1. THE URINARY SYSTEM
H.A MWAKYOMA, MD

2. Urinary System Kidneys Ureters Bladder Urethra
Be sure to go over diagrams and other structures within the urinary system.

5. URINARY BLADDER

6. Anatomy-Kidney

7. Components of Glomerulus:
Capillary basement membrane
Mesangium
Bowman capsule
Cells
Endothelial
Epithelial
Mesangial

8. Anatomy of Kidney

9. Anatomic Compartments
Glomerulus
Tubules
Blood vessels
Interstitium
Collecting system
(Callices & Pelvis)

10. Kidney Functions:
Excretion metabolic waste/drugs.
Water/fluid balance.
Electrolyte balance.
Acid-base balance.
Blood pressure.
Erythropoietin secretion.

11. Anatomy of Kidney Glomerulus Loop of Henley PCT, DCT, CT
Note the positions of
Glomerulus
Loop of Henley
PCT, DCT, CT
Cortex, Medulla, Pelvis.

12. JGA
GFR  Renin
Angiotensin
Blood Pressure

13. Filtration Membrane:

14. Normal Kidney:

15. Pathology definitions
Oliguria – a decrease in the amount of urine that is being passed.
Polyuria – too much urine is being excreted
Anuria – total suppression of urine formation and secretion
Retention – the bladder does not release urine
Hematuria – blood in the urine
Uremia – toxic wastes in the blood
Cystitis – inflammation of bladder
Pyelitis – inflammation of the renal pelvis.
Dysuria – painful urination

16. Kidney Diseases Developmental disorders Glomerular diseases
Tubulo-interstitial diseases
Urinary stones
Obstructive uropathy
Tumors

17. Developmental disorders

18. Congenital Anomalies:
Agenesis – Potter syndrome
Ectopia
Fusion
Dysplasia
Simple cysts
Polycystic kidney disease

19. Renal agenesis (Solitary kidney)
The total failure of a kidney to develop.
Results from a failure of the embryonic renal bud or renal vascular system to form.
Usually only occurs unilaterally

20. Bilateral renal agenesis

21. Unilateral renal ageneasis

22. Renal agenesis

23. Supernumerary kidney
A third kidney that is usually small and rudimentary and possesses a separate pelvis, ureter, and blood supply

24. Partially fused supernumerary kidney with bifid ureter

25. Hypoplaisa (Hypoplastic kidney)
A kidney that is less developed than normal.
It is often called a miniature kidney

26. Hypoplastic kidney with renal dysplasia

27. Renal Ectopia
A misplaced kidney that are usually found in the pelvis and associated with a short ureter.
The short ureter is the key factor to rule out Nephroptosis.
pg143

29. Anomalies of rotation, position and fusion
Mal-rotation
One or both kidneys may produce a bizarre appearance of the renal parenchyma, calyces, and pelvis that suggest a pathological condition when in reality the kidney is normal

30. Anomalies of rotation, position and fusion
Nephroptosis
The kidney falls down into the pelvis when a person stands up due to the pull of gravity
Also called “floating kidney” or ectopic kidney

31. Crossed Ectopy
One kidney lies either partially or completely across the midline and is fused with the other kidney at the lower pole.

32. Horseshoe kidney
Both kidneys are joined at their lower poles across the midline of the body.
Stones are more frequent
The most common fusion anomalies

33. Horse Shoe Kidney

34. Horseshoe Kidney Situated usually in front of fouth lumbar vertebra
Fused lower poles common
Ureters angulated
Infection
Nephrolithiasis
Fixed mass below umbilicus

35. Complete Fusion
Both of the kidneys are fused together in a single irregular mass which has no resemblance to a renal structure.

36. Polycystic kidney disease
Autosomal dominant (adult) (1:1,000)
Autosomal recessive (infantile (1:30,000)
Medullary cystic disease complex (1:10,000)
Medullary sponge kidney
Acquired cystic renal disease

37. Autosomal Dominant PKD
Common kidney disease (1:1,000)
ADPKD-1 gene (polycystin) mutation 85%
Bilaterally enlarged kidneys (>3,000g)
Symptoms appear in adult life
Renal failure 5-10 years thereafter

38. ADPKD:

39. ADPKD:

40. ADPKD Associated Conditions
Liver cysts (30%)
Splenic cysts (10%)
Pancreatic cysts (5%)
Cerebral aneurysms (20%)
Diverticulosis coli

41. Congenital cystic kidneys – polycystic kidneys
Hereditary
Autosomal dominant trait
Not usually detectable until the second or third decades of life and never manifests before the age of 30
Irregular upper quadrant mass
Loin pain
Haematuria
Infection
Hypertension
Uraemia
CT image : multiple cysts in both kidneys

42. URETERS Duplication of a ureter
The ureters usually join before they reach the bladder
Less commonly the ureters open indepedently into the bladder
Congenital megaureter

43. Double Ureter:

44. Ureteroceles
Cyst like dilations of a ureter near its opening into the bladder.
Radiographically it has the classic “cobra head” appearance.
Like a diverticula only it goes into the bladder not out from it. When the bladder is full, it decrease the size of the ureterocele due to an increase in the pressure in the bladder. May cause obstruction if large enough.

45. URINARY BLADDER

46. Congenital defects of the bladder
Ectopia vesicae – exstrophy of the bladder
Easily recognised at birth
Umbilicus absent, protruding due to the intraabdominal pressure
In addition epispadias
Mons and clitoris bifid
In the neonate the bladder should be covered with Saran Wrap or clingfilm to prevent trauma to the delicate mucosa

47. Ectopia vesicae – exstrophy of the bladder

48. Exstrophy of the bladder

49. A case of ectopia vesica with absent pelvic bone and herniated caecum

50. Diverticula
The bladder or ureters are common areas for diverticula (out pouching of the wall).
Best seen on a retrograde ureogram
Because urine can stay in these areas for a long period of time, infections or irritations may occur.

51. bladder. Bladder Diverticulum

52. Congenital abnormalities of the urethra and penis
Meatal stenosis
Congenital stricture
Congenital valves
Hypospadias
epispadias

53. Meatus
Congenital stenosis of the external urethral meatus – normally the narrowest part of the male urethra
Associated with phimosis – at times pin hole meatus
Back pressure effects
Spraying, dribbling

54. Congenital Urethral Stricture
Rare

55. Congenital valves of the posterior urethra
Folds of urothelium
Obstuction in boys
Within prostatic urethra
Catheter will pass easily
Micturating cystourethrogram
Pass catheter

56. Epispadias and Hypospadias
Hypospadias: congenital defect in which the urinary meatus is located on the lower or underside of the shaft
Epispadias: congenital defect in which the urinary meatus is located on the upper side of the penile shaft; less common than hypospadias

57. Epispadias and Hypospadias
Clinical manifestations
Ventral or dorsal placement of the urethral opening
Altered urinary stream
Chordee
Diagnostic evaluation
Based on physical examination

58. Hypospadias Most common urethral abnormality Glandular hypospadias
Coronal hypospadias
Penile and penoscrotal hypospadias
Perineal hypospadias
Avoid circumcision

59. Normal External Urethral Meatus

60. Hypospadias types

61. Hypospadias

62. Phimosis At birth foreskin adherent to the surface of the glans penis
Separate spontaneously with time
Can wait for 4 years to separate
Gentle retraction at bath permitted
Forcible retractions injure

63. Phimosis

65. “To be a great champion you must believe you are the best
“To be a great champion you must believe you are the best. If you’re not, pretend you are.” – Muhammad Ali