The Urinary System 泌尿系统 山东大学医学院 解剖教研室 李振华

The Urinary System Composition Kidney 肾－form urine Ureter 输尿管－conduct urine from kidneys to bladder Bladder 膀胱－receives and stores urine Urethra 尿道－conducts urine from bladder to exterior of body (discharged)

Kidney 肾 General features Bean shaped, reddish-brown organs Superior extremity－broad and thin Inferior extremity－narrow and thick Anterior surface－convex Posterior surface－flat Lateral border－convex

Kidney 肾 Medial border－concave Renal hilum 肾门－a vertical slit on the medial border of kidney Renal pedicle肾蒂 － the structures which enter and leave the renal hilum，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.

Kidney 肾 Renal sinus 肾窦 The renal hilum extends into a large cavity within the kidney Occupied by the renal vessels, minor renal calices, major renal calices, renal pelvis and some adipose tissue

Renal structure Renal cortex 肾皮质 Renal medulla 肾髓质 renal columns 肾柱 Renal medulla 肾髓质 Renal pyramids 肾锥体 (15～20) Renal papilla 肾乳头 Papillary foramina 乳头孔 Minor renal calices 肾小盏 (7－8) Major renal calices 肾大盏 (2～3) Renal pelvis 肾盂

Coverings of kidney Fibrous capsule 纤维囊 －a strong fibrous capsule which strips easily from a normal kidney surface but adheres firmly to an organ that has been inflamed

Coverings of kidney Fatty renal capsule 脂肪囊 －a thick adipose connective tissue capsule, surrounds the fibrous capsule. It acts as a shock absorber to protect the kidney from jolting and jarring Renal fascia 肾筋膜 －on outside, surrounds both the kidney and suprarenal gland, holding these organs in place

Position of Kidney Lie behind the peritoneum high up on the posterior abdominal wall on either side of the vertebral column Upper pole nearer to media plan than lower pole

Position of Kidney Left kidney lies at the level from the lower border of T11 to L2; the 12th rib is behind its middle part of the post surface Right kidney lies slightly lower than the left kidney, at the level from the upper border of T12 to L3; the 12th rib is behind its upper part of the post surface Renal hilum at the level of L1, is about 5cm from the posterior median line Renal region－the area between 12th rib and the lateral margin of erector spinae

Position of Kidney

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

Relations of kidneys Anteriorly Left kidney Stomach (superior) Tail of pancreas and splenic vessels (middle) Loops of intestine and left colic flexure (inferior) Right kidney Right lobe of liver (superior) Right colic flexure (inferior) Descending part of duodenum (medially)

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

Resin corrosion cast of human kidneys Resin corrosion cast of human kidneys. Ureter, pelvis and calyces are yellow; aorta, renal arteries and their branches are red.

Coronal multislice CT scans of the right and left suprarenal glands.

CT renal venogram. Acquired from a multislice CT examination and reconstructed as a 3D surface shaded reformat.

Ureters 输尿管 Muscular tube, about 25cm long Three parts Abdominal part－descend on the psoas major behind the peritoneum Pelvic part－in females, passes 2cm lateral to the neck of uterus and lies below the uterine artery Intramural part－passes obliquely through the bladder wall for 2cm long

Three constrictions of Ureters 1. At the pelvoureteric junction 2. Where it crosses the pelvic inlet and iliac vessels 3. Where it pierces the bladder wall obliquely (at intramural part)

Multislice CT urogram. Coronal reformat showing the enhancing renal parenchyma and both ureters along their entire length.

Multislice CT urogram. 3D-surface shaded reformat showing the kidneys, ureters, bladder and surrounding bony anatomy.

Stone in ureter

Relation of abdominal part of ureter Anterior to left ureter Duodenojejunal flexure Left colic vessels Testicular vessels Anterior to right ureter Descending part of duodenum Right colic vessels Iliocolic vessels Terminal part of ileum Right to right ureter Cecum Vermiform appendix

Bladder 膀胱 General features －pyramidal in shape when empty, having Apex Fundus Body of bladder Neck

Interior of bladder ★Trigone of bladder 膀胱三角 Smooth triangular area at inner surface of the funds of bladder Formed by internal urethral orifice anteriorly and two ureteric orifices laterally In this area absents submucosal layer, where the mucous membrane is firmly adherent to the muscular coat, and is always smooth Interureteric fold 输尿管间襞 －muscular elevation, between ureteric orifices.

Location of bladder In the adult, it lies in the lesser pelvis, behind the pubic symphysis, in front of seminal vesicle, ampulla ductus deferentis 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

Urethra 尿道 Female urethra Relatively short (about 5cm long), wide and straight Opens into vaginal vestibule