Escolar Documentos
Profissional Documentos
Cultura Documentos
Urinary Tract
Scope: Retroperitoneum,
Kidneys, Ureters, Bladder, &
Female Urethra
Urinary System
• Retroperitoneum & Adrenals
• Kidneys
• Ureters
• Bladder
• Urethra
Retroperitoneum
Retro- means “behind”
Bounded:
– Anteriorly: Peritoneal Sac
– Superiorly: Diaphragm
– Posteriorly: Contiguous with the
retroperitoneal portions of the pelvis.
– Posteriorly & Laterally: Abdominal Wall
Retroperitoneu
m
The Kidneys (L: renes)
Level of T12 to
L3.
The Kidneys
The kidneys remove excess
water, salts, and the products of
protein metabolism from the
blood and maintain its pH.
Then these are conveyed to the
urinary bladder through the
ureters.
Kidney Position
Lateral to the
vertebral Column
Generally, the
right kidney is
lower because of
the presence of
the large right
liver lobe
Kidney Regions:
Anterior surface
Posterior surface
Superior pole
Middle region
Inferior pole
Lateral margins/borders (convex)
Medial margins/borders (concave)
The Kidney
Perirenal fat
Gonadal veins
Points to Remember Regarding
the Major Blood Supply of the
Kidney
Both renal arteries arise from the aorta,
both renal veins drain into the IVC. Both
arteries and veins arise/drain just
opposite each other.
The kidneys consume 20% of the
heart’s cardiac output.
The arteries generally lie posterior to
the vein within the renal hilum.
The renal pelvis is generally infero-
posterior to the vessels.
Gonadal veins
Points to Remember Regarding
the Major Blood Supply of the
Kidney
Length
The right renal artery is longer
than the left.
The right renal vein is shorter
than the right
Gonadal veins
Points to Remember Regarding
the Major Blood Supply of the
Kidney
Crossings
The right renal artery crosses the
IVC posteriorly.
The left renal vein crosses the
aorta anteriorly.
Gonadal veins
Points to Remember Regarding
the Major Blood Supply of the
Kidney
Major branches:
The renal artery branches into the anterior and
posterior segmental arteries.
The anterior segmental artery further divides
into 4 additional segmental arteries:
– Apical - Middle
– Upper - Lower
These 5 segmental branches are responsible for
dividing the kidney into segments.
LOBAR ARTERIES
Lymphatic
s of the
Right
Kidney
Interaortoca
val &
Paracaval
Lymphatic
s of the
Left Kidney
Para-aortic
Ultrasonography
IVP or IVU
Intra Venous Pyelogram
or
Intra Venous Urogram
Renal Conditions
Renal Tumors
Acute Renal Failure
– Temporary
Chronic Renal Failure
– Permanent
– End-Stage Renal Disease (ESRD)
The Ureter
Conveys urine produced in the kidney to the
bladder through peristaltic motion.
Thick walled expandable muscular ducts with
a narrow lumen that carry urine from the
kidneys to the urinary bladder. Usually 25 cm
in length in adults
Continuous with the renal pelvis.
Completely retroperitoneal but adheres
closely to the parietal peritoneum.
Descends anterior to the psoas.
Points to remember regarding the Ureter’s course
From upper to
middle part, the
ureter runs lateral to
its corresponding
great vessel.
The IVC is on the
RIGHT, the AORTA is
on the LEFT.
Closely adherent to
the peritoneum
At the lower ureter,
the ureter shifts from
lateral to medial, by
crossing the iliac
vessels anteriorly.
The ureters then
course towards
the infero-
posterior bladder.
The ureters enter
the bladder
through its
opening, the
bladder hiatus.
The ureter ends
by opening into
the bladder lumen
through the
ureteral orifices.
The Ureter has three
points of narrowing
throughout its course
•Most common locations where
ureteral stones will lodge.
UPJ
Iliac Vessel
crossing
UVJ
The Ureter has multiple
blood supplies.
1. Point of narrowing.
2. Landmark in
surgical dissection.
Venous Drainage of the Ureter
Gonadal veins
Innervation of the
Ureters
Derived from the adjacent
autonomic plexuses which
contain pain fibers.
Afferent fibers from the ureters
enter the spinal cord via dorsal
roots T11, T12, & L1
Lymphatic Drainage of
the Kidneys & Ureters
Generally follow the course of the
renal vein and drain into the lumbar
(lateral aortic) lymph nodes.
Upper ureteral lymphatics join those of
the kidney.
Middle ureteral lymphatics drain to the
common iliac nodes.
Lower ureteral lymphatics drain to the
common, external or internal iliac
lymph nodes.
Urinary Stone Disease
Nephrolithiasis
– Calyceal calculi
– Infundibular calculi
Pelveolithiasis
Ureterolithiasis
– Proximal third
– Middle third
– Distal third
P3
M3
D3
Congenital Renal &
Ureteral Anomalies
Supernumerary Kidney
Renal Ectopia
Horseshoe Kidney
Ureteral duplication
End of Kidneys &
Ureter
Start of the Urinary Bladder &
Prostate
Urinary Bladder (L. vesica)
Apex
Differences in the
Bladder between Male
& Female
Male Female
Between the bladder & Between the bladder &
the rectum are the the rectum is the cervix
ampullae of the vas & & the superior part of
the seminal vesicles. the vagina.
Bladder neck opens into Bladder neck opens into
the prostatic lumen. the short female
There is a bulge just urethra.
beneath the trigone There is usually an
caused by the posterior extrinsic compression
lobe of the prostate. at the superior margin
caused by the
anteverted uterus.
Layers of the Bladder
(external to internal)
geneyus@urologist.ph