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Ureter & Urinary bladder
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Urinary system Urinary system consists of Kidneys Ureters
Urinary bladder Urethra
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Ureter Narrow, thick-walled, expansile muscular tube Conducts urine
From kidney to urinary bladder Retroperitoneal Length: 25 cm (10 inches) Diameter: 3 mm
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Formation Formation of Renal pelvis Formation of ureter
Is a funnel-shaped structure Formed by Union of major calyces Location Partially outside and partly inside the kidney Formation of ureter Renal pelvis continues as ureter At lower pole of kidney
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Parts Divided into Abdominal part Pelvic part
Each part is about the same length i.e., 12.5 cm (5 inches)
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Abdominal Part - Course
Extends From the renal pelvis To the bifurcation of the common iliac artery
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Abdominal part - Anterior Relations
Right side 2nd part of duodenum Right colic vessels Iliocolic vessels Right testicular / ovarian vessels Root of mesentery Left side Left colic vessels Sigmoidal vessels Left testicular / ovarian vessels Sigmoid mesocolon
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Abdominal part – posterior relations
Tips of transverse process of lumbar vertebrae Psoas major Genitofemoral nerve
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Pelvic part - course Runs downward in front to internal iliac artery, reaches ischial spine Turns forward and medially, enters the upper lateral angle of urinary bladder Near its termination, is crossed by the vas deferens Passes obliquely through the wall of bladder for about ¾ inch before opening into the bladder cavity
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Pelvic part - parts 2 parts First part Second part
From infront of beginning of external iliac artery To ischial spine Follows greater sciatic notch Second part From ischial spine Passes forwards and medially To base of urinary bladder
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Pelvic part of Ureter – first part
Relations Posterior Sacroiliac joint Internal iliac Anterior trunk of internal iliac Lumbosacral Anterior Peritoneum Forms posterior boundary of ovarian fossa Ovary & uterine tube
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Pelvic part of Ureter – first part
Laterally Ureter crosses in front of All nerves and vessels on lateral pelvic wall Umbilical artery Obturator nerve & vessels Inferior vesical vessels Vesical branch of Middle rectal vessels
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Pelvic part of Ureter – second part
In male Inferolaterally Levator ani At lateral aspect of urinary bladder Crossed infront by vas deferens Below by seminal vesicle
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Pelvic part of Ureter – second part
In female Near uterine cervix, Uterine artery is located above and in front of it (in female)
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Sites of Anatomical Constrictions
Lumen is not uniform throughout Has three constrictions At pelviureteric junction At pelvic brim Where it crosses common iliac artery At uretero-vesical junction Where ureter enters into bladder
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Ureteric calculus Lodge at one of the sites of anatomical narrowings
At the pelvic ureteric junction. Where it crosses the pelvic brim. In the intramural part—the narrowest part
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Arterial supply Derives its arterial supply from the branches of all arteries related to it Branches from Renal artery Gonadal artery Abdominal artery Common iliac artery Internal iliac
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Clinical anatomy Arteries supplying ureter form an anastomosis
During transplantation Surgeons should bear in their mind that stripping off fascia around ureter It will hamper the blood supply of the ureter and may cause its necrosis
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Nerve Supply Sympathetic supply Parasympathetic supply
T12–L1 spinal segments Through renal, aortic and hypogastric plexuses Parasympathetic supply S2–S4 spinal segments Through pelvic splanchnic nerves Sensory fibres pass through Both sympathetic and parasympathetic nerves
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Injury to ureters May be injured at
One of the following four dangerous sites Point where the ureter crosses the iliac vessels In ovarian fossa Where the ureter is crossed by the uterine artery (most dangerous site) as damage is likely at this site during hysterectomy At the base of the bladder
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Urinary bladder Hollow muscular organ Reservoir of urine
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Urinary bladder - Location
In anterior part of pelvic cavity Lies behind the body of pubis & is separated from it by the retropubic space
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Urinary bladder - Capacity
Normal capacity in adult ml Desire to micturate Beyond 220 cc Painful Up to 500 cc is tolerated Beyond this becomes painful
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Urinary bladder- Parts
Empty bladder is pyramidal in shape Has following Parts Apex Base 2 lateral angles 3 surfaces Superior, posterior and 2 inferolateral 4 borders Posterior, anterior, 2 lateral borders
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Apex Directed forward Lies behind the upper margin of symphysis pubis
Connected to umbilicus by Median umbilical ligament (remnant of urachus)
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Neck Non – movable part Attached by In males In females
Lateral ligaments of bladder Puboprostatic ligament in male and pubovesical ligament in female In males Rests on upper surface of prostate In females On urogenital diaphragm
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Posterior surface / base
Triangular in shape Upper part covered by peritoneum in male Lower part related to In males Vas deferens and seminal vesicles In females Vagina
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Superior surface Covered by peritoneum Related to
Coils of ileum or sigmoid colon in males Uterus in females Superior surface
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Inferolateral surfaces
Anterior part Retropubic pad of fat & the pubic bones Posterior part Obturator internus above Levator ani below
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Interior Rugae Trigone Uvula vesicae Folds formed by mucous membrane
Except in the triangular region Trigone Triangular area over the lower part of base of bladder Between the openings of the two ureters and the urethra Mucosa is smooth (no folds) Due to its firm attachment to muscular coat Uvula vesicae A slight projection posterior to urethral orifice Formed by middle lobe of prostate
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Arterial supply Superior and inferior vesical arteries
From anterior trunk of internal iliac arteries Vaginal artery replaces inferior vesical artery in female
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Venous drainage Venous plexus around the bladder and prostate drain into Inferior vesical vein Superior vesical vein Both veins drain into internal iliac vein
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Lymphatic drainage Upper ureter Middle ureter Lower ureter
To lumbar lymph nodes Middle ureter To common iliac lymph nodes Lower ureter To common , external and internal iliac lymph nodes Pelvic ureter and bladder To internal iliac lymph nodes
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Urinary bladder - Nerve supply
Parasympathetic From nervi erigentes (S2 3 4) Supplies Motor fibers to detrusor muscle Inhibitory to the sphincter vesicae Sympathetic Motor fibers to sphincter vesicae Inhibitory to detrusor muscle Sensory Both sympathetic & parasympathetic Voluntary motor control of external sphincter is by pudendal nerve Anatomy
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Applied anatomy Obstruction in urine outflow Cystoscopy Pyelography
Hypertrophy of bladder Hydroureter Hydronephrosis Cystoscopy Examining interior of urinary bladder By a hollow tube with a lens Pyelography Examining ureter and renal pelvis and calyces by radiograph
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