The Urinary System

Presented by Dr. Anusuya shrestha

Learning objectives
Students will be able to:
Describe the gross features of kidney.
List its relations.
Describe its blood supply, lymphatic drainage
and nerve supply.
List some applied aspects.

kidney

Kidney are pair of

excretory organs.
Reddish brown in
color and present a
smooth and glistening
appearance in living.

- The kidneys lie along the posterior abdominal

wall

Position
Lie behind peritoneum
one on each side of the
vertebral column high
up on the post
abdominal wall, upper
pole nearer to median
plan than lower pole.
The position of kidney
varies with respiration
and the posture of the
body.
.

Kidney

The longitudinal axis of

the kidney run obliquely
downward and laterally
and hence upper pole
is situated 2.5 cm and
lower pole 7.5 cm away
from midline.
The transverse axis of
the kidney runs laterally
and backwards.

Left kidney lies at the level

from the lower border of T11
to L2.

Right kidney lies slightly

lower than the left kidney, at
the level from the lower
border of T12 to L3.

Kidney
General features
Superior pole broad and thin
Inferior pole narrow and thick
Anterior surface convex
Posterior surface flat
Lateral border convex and smooth
Medial border concave and shows
the depression of hilum at its middle.

Medial border concave

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
posterior V. A. P.; from
superior to inferior A. V. P.

Renal hilum at the

level of L1, is about
5cm from the
posterior median line.

The transpyloric plane

passes through the
lower part of the hilum
of the left kidney and
upper part of the right
kidney.

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.

Fatty renal capsule

a thick adipose
connective tissue
capsule, surrounds the
fibrous capsule..
Renal fascia on
outside, surrounds both
the kidney and
suprarenal gland, holding
these organs in place.

Supports of kidney

The factors that

maintain the kidney
in position are fatty
capsule, fascial
capule and the renal
vessels.

Relationships of kidneys
Superiorly suprarenal gland
Posteriorly
Three muscles
Diaphragm (pleural cavity),
Psoas major
Quadratus lumborum
Three nerves
Subcostal
Iliohypogastric
Ilioinguinal
Medial
Left kidney abdominal aorta
Right kidney inferior vena cava

Renal sinus
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 (outer)
renal columns
Renal medulla (inner)
Renal pyramids : 6 12
Renal papilla
Cortical arch

Minor renal calices (7 8)

Major real calices (2 3)
Renal pelvis

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

Path of Blood Through

Kidney
Renal artery
interlobar arteries (up renal columns, between
lobes)

arcuate arteries (over pyramids)

interlobular arteries (up into cortex)
afferent arterioles
glomerulus (cluster of capillaries)
efferent arterioles (near medulla vasa recta)
peritubular

capillaries

interlobular veins arcuate veins interlobar veins

Renal vein

Lymphatic drainage

The lymphatic vessels

accompany the renal
vessels and terminate
in lateral aortic lymph
nodes near the origin
of renal arteries.

Nerve supply

Both sympathetic and parasympathetic

innervations are provided to the kidney
through renal plexus.

Renal artery angiography

Clinical applied of kidneys

Injured kidneys
Calculi
Perinephric abscess
Renal failure

URETER

Thick muscular tube.

Which convey urine from renal

pelvis to the urinary bladder.

Location-

Length and diameter25cm and 3mm

Extent-

Part-

Course of ureter

The abdominal part of each

ureter runs downwards
posteriorly it rest on the psoas
major. At brim of pelvis the
ureter crosses at the junction
between bifurcation of common
iliac vessels and comes to lie
on the lateral wall of the pelvis.
here it runs backwards and
laterally.

COURSE OF URETER

Finally it leave the

pelvic wall and turns
medially and forwards
to reach the posterio
lateral part of urinary
bladder.

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)
These constricted areas
are potential sites of
obstruction by ureteric
stones.

