Kidney and Urinary System

Anatomy&Physiology

Dr. Besut Daryanto SpB,SpU(K)

Departemen of Urology Saiful Anwar Hospital
Faculty of Medicine, Brawijaya University
Malang 2016
email besut.daryanto@yahoo.co.id
Clinical process
History taking

Laboratory-imaging-
others examination

Histopathology
Examination
Regions,
quadran
ts, and
surface
projectio
ns
Organs that involve in urinary
FPA
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8
Epidemiologi

Faktor dari dalam

• Keturunan
• Usia: 30-50 th.
• Jenis kelamin , P:W= 3:1

Faktor dari luar

• Geography
• Iklim
• Cairan
• Diet
• Pekerjaan
Lower Urinary Tract
Anatomy of Vesicourethral unit

(Ross and Wilson, anatomy and physiology,

2004)
Anatomy of Vesicourethral unit

Van de graaf, human

anatomy, 2004;
Anatomy
The Rectum
Inferior rectal valve

Crypts
Internal h. plexus
Columns

Internal sphincter

External sphincter
DRE Findings (prostate)
 Shape and size
 Consistency
 Symmetry
 Nodularity
 Tenderness
 Mobility
Prostate consistency
 Consistency of a normal
prostate or an enlarged
benign prostate is elastic or
rubbery, similar to the
consistency of the thenar
eminence of a hand
closed in a tight fist with
the thumb folded into the
palm
 A hard consistency is the
same of the consistency of
the knuckle of the thumb
 A boggy consistency is
similar to that of the thenar
eminence when the fist is
closed but relaxed
 Physical Examination:
Bimanual Kidney Palpation
Transiluminasi
 Physical Examination:
Digital rectal examination
 Micturition
process

(Ross and Wilson, anatomy and

physiology, 2004)
 1 . B la d d e r fills
D e tru s o r m u s c le re la x e s

U r in a tio n U re th ra l s p h in c te r
c o n tra c ts
2 . F ir s t d e s ir e to
u r in a te (b la d d e r h a lf
fu ll)
B la d d e r
F illin g &
Em p t y in g
D e tru s o r m u s c le U re th ra l s p h in c te r Cy c le
c o n tra c ts re la x e s

3 . U r in a tio n
v o lu n ta r ily in h ib ite d u n til
tim e a n d p la c e a r e r ig h t
Normal Control of Urination
 Bladder Control System
bladder muscle bladder muscle

bladder bladder
urine urine

Urethra closed Urethra open

Sphincter Muscles Squeezed Sphincter Muscles Relaxed

 Normal Vs Abnormal Voiding
Frequency Urgency
Nocturia Voiding
sensation

Incomplet Satisfied Beginning

e voiding voiding Hesitancy
emptying

Good flow &

caliber Decrease
Post voiding Stop voiding
Uninterrupted calibre & force
after bladder
dribbling empty Painless Intermittency
Dysuria
Foley catheter
(2-way and 3-way)
Tieman tip catheter
Catheter diameter
Penile vascularization
Penile vascularization
Flacid phase Erection phase
Nitric Oxide/cGMP Mechanism of Corpus Cavernosal
Smooth Muscle Relaxation and Penile Erection
Endothelial
cells
NANC NO

Guanylate
cyclase

GTP Penile
cGMP RELAX
GMP erection

PDE5

NO = nitric oxide
NANC = nonadrenergic-noncholinergic
neurons
NO Receptor
• Diseases with abnormal NO Production
• Hypertension
• Obesity
• Dyslipidemias
• Diabetes I and II
• Heart Failure
• Atherosclerosis
• Aging
• Cigarette smoking
Smooth muscle contraction and
relaxation
Etiology
Anatomy of male reproductive
organs
Physiology of ejaculation
 Erection
 Emision
 Ejaculation
Physiology of ejaculation
Physiology of ejaculation
Testicular Descent
 5-8 wk processus vaginalis
 Gubernaculum attaches to lower
epididymis
 12 wk transabdominal descent to internal
inguinal ring
 26-28 wk gubernaculum swells to form
inguinal canal, testis descends into
scrotum
 Insulin-3 (INSL3) effects gubernacular
growth
A. 5th week B. 8th-9th weeks
Testis begins its primary descent; Kidney reaches adult position.
kidney ascends.
C. 7th month D. Postnatal life.
Testis at internal inguinal ring;
gubernaculum (in inguinal fold)
thickens and shortens.
ANATOMY
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