inary System Disorders of the Urinary System STUDY OBJECTIVES s organs of the urinary system, Y To describe the anatomy and physiology of ureters, i¢ anatomy of kidney. urinary bladder and urethra. in the process of urine formation. ¥ To.understand the process of micturition. it i Y Togive a brief idea about the various disorders of the int idney in homeostasis. ipain the role of kidney i yout WUC De TTS i i stitute a system, Teorgans associated with the production and excretion of the urine from the body con: called the urinary system, : id volume and blood pressure an The urinary system maintains the water and electrolyte balance cals cand blog “atte the pH of the body. All these functions contribute to the UTS PULeN LL Te urinary system consists of the following organs: Two kidneys Two ureters 9 One urinary bladder One urethra cted and stored in the urinary Th ig. 13.1). T and eliminated out of the body by the urethra lle the ureters, co! blag Utne is produced by the kidneys, conveyed by laddeyFEY stor Ploy and Health Education ee FUNCTIONS OF THE URINARY SYSTEM urinary system is which maintains the following ‘The majority of work in the performed by the kidneys, homeostasis by performing functions: 1, Excretion of wastes and foreign substances: Kidneys exerete the waste products formed during metabolism such as urea, creatinine, uric acid and bilirubin. Kidneys also excrete toxins, drugs, heavy metals, and so on. 2, Maintenance of water and electrolyte balance: Kidneys maintain the water balance Abdominal aorta ‘Adrenal gland (part of the endocrine system) vost 449, Passed tough he anys da a Tough we keep descibing i Shaped organs, the beans wery bean, Organ and not vce versa, 4 er Q Urine is almost odour, es u SSS uhEn esha Q Have you heard of uring therapy involves erticatn ee, a Wing 7 People apply ine enc Metin bee or cosmetic purposes, kin and even drink urine for DO YOU KNOW | Kidney {—Renal hilus j— Renal artery {Renal vein Ureter Figure 13.1 Components of the urinary system. QO Osmosis: It is the diffusion of flui Concentration of ff Q Passive diffusion: Gradient, Q Peristalsis: tt through the di luid on both sides Tt is the passi is the coordinated, 'Sestive tract, bile MEebIcaL TermiNoLocy low-solut i d through a semipermeable membrane from a sol 'e concentration to a Solution with a higher solute concentration until there of the membrane, 'vé movement of molecules or particles along Thythmic serial contraction of smooth muscle that through the bile duct and urine through the ureters.The Urinary System eng water (when dereased) and excreting water (when excess). Kidney also regulate von of ons such as sodium, chloride, potssium, eum and phosphate ine ody ‘ fase 810 ion of pI fi ts and buffers in the blood. Among these, kidn HH and conserving bicarbonate ions, HI: The pH of blood and body fluids is maintained within a narrow range by the 5 Re eys play a major role in regulating pH by dey xt docrit . 4 Fae jropoien:Itstimulates red blood cell (RBC) production, 3 Thrombopoietin: It stimulates platelets production, 5 Renn It regulates blood pressure. ine function: Kidneys secrete many hormones that include the following: Q Prostaglandins «Regulation ofthe blood calcium level: Kidneys play a major role in regulating blood calcium level by activating 1,25-dihydroxycholecalciferol to vitamin D. Vitamin D is essential forthe abso a ofcalcium from the intestine. pt HDNEY - Anatomy of the kidney Kutneys are dark red, bean-shaped organs about 10-11 cm in length, 5-6 cm in width and 2-3 cm in thickness. Each kidney weighs about 150 g in adult male and about 135 g in adult female, : Ise are present on either side of the vertebral column behind the peritoneum just below the “phragm extending from the level of the XII thoracic vertebra to the III lumbar vertebra. Because ‘the . é a a . yar situated posterior to the peritoneum of the abdominal cavity, kidneys are also referred to as "eoperitoneal organs, The left kidn ou cy is slightly larger than the right one, and also, the liver present above the right kidney s down the right kidney a little lower than the left kidney. Eternal anatomy nei Portion of the concave border of each kidney presents a notch called hilum where the blood 5 "mph vessels, nerves and ureters enter and leave the kidney. yp imi the kidneys are enclosed by the following three layers of tissue: = tal capsule Atos capsule nal fascia he enal fascia is the outer layer made of fibrous connective tissue that fixes the kidney to the ea Wall and to the surrounding structures. : ee ae ahd he adipose Capsule is the middle layer of fat that holds the kidneys in the upright positio ‘minal Cavity, The rey ynnective tissues that enclose the hi ney, ‘enal capsule is the inner layer made of transparent, fibrous co YS,lth Education Anatomy, Physiology and He Internal anatomy following two regions: rdneys can be divided into Internally, Q Renal cortex 3g Renal medulla Renal cortex is the ou into the following 80 different js the inner, ive a strial fase towards the cortex and & narrow end cal