What is the urinary system and how does it work?

The urinary system is divided into upper and lower sections. The
upper urinary system is made up of the kidneys and a tube called
the ureter, which transports urine from the kidney to
the bladder. There is one kidney for each side of the body and
each kidney has its own ureter.
The lower urinary system consists of the bladder and another
tube called the urethra, which transports urine from the bladder
out of the body. The function of the urinary system is to remove
waste products from the body, regulate water and salt balance,
and to store and transport urine.
Upper urinary system
Kidneys
The kidneys are a pair of bean-shaped organs located near your
back and just below the ribcage. The right kidney sits a little
higher than the left because of the position of the liver. In an
adult, the average kidney is 10 cm long, 6 cm wide and 3 cm
thick, and weighs about 150 g.
The outer surface of the kidney is curved outwards, while the
inner surface is curved inwards, just like a kidney bean. Several
important structures enter and leave the kidney from its inner
surface, including the ureter, blood vessels, nerves and
lymphatic vessels.
The kidney is covered in three layers, including an inner layer, a
fatty middle layer and a tough outer layer which protects the
kidney from trauma. Under these layers lies the inside of the
kidney, which is made up of inner and outer sections responsible
for making urine. Blood flows into the kidney and is filtered
through little units known as nephrons to make urine, which
then passes via the ureter to the bladder.
The main roles of the kidneys are to remove waste substances
from the blood, create a balance between water and salt in the
body, and to produce hormones.
Ureter
The tubes that connect the kidneys to the bladder, known as the
ureters, are approximately 30 cm long and 6 mm wide. They
enter the bladder from behind and at an angle which creates a
valve that stops urine from back-tracking up to the kidneys. The
wall of the ureter is made up of three layers, including a layer of
muscle which helps it to contract and propel urine from the
kidney to the bladder.

For more information on the upper urinary

tract, see Anatomy of the Renal System.
Lower urinary system
Bladder
The bladder is a hollow muscular organ that lies just behind the
pubic bone. In males, the prostate gland sits behind the bladder,
whereas in females, the vagina and uterus sit behind the
bladder.
The bladder wall is made up of three layers. The innermost layer
lines the bladder, the middle layer is made up the detrusor
muscle, and the outermost layer surrounds the bladder. The
detrusor muscle is made up of two different types of muscle
which allow the bladder to contract and empty itself of urine.
At the bottom of the bladder is a triangular-shaped region
known as the trigone. Urine enters the bladder from the ureters
at the uppermost aspect of the trigone, and leaves the bladder
via the urethra at the lowermost aspect of the trigone.
The bladder neck is a funnel-shaped extension at the bottom of
the bladder that then connects with the urethra. It is 2–3 cm long
and forms a muscular band around the urethra, known as
the internal sphincter. This sphincter is normally closed tight to
stop urine from leaking out of the bladder. When one decides to
pass urine, the sphincter relaxes and urine can leave the bladder
and pass into the urethra.
Male urethra
The urethra is a tube that runs from the bottom of the bladder
to the opening where urine exits the body. In males, it is
responsible for transporting both urine and sperm. The average
male urethra is approximately 20 cm in length and is divided into
four different parts along its course.
At the lower aspect of the urethra lies the external sphincter,
which is formed by two groups of muscles which wrap around
the urethra. The first component of this sphincter comes from
the pelvic floor muscles, which form a sling around the urethra.
This component only works to stop urine leaking when there is a
sudden rise in pressure, for example, when one coughs, sneezes
or lifts something heavy. The second component of the sphincter
is formed by muscle from within the urethral wall itself. This
component offers a more sustained level of tightening and is
therefore the most important when it comes to stopping urine
from leaking out of the bladder in males.

For more information on the lower urinary tract

in males, see Anatomy of the Male Urogenital
System.

Female urethra
The female urethra is much shorter than the male urethra and is
only 4 cm long. Urine leaves the body via an opening in the
urethra, which sits in front of the vagina. As with males, females
also have an external sphincter which has two components.
Contrary to males, the most important components to stop
leakage of urine in females are the pelvic floor muscles which
wrap around the urethra. Muscle in the wall of the urethra also
contributes to the external sphincter mechanism in females.

For more information on the lower urinary tract

in females, see Anatomy of the Female
Urogenital System.

What controls the process of urination?

