GENITOURINARY/REPRODUCTIVE SYSTEMS

1. Coverings, attachments and relations of kidneys

 The kidneys are retroperitoneal reddish-brown bean-shaped glands directly inferior to the adrenal galnds and run
from levels T12-L3.
 The superior poles of the kidneys are well protected by the floating ribs.
 The right kidney is lower than the left because of the liver.
 The inferior pole of the right kidney is located close to the iliac crest.

Anterior Posterior
Spleen Diaphragm
Stomach 11th and 12th ribs
Pancreas Psoas major
LEFT KIDNEY
Left colic flexure Quadratus lumborum
Descending colon Transversus abdominis
Jejunum Subcostal, iliohypogastric and ilioinguinal arteries
12th ribs
Liver
Psoas major
Duodenum
RIGHT KIDNEY Quadratus lumborum
Right colic flexure
Transversus abdominis
Ascending colon
Subcostal, iliohypogastric and ilioinguinal arteries

 Coverings from outermost to innermost:

o Pararenal fat – extraperitoneal fat
o Renal fascia (Gerota's fascia) – Surrounds the kidneys, the adrenal glands, and the renal vessels; forms
the periureteric fascia (Note: In some sources, Gerota's fascia is also known as the anterior renal fascia; the
posterior renal fascia is also known as Zuckerkandl's fascia)
o Perirenal or perinephric fat capsule – Surrounds the vessels and extends until the renal sinuses
o Fibrous capsule – Innermost covering which is easily stripped from the kidney except in pathologic states

2. Constrictions of ureters

 Ureters normally demonstrate relative constrictions in 3 places:

o At junction of ureters and renal pelvis (ureteropelvic junction)
o Where it crosses the brim of the pelvic inlet (pelvic brim)
o Where it enters the bladder wall – narrowest point, prevents urine reflux from bladder to ureter
 Ureter takes a diagonal course through the bladder wall and gets compressed
 Contraction of bladder wall muscles during micturition also serves as a physiologic sphincter to
prevent urine reflux

3. Lobules and zones of prostate

 Lobes of the prostate
o Isthmus: fibromuscular portion found anterior to urethra; muscle fibers continuous from external urethral
sphincter
o Right & left lobes: anteriorly separated by isthmus and posteriorly separated by central, shallow
longitudinal furrow; divided into lobules based on proximity to urethra, ejaculatory ducts and arrangement of
ducts
 Inferoposterior lobule: posterior to urethra, inferior to ejaculatory duct, can be palpated during DRE
 Inferolateral lobule: lateral to urethra
 Superomedial lobule: deep to inferoposterior lobule, surrounding ipsilateral ejaculatory duct
 Anteromedial lobule: deep to inferolateral lobule, lateral to proximal prostatic urethra
o Middle/median lobe: embryonic structure which gives rise to superomedial and anteromedial lobules; lies
between the urethra and ejaculatory duct; related to neck of bladder; gives rise to middle lobule in advanced
age due to hormone induced hypertrophy

 Zones of the prostate: divided based on proximity to the urethra

o Periurethral
o Central – comparable to middle lobe
o Peripheral
 Zones of prostate according to Netter (said to be more clinically significant, hence included it here):

o Anterior portion = Fibromuscular stroma (counterpart of isthmus in Moore anatomy); muscular layer derived
from external urethral sphincter
 o Transitional zone: enlarges during benign prostatic hypertrophy

4. Ligaments of the ovaries

 The ovaries are suspended by the mesovarium, a short peritoneal fold or mesentery coming from the broad ligament
of the uterus. It projects from the posterior surface of the broad ligament and attaches to the hilum of the ovary,
enclosing its neurovascular supply. It does not, however, cover the surface of the ovary itself.
 Ovarian vessels, lymphatics and nerves are contained in the suspensory ligament.
 The ovarian ligament is attached to the ovary inferiorly. It connects the ovary to the side of the uterus. Structurally, it
is a fibrous band of tissue that lies within the broad ligament. It joins the uterus just below the origin of the fallopian
tubes.
 In operations involving ovarian pathology, remove ligaments in this order: suspensory (also known as
infundibulopelvic ligament) as it contains the blood supply > mesovarium > ovarian ligament.

5. Blood supply of uterus and ovaries

 The uterine artery is an additional branch of the internal iliac artery in females, usually arising separately and directly
from the internal iliac artery.
o Descends on lateral wall of pelvis, anterior to the internal iliac artery, and passes medially to reach the
junction of the uterus and vagina, where the cervix (neck) of the uterus protrudes into the superior vagina
o As it passes medially, the uterine artery passes directly superior to the ureter (water under the bridge).
o On reaching the side of the cervix, the uterine artery divides into a smaller descending vaginal branch,
which supplies the cervix and vagina, and a larger ascending branch, which runs along the lateral margin of
the uterus, supplying it.
o The ascending branch bifurcates into ovarian and tubal branches, which continue to supply the medial ends
of the ovary and uterine tube and anastomose with the ovarian and tubal branches of the ovarian artery.
 The ovarian artery arises from the abdominal aorta inferior to the renal artery but considerably superior to the
inferior mesenteric artery.
 o As it passes inferiorly, the ovarian artery adheres to the parietal peritoneum and runs anterior to the ureter
on the posterior abdominal wall, usually giving branches to it.
o As the ovarian artery enters the lesser pelvis, it crosses the origin of the external iliac vessels. It then runs
medially, dividing into an ovarian branch and a tubal branch, which supply the ovary and uterine tube,
respectively.

6. Contents of spermatic cord

 Begins in the inferior abdomen and ends in the scrotum
 It is formed at the opening of the inguinal canal, known as the deep inguinal ring (lateral to inferior epigastric vessels).
 The cord passes through the inguinal canal, entering the scrotum via the superficial inguinal ring. It continues into the
scrotum, ending at the posterior border of the testes.

 Contains the following structures:

o Blood vessels:
 Testicular artery – branch of the aorta that arises just inferiorly to the renal arteries.
 Cremasteric artery and vein – supplies the cremasteric fascia and muscle.
 Artery to the vas deferens – branch of the inferior vesicle artery, which arises from the internal iliac.
 Pampiniform plexus of testicular veins – drains venous blood from the testes into the testicular vein.
o Nerves:
 Genital branch of the genitofemoral nerve – supplies the cremaster muscle.
 Autonomic nerves
o Other structures:
 Vas deferens – the duct that transports sperm from the epididymis to the ampulla (a dilated
terminal part of the duct), ready for ejaculation.
 Procesus vaginalis – projection of peritoneum that forms the pathway of descent for the testes
during embryonic development. In the adult, it is fused shut.
 Lymph vessels – these drain into the para-aortic nodes, located in the lumbar region.

7. Blood supply of penis