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

2. 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)

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Position of Kidney

12. 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

13. 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)

14. 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

15. 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.

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

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

19. 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

20. 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)

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

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

23. Stone in ureter

24. 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

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

26. 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.

27. 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

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