Relation of abdominal part

of ureter

Anterior to right ureter

Horizontal part of
duodenum
Right colic vessels
Iliocolic vessels
Right gonadal vessels
Root of the mesentery
and coils of intestine.

Relation of abdominal part

of ureter

Right to right ureter

Cecum
Vermiform appendix
Left to right ureter
inferior venacava

Relation of abdominal part

of ureter

Anterior to left
ureter
Left colic vessels
Left gonadal
vessels
Sigmoidal vessels
The sigmoid
mesocolon lies
anterior at its lower
part.

Posterior relations

Pelvic part of ureter in male

The pelvic part of

ureter can be divided
into two parts, namely
posterolateral and
anteromedial.
The posterolateral
part is in contact with
lateral pelvic wall.

Relations of pelvic part of ureter

Posteriorly- internal iliac
invessels,
male
lumbosacral

trunk and sacroiliac joint,

from before backwards.
Anteriorly- it is covered
with peritoneum
Laterally- obliterated
umbilical artery, obturater
nerve and vessels,
inferior vesical vessels
and middle rectal vessels

Relations of pelvic part of

ureter in male

The anteromedial or
second part lies in
the floor of the pelvic
cavity.
It is related superiorly,
to the pariteal
peritoneum and
inferiorly, to the
levator ani muscle.

Relations of pelvic part of

ureter in male

Near its termination in

the bladder, it is
crossed by vas
deferens anteriorly
and is related to the
upper end of seminal
vesicle

Relations of pelvic part of ureter

in female

Intravesical part

The ureter has an oblique course in the wall of

urinary bladder.
The intramural part of the ureter is narrowest.
The oblique passage of ureter prevents the reflux
acting as a flap valve.

Blood supply of ureter

The arterial supply to the

ureter is as follows: upper
end, the renal artery;
middle portion, the
testicular or ovarian
artery; and in the pelvis,
the superior vesical
artery.
Venous blood drains into
veins that corresponds to
the arteries.

Lymphatic drainage

The lymph drains to the lateral aortic nodes

and iliac nodes.

Nerve supply of ureter

The nerve supply is the renal, testicular (or

ovarian), and hypogastric plexuses (in the pelvis).
Afferent fibers travel with the sympathetic nerves
and enter the spinal cord in the first and second
lumbar segments.

Stone in ureter

Urinary Bladder
Students will be able to:
Describe the gross features urinary bladder.
List its relations.
Describe its blood supply, lymphatic drainage
and nerve supply.
List some applied aspects.

Urinary Bladder

Smooth, collapsible, muscular sac that

temporarily stores urine
It lies retroperitoneally on the pelvic floor
posterior to the pubic symphysis

Males prostate gland surrounds the neck

inferiorly
Females anterior to the vagina and uterus

59

Bladder
General features
Hollow muscular organ
Pyramidal in shape
when empty, having

Apex,
Neck
Body of bladder

Location
In the adult, it lies in the
lesser pelvis, behind the
pubic symphysis, in front
of seminal vesicle,vas
deferens 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

Shape and capacity

Empty- tetrahedral
Distended- globular or
ovoid
The capacity of the
bladder varies from
120 to 250 ml.
The maximum
capacity is 500 ml.

Surfaces, border and angles

4 triangular surfaces, 4
borders and 4 angles.
The borders are anterior,
right and left lateral and
posterior.
The surfaces are
posterior, superior, rt and
lt inferolateral surface.

Urinary Bladder (Cont.):

Urachus: closed remnant

of the allantois.
Prostate gland:
In males,

Lies directly inferior to

the bladder
Surrounds the urethra

64

Relation of urinary bladder

Posterior surface of the bladder

66

Contd.

Neck of the bladder

It is pierced by the
internal urethral
meatus.
At the neck, the
circular fibres of
detrusor muscle show
slight aggregation to
form internal
sphincter of the
bladder.

Neck of the bladder

In the male , the neck

is in direct contact
with the base of the
prostate while in
female it rest on the
pelvic fascia.

ligaments

Divided into true and false..

