1. Anatomy of he Urinary System
The urinary system consists of the following
Kidneys
Ureters
Urinary bladder
Urethra

2. The Kidney Bean-shaped organ
It lies on the posterior abdominal wall at the side of vertebral column
It measures 4x2x1 inches
It has anterior and posterior surfaces and medial and lateral borders
Right kidney is lower than the left because of the liver
The level of kidneys varies with respiration of about 1 inch

3. The Kidney Cont., Renal hilum Is found at the medial concave surface
Renal vein, renal artery and ureter are found in the hilum in anterior posterior order
Lymphatics and sympathetic nerves pass through the hilum
Renal sinus
All structures pass through the hilum in addition to small amount of fat and the pelvis are found in the sinus

4. Suprarenal glands, kidneys, and ureters and their vessels are retroperitoneal structures
Renal capsule formed of dense connective tissue surrounding the kidneys for support and protection
Perirenal fat a layer of fat surrounds the kidney outside the renal capsule

5. Kidneys, suprarenal glands, and perirenal fat are enclosed by fascial membrane called Renal fascia
The two layers extend medially to enclose the renal vessels and blend with vascular fascia
The two layers extend inferiorly to enclose the ureters as as Periuretric fascia
A layer of fat surrounding the kidneys, ureters, suprarenal glands external to renal fascia called Pararenal fat

6. Perirenal fat, renal fascia, pararenal fat and some collagen fibers hold the kidneys in fixed position
Superiorly, renal fascia is attached to inferior diaphragmatic fascia

7. Internal structure of the Kidney
Each kidney consists of:
Outer cortex
Inner medulla formed of renal pyramids with apex forming renal papilla
Cortex extends into medulla as renal columns
Renal pelvis fills most of the sinus
Major calyces
Minor calyces

8. Anterior relation of the Kidney
Right kidney:
Suprarenal gland
Liver
Duodenum
Right colic flexure
Ileum
Left kidney
Stomach
Spleen
Splenic artery
Pancreas
Jejunum
Left colic flexure

9. Anterior relation of the Kidney
Right Kidney
Left Kidney

10. Posterior Relation of the Kidney
Diaphragm separates the kidney from the pleural cavity and 11th and 12th ribs
Psoas major medially
Quadratus lumborum in the middle, transversus abdominis laterally
Subcostal, iliohypogastric and ilioinguinal nerves descend obliquely behind the kidney

11. The Ureter It is a muscular organ
Extends from renal pelvis in abdomen, crosses the pelvic brim at common iliac artery bifurcation to the urinary bladder
It 10 inches in length
On the back, extends along a line from a point 5 cm from spine of L1 to posterior superior iliac spine

12. The Ureter Cont., The abdominal part is retroperitoneal
It runs close to the tips of transverse processes of lumbar vertebrae as seen in contrast radiographs
It passes vertically on psoas muscle
It enters the pelvis crossing the external iliac artery
It shows three constriction along its course:
Between ureter and pelvis
At crossing the external iliac artery
At entrance to urinary bladder
They are the sites of obstruction by renal calculi

13. The Ureter Cont., Ureter runs on the lateral part of lesser pelvis
It runs parallel to medial part of greater sciatic notch
At level of ischial spine, it turns anteromedially to enter the inferior surface of the bladder in inferiomedial dirction
The enterance is 5 cm a part on external surface and 2.5 cm a part at internal surface
Oblique passage creates a sphincter like structure at lower end of ureter

14. Anterior Relation of the Ureter
Duodenum
Terminal Ileum
Left gonadal vessels
Right gonadal vessels
Left colic vessels
Right colic vessels
Sigmoid colon and mesocolon
Ileocolic vessels

15. The Urinary Bladder It is a hollow muscular organ
It is a pelvic organ after puberty
It lies behind and superior to pubic bones leaving retropubic space in between
It is divided into apex, fundus and body
It has 4 surfaces, superior, posterior (base) and two inferiolateral
It is freely movable except at the neck that is attached by lateral ligaments of bladder and puboprostatic ligament in male and pubovesical ligament in female
Body
Apex
Fundus

16. The Urinary Bladder Cont.,
Posterior relation in male:
Vas deferens
Seminal vesicle
Rectum
Rectovesical fascia
Peritoneum
Posterior relation in female:
Vagina and part of uterus
Superior relation in male:
Coils of ileum
Sigmoid colon
Superior relation in female:
Uterus
Lateral relation
Obturator internus muscle
Levator ani muscle