The renal cortex extends in between the space of renal pyramids in the form columns or columns of Bertin. Renal columns along with the renal pyramid of columns ale the renal cortex constitute & renal lobe. and superimy nu ithi i Posed area of ity within the kidney called the renal sinus, which or , which onak subdivisions of pelvis (major an MS of part nnOr cal), ‘The hilum expands into a cavit of renal pelvis (the upper expanded part of ureter), branches of renal blood vessels and fats. ter, light red, smooth-textured region of the kidn i ; iey. It can by t zones: cortical zone (outer) and juxtam ¢ furth edullary zone (ne tai ne (inner), ivideg ark red-coloured region of the kidne; i y. Itcon zed appearance to the renal medulla, ae Of cone-sha - The pyramids havea 0a Renal medulla led renal papilla towards the hilum, called renal pyramids that 8! Fibrous capsule Renal column Minor calyx Fat in renal sinus- Re fenal artery Re enal sinus: Renal pelvis Renal vein Renal lob Renal pyramid Ureter Fi inom he igure 13.2 Internal structure of the kidney. / in the kid alld minor calyx (8-10 in cath Kid through renal papilla, which drains it into the cup? sinc ES Inajorcalyces tht deliver th idney) through the papillary ducts. The minor calyoes jit eter. The urn ally reaches the unary iedde oet called the renal pelvis, which 26s pe inary bladder through the ureters Cis g. 13.2). Mi 5 mee structure of the kidni 1¢ kidney is cor ve : The nephrons mposed of numerous mic: ic coi — nar eee «million nephrons are present in each kidne an cl ey. based on Types of ney F hron: inthe kina Pm: NeDhtons are of two types: cortical : cortical and juxtamedullarysThe Urinary System 1 nephrons have their renal corpuscles in the al a ¢ kidney and have a very oot le, which penetrates only the outer Zone of the human ki Me 1 oncom about 80% ofthe total nephrons, "Mulla. In human kidneys, the a . oil edullary neurons (juxta: near) have their corpuscles in the j ramedullary © inner cortex near the a ie ‘edullary junction. These nephrons have very long loop of Henle, which extends deep into Cc ula . . oe consists of the following parts Fig, 13,3) Aon " r oc (Bowman's) capsule | manne Glmerlus a 4 poxinal convoluted tubule 2 Loop of Henle eae 3 Distal convoluted tubule 0 Collecting ducts Juxtamedullary nephron Nephron loop Proximal convoluted tubule! Distal convoluted tuble Renal corpuscie Proximal convoluted tubule” enal corpuscte (cut) lomerulus ‘Glomerular Figure 12.3 Parts of nephron.EE tom Phyoteay and Health Education ‘The different parts of the nephron (sce Fig. 13.3) are discussed in the sections that fall low, Glomerulus Glomerulus consists of ‘the bun i jal artery enters the glomerulus and divides i The afferent arteriole from the renal arte us and divides into capillaries. Each large capillary subdivides into a cluster of fine capillaries called, lame Or Five ap ‘Stich rejoin to form efferent arteriole through which a reduced volume of blood leaves the «a, Thus, the vascular system in the glomerulus is purely arterial. le Slomerjs The glomerular capillaries are made of a single layer of endothelial cells that rest on smenivene, The endothelial cells have many pores between them called fenestration that fac tate the filtration process. ch of fine network of capillaries called glomerular capil laries, Glomerulus (Bowman’s) capsule It is a cup-shaped structure present in the renal cortex that forms the beginning of the epiron, “The Bowman’s capsule encloses the glomerulus and it is formed by the following two layers Visceral layer: inner Q Parietal layer: outer The visceral layer covers the glomerular capillaries and the parietal layer is continuous with te tubular portion of the nephron. The space between the two layers is known as the capsular space, wits is continuous as lumen of the tubular portion. _ Both the layers are composed of a single layer of squamous epithelial cells, andthe els visceral (inner) layer are called podocytes. The podocytes subdivide into primary, secondary andterixy branches to terminate into pedicels and have gaps between them called filtration slits that fvliste be ultrafiltration process (Fig. 13.4). Pores in endothelium ‘ Filtered ‘ material fon sit: Figure 13.4 Passage of fitered substances through pores and filtration $ The st ! Tucture of the glomerular capsule is explained in Figure 13.5.Proximal convoluted tubule Afferent arteriole Efferent arteriole | Parietal layer of glomerular capsule Figure 13.5 Structure of the glomerular capsule. Proximal convoluted tubule Froximal convoluted tubule (PCT) (proximal: near; convoluted: tightly coiled) is the coiled tubule sing from the Bowman’s capsule and located in the cortex of kidney. wall consists of a single layer of cuboidal epithelial cells bearing microvilli (hair-like projections) surface. Because of these microvilli, the epithelial cells are called brush-bordered cells, and they serve to increase the luminal surface for secretion and reabsorption. 