The true ligaments are the condensations of
the pelvic fascia around the base and neck of
the bladder.
The false ligaments are the peritoneal folds

True ligaments

The median umbilical ligament

The medial and lateral puboprostatic or
pubovesical ligaments
The lateral true ligaments
The posterior true ligaments

False ligaments

The median umbilical fold

The medial umbilical folds
The lateral false ligaments
The posterior false ligaments

Interior of bladder
Mucous membrane folded, except for
trigone of bladder
Trigone of bladder
smooth
triangular area on the posterior
surface of the interior of bladder,
formed by internal urethral orifice 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

Interior of bladder

Interureteric fold

muscular elevation, between

ureteric orifices.
Clinically important because
infections tend to persist in
this region
Uvula vesicae.
Mucosa of the trigone is
most vascular more sensitive

Blood supply of urinary bladder

Arteries
The superior and inferior vesical arteries, branches
of the internal iliac arteries.
Veins
The veins form the vesical venous plexus which
drains into the internal iliac vein.

Lymph Drainage

Internal and external iliac nodes.

Nerve Supply

Both parasympathetic and sympathetic

components of autonomic nerve supply the
bladder through the vesical plexus of nerve.

Urethra

In anatomy, the urethra is a tube that connects the

urinary bladder to the genitals for the removal of
fluids out of the body. In males, the urethra travels
through the penis, and carries semen as well as
urine. In females, the urethra is shorter and
emerges above the vaginal opening.

The male urethra

Is a membranous canal for
external discharge of urine
and seminal fluid.
(18-20 cm long).
In the flaccid (non-erect)
state, the urethra has a
double curvature.

Extent and location

Internal urethral
orifice at the neck of
the urinary bladder to
the external urethral
orifice at the tip of the
penis.

Male Urethra

Internal urethral sphincter

External urethral sphincter

3 regions
prostatic urethra
membranous urethra
penile urethra

Prostatic part of the urethra

3cm long
Embedded within the
prostate gland.
Most widest and dilatable
part, The prostatic part
starts at the internal
urethral orifice and run
vertically downwards
through the anterior part
of the prostate to reach
the urogenital diaphragm.

On transverse section, it
is star shaped. The
posterior wall of the
prostatic urethra present
the following features.
The urethral crest or is a
median longitudinal ridge
of mucous membrane.
The colliculus seminalis
is an elevation on the
middle of urethtal crest.

On this elevation there

are three opening on it a
median for prostatic
utricle and lateral for
ejaculatory duct of each
side.
Prostatic sinus is a
groove on each side of
the crest. About 15 to 20
prostatic duct open in
the prostatic sinus.

Continued

The prostatic utricle is a

blind sac directed upwards
and backwards.
It opens at the middle of
the urethtal crest.
6 mm long.

Membranous part of urethra

The membranous part

passes through the
deep perineal space.
The perineal space is
bounded above by the
superior fascia of the
urogenital diaphragm
and below by the
inferior fascia of the
urogenital diaphragm.

Continued

The membranous
urethra is about
(1.5cm) long and lies
within the urogenital
diaphragm, surrounded
by the sphincter
urethrae muscle. It is
the least dilatable
portion of the urethra

Bulbourethral gland

two small pea-shaped glands, located in the deep

transverse muscle of perineum, opens into the fixed part
of the penile urethra about 2.5 cm below the perineal
membrane.

Spongy or penile part of the

The third part of the urethra
urethra
runs through the bulb and the

corpus spongiosum of the

penis.
The urethra enters the bulb
immediately after piercing this
membrane and terminates at
the external urethral orifice
situated at the tip of the glans
penis
The total length is about 15cm.

Contd

The external meatus is

the narrowest part of the
entire urethra. The part of
the urethra that lies within
the glans penis is dilated
to form the fossa
terminalis (navicular
fossa). The bulbourethral
glands open into the
penile urethra below the
urogenital diaphragm.

