2. Ureter & Urinary bladder

3. Urinary system Urinary system consists of Kidneys Ureters
Urinary bladder
Urethra

4. Ureter Narrow, thick-walled, expansile muscular tube Conducts urine
From kidney to urinary bladder
Retroperitoneal
Length: 25 cm (10 inches)
Diameter: 3 mm

5. 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

6. Parts Divided into Abdominal part Pelvic part
Each part is about the same length
i.e., 12.5 cm (5 inches)

7. Abdominal Part - Course
Extends
From the renal pelvis
To the bifurcation of the common iliac artery

8. 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

9. Abdominal part – posterior relations
Tips of transverse process of lumbar vertebrae
Psoas major
Genitofemoral nerve

10. 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

11. 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

12. 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

13. 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

14. 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

15. Pelvic part of Ureter – second part
In female
Near uterine cervix,
Uterine artery is located above and in front of it (in female)

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Urinary bladder
Hollow muscular organ
Reservoir of urine

23. Urinary bladder - Location
In anterior part of pelvic cavity
Lies behind the body of pubis & is separated from it by the retropubic space

24. 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

25. 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

26. Apex Directed forward Lies behind the upper margin of symphysis pubis
Connected to umbilicus by
Median umbilical ligament (remnant of urachus)

27. 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

28. 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

29. Superior surface Covered by peritoneum Related to
Coils of ileum or sigmoid colon in males
Uterus in females
Superior surface

30. Inferolateral surfaces
Anterior part
Retropubic pad of fat & the pubic bones
Posterior part
Obturator internus above
Levator ani below

31. 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

32. Arterial supply Superior and inferior vesical arteries
From anterior trunk of internal iliac arteries
Vaginal artery replaces inferior vesical artery in female

33. Venous drainage
Venous plexus around the bladder and prostate drain into
Inferior vesical vein
Superior vesical vein
Both veins drain into internal iliac vein

34. 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

35. 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

36. 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