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Anatomy of he Urinary System

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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

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