17. The Urinary Bladder Cont.,
Anterior relation
Symphysis pubis
Retropubic fat
Inferior relation:
Prostate gland
The muscle of the bladder wall is called Detrusor muscle
It is thickened at the neck to form involuntary internal urethral sphincter
Trigone is triangular area where the two ureters and urethra open into its angles

18. Blood Supply of the Urinary System
Kidney:
Renal arteries are paired branches arise from aorta at the level of intervertebral disc between L1,2
Right one longer than the left, passes behind IVC
At the hilum, each one divides into 5 segmental arteries each supplies a renal segment
Renal segments are independent in their blood supply
Blood is drained by segmental veins to renal veins

19. Blood Supply of the Urinary System Cont.,
Abdominal part of ureter:
Uretric branches from the renal artery are constant ones.
Other branches from gonadal, aorta and common iliac arteries
They give ascending and descending branches that anastomose with each other
Veins are drained by renal and gonadal veins

20. Blood Supply of the Urinary System Cont.,
Pelvic part of ureter
Uretric branches of common iliac, internal iliac and gonadal arteries
Constant branches come from inferior vesical and (in female) uterine arteries
Veins are corresponded
to arteries

21. Blood Supply of the Urinary System Cont.,
Urinary bladder
Superior vesical artery
Inferior vesical artery
Vaginal artery replace inferior vesiacal artery in female
In male, venous plexus around the bladder and prostate drain into inferior vesical vein
Also, superior vesical vein drains the bladder
Both veins drain into internal iliac vein
In female, venous plexus around bladder drain into vaginal or uterovaginal vein and then to internal iliac vein

22. Lymphatic drainage Kidney Into left and right lumbar
(aortic and caval) lymph nodes
Upper ureter
To kidney lymphatics or
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

23. Nerve Supply
Parasympathetic fibers leads to contraction of smooth fibers in ureter and bladder and relaxation of smooth fibers in internal urethric sphincter
Sympathetic fibers cause the opposite effect
Sympathetic fibers to kidney are vasomotor comes from renal plexus
Parasympathetic fibers from S2-4 form pelvic splanchnic nerve
Sympathetic fibers from L1-2 form inferior hypogastric plexus

24. Male Urethra
It is 20 cm long in male from the bladder neck to external urethral meatus
It has a tortous course
It divides into three parts:
1. Prostatic part:
widest portion
It is 3 cm long
Most dilatable part
Ducts of prostate gland and
ejaculatory ducts open in it
2. Membranous part:
Lies within urogenital diaphragm
It is 1.5 cm long
Least dilatable part

26. Male Urethra cont.,
3. Penile part: It is 15.5 cm Is surrounded by erectile tissue of bulb and corpus spongiosum It is dilated at the end as navicular fossa Bulbourethral and penile glands open in it

27. Female Urethra It is 4 cm in length and 6 mm in diameter
Extends from neck of bladder to external meatus
It passes under the symphysis pubis
It lies anterior to vagina
It opens in the vestibule anterior to vaginal opening
Paraurethral glands
They are mucus secreting glands located at the sides of external meatus
It is easily dilatable
It is straight

28. Blood Supply of Urethra
Male Urethra
Female Urethra
Prostatic branches of inferior vesical and middle rectal arteries
Dorsal artery of the penis
Arteries of the bulb of the penis
Internal pudendal artery
Vaginal artery

29. Nerve Supply of Urethra
Parasympathetic supply
From pelvic plexus made of S2-4 roots to form pelvic splanchnic nerve
Sympathetic supply T12-L1-2
Form hypogastric plexus and then form pelvic
Somatic supply
Pudendal nerve from sacral plexus
Sensory and motor to external urethral sphincter

30. Surface Anatomy Kidney Ureter
Hilum of each kidney is three finger breadth from the midline in transpyloric line (L1)
On the back, kidney extends from spine of T12 to spine of L3
Kidney move about one inch on respiration
Right kidney is one inch lower than the left because of liver
Anteriorly is represented by a line from a point 5 cm from the midline at level of L2 to a point at anterior iliac spine and from there a curved line is drawn anterior and medially to pubic tubercle
Posteriorly is represented by a line from spine of L1 to posterior inferior iliac spine