Anatomy of the

Lower Urinary
Tract

Arley Telussa
Bladder
Urinary Bladder
• The bladder is a hollow muscular organ
that serves as a reservoir for urine.
• In women, its posterior wall and dome are
invaginated by the uterus.
• Adult bladder normally has a capacity of
400-500 mL
Bladder
Bladder
• When empty, adult bladder lies behind the pubis symphisis as
a pelvic organ. In infant and children, its higher.
• When full, it rises well above.
• Extending from the dome of the bladder to umbilicus : median
umbilical ligament (the obliterated urachus).
• Ureters enter the bladder posteroinferiorly in oblique manner
(5 cm apart).
• The trigone occupies the area between the ridge and the
bladder neck.
Trigone
 Relations
• In males, the bladder is related posteriorly to the seminal
vesicle, vasa deferentia, ureters and rectum.
• In females, the uterus and vagina are interposed between
the bladder and rectum.
• The dome and its posterior surfaces are covered by
peritoneum. Hence, this is the area the bladder related to
small intestine and sigmoid colon
• Related to the posterior surface of the pubic symphysis,
when distended, its in contact with the lower abdominal
wall.
Male bladder
relations with other organs
Female bladder
 Histology
• Mucosa : composed of transitional epitelium.
• Beneath the mucosa : sub mucosal layer
(connective and elastic tissues)
• External to submucosa : detrusor muscle.
• 3 layers : inner longitudinal, middle circular,
outer longitudinal.
Histology of the bladder
Blood supply
Arterial :
• Superior, middle, and inferior vesical arteries, which arise from
anterior trunk of the internal iliac artery.
• Smaller branches from the obturator and inferior gluteal
arteries.
• In females, the uterine and vaginal arteries also send branches
to the bladder.
Venous :
• Surrounding the bladder is a rich plexus of veins thar empties
into internal iliac veins.
 Innervation of the bladder

 The autonomic nerves serving the urinary bladder are

derived from pelvic plexuses.
 Sympathetic innervation arises from the last thoracic and
first and second lumbar spinal nerves
 Parasympathetic innervation arises from the second,third,
and fourth sacral nerves to serve the detrusor muscle.
 The sensory receptors of the urinary bladder respond to
distension and relay impulses to the central nervous
system via the pelvic spinal nerves.
 Urethra
 Diameter is 8-9mm
 Conveys urine from the urinary bladder to the outside of the
body.
 Two muscular sphincters surround the urethra. The
involuntary smooth muscle sphincter, the superior of the two,
is the internal urethral sphincter, which is formed from the
detrusormuscle of the urinary bladder.
 The lower sphincter, composed of voluntary skeletal muscle
fibers, is called the external urethral sphincter
 Female urethra
• The urethra of the female is a straight tubular organ, about 4
cm (1.5 in.) long, that empties urine through the urethral
orifice into the vestibule between the labia minora.
• The urethral orifice is positioned between the clitoris and
vaginal
• The female urethra has a single function: to transport urine to
the exterior.
Female urethra
Male urethra
• The urethra of the male serves both the urinary and
reproductive systems. It is about 20 cm (8 in.) long, and is S-
shaped because of the shape of the penis.
• Three portions can be identified in the male urethra: the
prostatic part, the membranous part, and the spongy part
Male urethra
Histology of the urethra
 the muscle layer, continuous with that of the bladder.At its
origin there is the internal urethral sphincter, consisting mainly
of elastic tissue and smooth muscle fibres, under autonomic
nerve control.
 the submucosa, a spongy layer containing blood vessels and
nerves
 the mucosa, which is continuous with that of the bladder in
the upper part. In the lower part the lining consists of stratified
squamous epithelium, continuous externally with the skin of
the vulva.
Histology of the urethra
Micturition
Prostate
 A fibromuscular and glandular organ lying just inferior to the
bladder.
 Weighs about 20 g and contains the posterior urethra, which is
about 2.5 cm in length.
 Supported anteriorly by the puboprostatic ligaments and
inferiorly by the urogenital diaphragm
 Perforated posteriorly by the ejaculatory ducts, which pass
obliquely to empty through the verumontanum on the floor of
the prostatic urethra just proximal to the striated external
urinary sphincter .
According to McNeal (1972),
the prostate has a peripheral
zone, a central zone, and a
transitional zone; an anterior
segment; and a preprostatic
sphincteric zone .
Histology of prostate
 Have two main component, stromal and glands component
 Consists of a thin fibrous capsule under which are circularly
oriented smooth muscle fibers and collagenous tissue that
surrounds the urethra (involuntary sphincter).
 Deep in this layer lies the prostatic stroma, which are
embedded the epitelial glands.
 These glands drain into the major excretory ducts (about 25 in
number) which open chiefly on the floor of the urethra
between the verumontanumand the vesical neck.
 Beneath the transitional epithelium of the prostatic urethra lies
the periurethral glands
Histology of the prostate
Blood supply & innervation

 Blood is supplied to the prostate from branches of the middle

rectal and inferior visceral arteries.
 The venous return forms the prostatic venous plexus, along
with blood draining from the penis. The prostatic venous
plexus drains into the internal iliac veins.
 The prostate has both parasympathetic (S2-4) and sympathetic
(T10-L2) innervation arising from the pelvic plexuses.