1. David Fu
The Urinary System School of Basic Medical Science of Jiujiang University

2. Urinary System Functions
To excrete the waste products, such as urea and uric acid, excess water and some inorganic salts, so as to regulate the composition of the internal environment of the body, in terms of water content, osmotic relations and acid-base balance. The female urethra is an urinary duct, while the male urethra serves urinary and genital functions.

3. ★
Composition
Two kidneys－produce urine
Two ureters－convey urine from kidneys to the urinary bladder
One urinary bladder－receives and stores urine temporarily
One urethra－carries urine from the urinary bladder to the outside of the body .

4. Kidney Each kidney has two extremities, two surfaces and two borders.
General features
Bean-shaped, reddish-brown organs
Superior extremity－broader and thinner
Inferior extremity－narrower and thicker
Anterior surface－convex
Posterior surface－flat
Lateral border－convex

5. 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.

6. Location of kidneys
Lie behind the parietal peritoneum against the muscles of the posterior abdominal wall. one on each side of the vertebral column high up on the posterior abdominal wall, upper pole nearer to media plan than lower pole.
The right kidney is lower about a half body of vertebra than the left one, possibly because of its close relationship to the liver.
Generally in female it is lower than in male. It is higher in adult than in child. In newborn child the inferior extremity of kidney may be at the level of the iliac crest.

7. 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 lower border of T12 to L3; the 12th rib is behind its upper part of the post surface
Renal hilum is at the level of L1, about 5cm lateral to the posterior median line of the body
Renal region★－in clinic the area between 12th rib and the lateral margin of the erector.

8. Relationships of kidneys
Superiorly－superarenal 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

9. Anteriorly Left kidney Right kidney Stomach (superior),
Pancreas (middle),
Loops of intestine and left colic flexure (inferiorly)
Right kidney
Right lobe of liver (superior)
Right colic flexure (inferior)
Descending part of duodenum (medially)

10. Structure of the kidney
Renal cortex
renal columns
Renal medulla
Renal pyramids: 15～20
Renal papilla
Papillary foramina
Minor renal calices
(7 ～ 8)
Major real calices (2～3)
Renal pelvis

11. Renal sinus
－which is the renal hilum leads into a space within the kidney, the renal sinus is occupied by the renal vessels, minor renal calices, major renal calices, renal pelvis and some adipose tissue

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

13. Fatty renal capsule －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 －on outside, surrounds both the kidney and suprarenal gland, holding these organs in place

14. What is the difference between renal hilum & renal sinus?
Arrows review basic parts
rest of picture shows details of drainage system
minor calyx accepts tip of pyramid where urine is dripping off papilla
3 minors empty into major in yellow
major empty into pelvis which is the top of the ureter
variability between kidneys
What is the difference between renal hilum & renal sinus?
Outline a major calyx & the border between cortex & medulla.

15. 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

16. ectopic kidney
renal transplantation
renal calculus or kidney stone
horseshoe kidney

17. Ureters 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 for1.5～ 2.0 cm long

18. Three constrictions ★
At the junction of the ureter and the renal pelvis
Where it crosses the pelvic inlet and iliac arteries
Where it pierces the bladder wall obliquely (at intramural part)

19. Stone in ureter
uronephrosis

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

21. Anatomy of Urinary Bladder
Hollow, in the adult the normal capacity of the urinary bladder is from 300 ml to 500 ml

22. Urinary Bladder General features Pyramidal in shape when empty, having
Apex,
Fundus
Body of bladder
Neck

23. Interior of bladder
Mucous membrane folded, except for trigone of bladder
Trigone of bladder★ －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 －muscular elevation, between ureteric orifices.

24. Location
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

25. Location
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

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

27. Male urethra Three parts
Prostatic part －lies within the prostate and is the widest and most dilatable portion of urethra.
Membranous part –lies within the urogenital diaphragm surround by the sphincter of urethra
Cavernous part－transverse the length of cavernous body of urethra
Posterior urethra－prostatic part and membranous part
Anterior urethra –-cavernous part

28. Within prostatic part Urethral ridge Prostatic utricle
The orifices of the ejaculatory ducts

29. Three constrictions Three enlarged parts
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

30. Two curvatures Subpubic curvature－concave upward
Prepubic curvature －concave downward
cystoscopy
catheterization

31. Which constrictions and curves are to go through essentially when lithecbole of renal pelvis in male?