Three constrictions

At the internal urethral

orifice
At the membranous part
At the external orifice of
urethra

Three enlarged parts

At prostatic part
At bulb of urethra
At navicular fossa of urethra

Arterial Supply of the Male

Urethra

The inferior vesical, middle rectal and penile

branches of internal pudendal arteries supply the
male urethra.

Venous and Lymphatic

Drainage of the Male Urethra

The veins from the urethra drain into the prostatic

venous plexus. The lymphatic vessels pass mainly
to the internal iliac lymph nodes; a few vessels
drain into the external iliac lymph nodes

Innervation of the Male

Urethra

The nerves are derived from the prostatic plexus

(mixed sympathetic, parasympathetic, and visceral
afferent fibers)

Urethra
Female urethra
Relatively short (about
4cm long), wide and
straight
Opens into vaginal
vestibule

Female Urethra

The female urethra

(approximately 4 cm
long and 6 mm in
diameter) passes
anteroinferiorly from the
internal urethral orifice
of the urinary bladder,
posterior and then
inferior to the pubic
symphysis, to the
external urethral orifice

Female Urethra

3 to 4 cm long
External urethral orifice

between vaginal orifice and

clitoris

Internal urethral sphincter

detrusor muscle thickened,

smooth muscle, involuntary
control

External urethral
sphincter
skeletal muscle, voluntary

Contd..

In females, the external urethral orifice is located in

the vestibule, directly anterior to the vaginal orifice.
The urethra lies anterior to the vagina.

Contd

Urethral glands are present, particularly in the

superior part of the urethra. One group of glands
on each side, the paraurethral glands, are
homologues to the prostate. These glands have a
common paraurethral duct, which opens (one on
each side) near the external urethral orifice.

Arterial Supply of the Female

Urethra

Blood is supplied to the female urethra by the

internal pudendal and vaginal arteries

Venous and Lymphatic

Drainage of the Female
The veins follow the arteries and have similar
Urethra

names. Most lymphatic vessels from the urethra

pass to the sacral and internal iliac lymph nodes,
but a few vessels from the distal urethra drain into
the inguinal lymph nodes.

Innervation of the Female

Urethra

The nerves to the urethra arise from the vesical

(nerve) plexus and the pudendal nerve.

Contd.

Passage of kidney stones through the urethra

can be painful, which can lead to
urethral strictures.
Urethritis
Rupture of urethra
Urethral stricture
Cancer of the urethra.

Clinical applied

Traumatic injury to urethra.

The penile urethra may open at an abnormal site.
a) if the opening is located on the undersurface of
the penis is called hypospadias.
b) when (much more rarely) it is on the dorsal
surface the condition is called epispadius.
Infection of the urethra is urethritis, said to be more
common in females than males. Urethritis is a
common cause of dysuria (pain when urinating).

Retroperitoneal space and

contents

Position it lies between

the parietal peritoneum and
transvers fascia of the
posterior abdominal wall,
from diaphragm to
promontory of sacrum,
continuation with
extraperitoneal fascia.
Contents kidney,
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.

Venous drainge

Right suprarenal v. drains into inferior

vena cava
Left suprarenal v. joins left renal v.

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)

Posteriorly

Upper four lumber

vertebrae

On its right

Pancreas
Ascending part of
duodenum
Radix of mesentery

Inferior vena cava

On its left

Left lumbar sympathetic

trunk

Relations of inferior vena cava

Anteriorly (cranially to caudally)

Posteriorly

Right crus of diaphragm

Upper four lumber vertebrae
Left sympathetic trunk
Parietal branches of abdominal aorta

On its right

Liver
Head of pancreas
Horizontal part of duodenum
Right testicular (or ovarian) a.
Radix of mesentery

Psoas major
Right kidney
Right suprarenal gland

On its left

Abdominal aorta