongiosum

In flaccid penis, it is about 15 cm long

Extends from the end of the membranous

urethra to the external urethral orifice

Starts below the perineal membrane at a

point anterior to the lowest level of the
symphysis pubis as the Bulbar Urethra

Widest part of the urethra

Surrounded by bulbospongiosum

Urethra curves downwards as the Penile

Urethra

Narrow, transverse slit when empty

Approximate diameter of 6 mm
when passing urine

Dilated at its termination within the

glans penis where it is known as
the navicular fossa

External Urethral Orfice

Narrowest part of the urethra

Sagittal slit

6 mm long

Bounded on each side by a labium

Pathological Conditions Associated with the
Male Urethra

Traumatic Injury to the Male Urethra

May be ruptured by a fall-astride

(straddle) injury to the bulbar
urethra in the perineum

May be injured by pelvic fracture

Affect
the
junction
of
the
membranous with the bulbar
segments across the perineal
membrane

Complications associated are:

Extravasation of urine into

the Colles Fascia

Congenital Anomalies of the Male

Urethra

Hypospadias

1 of 300 boys

Results in the urethra

opening in the distal penis

Either
on
the
ventral aspect of
the penis

Dorsally on to the
perineum

Associated abnormality of
the prepuce

Longer
dorsally
and
lacking
ventrally

Associated with chordee

Causes
ventral
curvature of the
penis

Posterior Urethral Valves

Occur in 5000 to 8000

males

Most common cause of

urinary flow obstruction

Most common type (Type

I) occurs in the Wolffian
ducts

Open
too
anteriorly
onto
the
primitive
prostatic urethra

Abnormal migration of
ducts leaves behind a
thick vestigial tissue that
forms rigid valve cusps
extending caudally from
the verumontanum

Urethral Duplication

Two urethra lie on top of

each other

One, usually the more

dorsal, may be blind
ending
Vascular Supply, Lymphatic Drainage and
Innervation of the Male Urethra

ARTERIAL SUPPLY

Urethral Artery

Arises from the internal

pudendal
artery
or
common penile artery

Supplies the urethra and

erectile tissue around it

Supplementary supply by
the dorsal penile artery

Blood supply to the corpus

spongiosum is so plentiful
that the urethra can be
divided
without
compromising its vascular
supply

VENOUS DRAINAGE

Drainage is through:

Dorsal veins of the penis

Internal pudendal veins

These veins drain into the prostatic

plexus

Posterior urethra drains into the:

Prostatic plexus

Vesical venous plexus

All these veins drain into the

internal iliac veins

LYMPHATIC DRAINAGE

Pass mainly into the internal iliac

nodes

Few may end in the external iliac

nodes

Vessels from the membranous

urethra accompany the internal
pudendal artery

Vessels from the anterior urethra

accompany those of the glans
penis, ending in the deep inguinal
nodes

INNERVATION

ANATOMY OF THE URINARY SYSTEM

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Grays Anatomy 40th Edition by Susan Standring

Prostatic Plexus

Supplies
the
smooth
muscle of the prostate and
prostatic urethra

Lesser Cavernous Nerves

Pierce the bulb of the

corpus
spongiosum
to
supply the penile urethra
Greater Cavernous Nerves

Carry sympathetic supply

casing contraction of the
preprostatic sphincter
Fibers from Onufs Nucleus

Somatic

Supply the membranous

urethra

THE FEMALE URETHRA

Gross Characteristics of the Female Urethra

Approximately 4 cm long

6 mm in diameter

Begins at the internal urethral orifice of the

bladder and runs anteroinferiorly behind the
symphysis pubis

Suspended beneath the pubis by the

Posterior Pubourethral Ligaments and
anteriorly by the Suspensory Ligaments
of the Clitoris

Ends at the external urethral orifice in the

vestibule as an anteroposterior slit with
rather prominent margins, directly anterior
to the opening of the vagina, and 2.5 cm
behind the glans clitoris

When no urine is passing through, the walls

of the urethra are thrown into folds

Posterior
folds is termed the
Urethral Crest

Many small mucous urethral glands and

minute pit-like recesses or lacunae open
into the urethra and give rise to Urethral
Diverticulae

On each side, near the lower end of the

urethra, the Skenes Glands, are grouped
together and open into the para-urethral
duct
Vascular Supply, Lymphatic Drainage and
Innervation of the Female Urethra

ARTERIAL SUPPLY

Urethral Artery

Urethra
is
supplied
principally by the vaginal
artery

Receives supply from the

inferior vesical artery

VENOUS DRAINAGE

Venous plexus around the urethra

drain into the vesical venous
plexus around the bladder neck
and into the internal pudendal
veins

Erectile plexus of veins along the

length of the urethra is continuous
with the erectile tissue of the
vestibular bulbe

LYMPHATIC DRAINAGE

Urethral lymphatics drain into the

internal and external iliac nodes

INNERVATION

Parasympathetic
preganglionic
fibers arise from neurons in the
second to fourth segments of the
sacral spinal cords

Synpase in the vesical plexus near

the bladder wall

Somatic fibers to the striated

muscle are derived from S2 to S4

Sensory fibers run in the pelvic

sphlancic nerves to the second to

ANATOMY OF THE URINARY SYSTEM

Grays Anatomy 40th Edition by Susan Standring

fourth segments of the sacral

spinal cord
Postganglionic sympathetic fibers
arise from the plexus around the
vaginal arteries

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