The process of urination is controlled by a complex circuit of
nerves which relay messages between the bladder, the spinal
cord and the brain.
Receptors within the bladder wall sense how full the bladder is
and send this information to a urinary centre located at the
bottom of the spinal cord. This region, known as the spinal
micturition centre, co-ordinates signals going to and from the
bladder as well as signals to and from the brain.
Until approximately 2–4 years of age, a simple circuit is involved
in the process of urination. At this age, the central nervous
system is immature and urination is therefore an involuntary
process over which the child has no control. As the bladder fills,
receptors in its wall send a message to the spinal micturition
centre. The centre in turn sends a message to the detrusor
muscle telling it to contract, and to the sphincters telling them
to relax. This results in emptying of the bladder and urine being
passed from the body.
As the brain matures with age, we develop the ability to control
this process and choose an appropriate time and place to
urinate. This conscious control over the process of urination is
the result of a specialised area within the brain which
communicates with the spinal micturition centre. This area in the
brain blocks the signal that runs from the spinal cord to the
bladder to initiate urination. When it is time to pass urine and an
appropriate time and place are available, this region of the brain
gives a ‘safe signal’, resulting in activation of the bladder,
relaxation of the sphincters and the passage of urine.

Figure 1: Simplified illustration of connections between the

bladder, spinal cord and brain.
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Filling phase
The bladder is very elastic and designed well for its role of urine
storage. As the bladder fills, it expands and its muscular wall
stretches and thins out, allowing for large amounts of urine to
collect without a significant rise in pressure. During this filling
phase, the brain blocks messages from the spinal cord to the
bladder, which stops the bladder from emptying. When a
bladder volume of about 200 mL is reached, receptors in the
bladder wall send a signal to the spinal cord and up to the brain.
If urination is not appropriate at this time, the brain blocks the
signal from the spinal cord that would normally activate the
bladder.
Kidney and urinary system parts and their functions:

 Two kidneys. This pair of purplish-brown organs is located

below the ribs toward the middle of the back. Their function
is to remove liquid waste from the blood in the form of
urine; keep a stable balance of salts and other substances in
the blood; and produce erythropoietin, a hormone that aids
the formation of red blood cells. The kidneys remove urea
from the blood through tiny filtering units called nephrons.
Each nephron consists of a ball formed of small blood
capillaries, called a glomerulus, and a small tube called a
renal tubule. Urea, together with water and other waste
 substances, forms the urine as it passes through the
nephrons and down the renal tubules of the kidney.
 Two ureters. These narrow tubes carry urine from the
kidneys to the bladder. Muscles in the ureter walls
continually tighten and relax forcing urine downward, away
from the kidneys. If urine backs up, or is allowed to stand
still, a kidney infection can develop. About every 10 to 15
seconds, small amounts of urine are emptied into the
bladder from the ureters.
 Bladder. This triangle-shaped, hollow organ is located in
the lower abdomen. It is held in place by ligaments that are
attached to other organs and the pelvic bones. The bladder's
walls relax and expand to store urine, and contract and
flatten to empty urine through the urethra. The typical
healthy adult bladder can store up to two cups of urine for
two to five hours.
 Two sphincter muscles. These circular muscles help keep
urine from leaking by closing tightly like a rubber band
around the opening of the bladder.
 Nerves in the bladder. The nerves alert a person when it is
time to urinate, or empty the bladder.
 Urethra. This tube allows urine to pass outside the body.
The brain signals the bladder muscles to tighten, which
squeezes urine out of the bladder. At the same time, the
brain signals the sphincter muscles to relax to let urine exit
 the bladder through the urethra. When all the signals occur
in the correct order, normal urination occurs.

PROCEDURES ASSOCIATED WITH THE URINARY SYSTEM

 Denis Browne: Surgical procedure to correct hypospadias
 Millen-Read: For correction of stress incontinence using a
suprapubic approach
 Stanischeff: Surgery to correct renal ptosis (nephropexy)
SIGNS OF URINARY SYSTEM PROBLEMS
 Flush-tank: Passage of a large amount of urine and
coincidental temporary disappearance of a lumbar swelling;
a sign of hydronephrosis
 Lloyd: Pain in loin on deep percussion over the kidney,
indicating renal calculi or nephritis
 Rommelaere: Diminished phosphates, sodium chloride,
and nitrogen in the urine, indicating cancerous cachexia
URINARY SYSTEM SYNDROMES
 Fanconi: Disorder of kidney tubules; substances normally
absorbed into the bloodstream by the kidneys are released
into the urine instead
 Megacystis-megaureter: Presence of massive, primary,
nonobstructing reflux with a large, smooth, thin-walled
bladder due to continued recycling of refluxed urine
 Nonnenbruch (extrarenal kidney): Resulting in oliguria
References
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micturition. Nat Rev Neurosci. 2008;9(6):453-66.
[Abstract | Full text]
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continence. Urology. 2002;59(5 Suppl 1):13-7. [Abstract]