0 {oop of Henle i akes a lop of Henle i the U-shaped segment of nephron that extends into the renal medulla, m ri it i id has three parts: "Fin tum (Joop) and then returns tothe renal cortex. Iti continuous with PCT an parts “sending limb, loop and ascending limb. ee , oe tex and a thin region oth the ascending and the descending limbs have a thick region ida bare cells and the thin ‘athe other side, The thick regions are walled by brush-bordered cubor ‘gions by flat cells, 'n the final part of the ascending limb, which lies close 0 th ig A is wn as: "e.13.6), the cuboidal cells are closely packed and tis zones kno esa dense), it arteriole (as shown in m ola densa (macula: spot; i yth muscle , ed of modified smoot fy teal ofthe afferent arteriole alongside the macula densa is compos "called juxtaglomerular (JG) cells (Fig. 13.6). paratis, : it juxtaglomerular appare 1c cells along with macula densa const the Jal retwer in detail). Pressure within the kidneys by renin sect which helps regulateEZEN Anatomy, Physiology and Heath Education ‘Glomerulus Juxtaglomerular cel Macula densa convoluted Glomerular capsule tubule Afferent arteriole Efferent arteriole Figure 13.6 Juxtaglomerular apparatus. Distal convoluted tubule oo hort terminal po The distal convoluted tubule (DCT) is tightly coiled and lies in the renal cortex. A shot 5 into the collecting of the DCT that collects urine is called the collecting tubule, which further opens 1 ducts. jc hormot , ntidiuretic hom The wall of DCT is mainly composed of principal cells (contain receptors for a (ADH) and aldosterone) and intercalated cells, Collecting ducts ing tubules of 5" i lecting tubul These are large tubes Present in the renal medulla that receive the colle nephrons, a mids 10 . in renal pyr" eset The collecting tubules further join many large collecting tubules sat th ‘ joins the ureter ducts of Bellini that Open into calyces through renal papilla. It then j pelvis.wera phystology (formation of urine) ogy of the formation of urine involves the following three processes: \\s described in Figure 13.8.jalth Education ‘Anatomy, Physiology and H' Tubular reabsorption Tubular secretion Peri Glomerular fitration Huber =Piay Distal Proximal convol yervlus luted aa Glomerular capsule convoluted tubule tubule r Collecting duct Hy Reabsorption of water Loop of the the nephron Renal pelvis excretion Figure 13.8 Formation of urine. Glomerular filtration The first step in the formation of urine is glomerular filtration, In this step, the glomerulus filters ‘ater and certain dissolved substances from the plasma of blood. The blood pressure in gave capillaries is very high as the efferent arteriole is smaller in diameter than the afferent arteriole. Note: The blood pressure in glomerular capillaries is the highest capillary pressure in the body. The high blood pressure forces the fluid to filter from the blood and pushes it out of the Lo capillaries into the capsular space and Subsequently into the Bowman’s capsule. The filtered PX plasma is called the glomerular Jiltrate and it contains sodium, potassium and chloride ions, 8 amino acids, urea, uric acid, creatinine, ketone bodies and a large amount of water. oo lr Glomerular filtration is called ultrafiltration as even the minute particles are filtered ts through fenestrations in the endothelium of glomerular capillaries and filtration slits in ines as they capsule. The plasma proteins, blood cells and other large molecules remain in the capil is te 1S Ws fo0 large to be filtered. Except the plasma proteins, the composition of the glomerular fill Very much similar tothe blood plasma. , (GFR). ‘The rate at which the kidneys filter the blood plasma is called glomerular filtration rate a widned fine on it 28 adult is about 180 Liday or 125 mL/day. The GFR is the measure O! function, that is how efficiently the kidneys are able to filter. The pressures ti that determine GER are as follows:The Urinary System A merular blood hydrostatic pressure (G) Tei r Pn 2 He promos fitaton (GBHP): It is the blood pressure in glomerular capillaries (al ‘man’s capsule pressure (BCP): It is the 2 iin filtration (about 18 mm 1g); it opposes breve exerted by the filtrate in Bowman's capsule Smeralar colloid osmotte pressure (GCOP): Thi i Caton fas proeins nthe glomenta dng Ata on san iteppoes ; it opposes ‘spe net filtration pressure (NFP) can be calculated as follows: NEP = (GBHP ~ BCP - GCOP)= (60 ~ 18 ~ 32) mm ig = 10 mm Hg Hence, the NFP required to filter the blood plas ir os he NF ng plasma from the glomerulus into the Bowman's capsule Afferent arteriole Figure 13.9 Pressures determining GFR. Asoregulation of GFR food flow and GFR despite normal changes in blood echanism underlying is called + Kidneys help maintain a constant renal bl. a—provides Feeback 10 the ure everyday, This capability is called autoregulation and the m “iuloglomerular feedback (ie. part of renal tubules—macula dens dlomerulus), ls When the glomerular filtrate passes through the end portion of the loop Son aes dan a omer te Peodium chloride (NaC) and aecOiney EN reine fo blod pressure clowe down the ow of tered uid along the cule sete whic i ‘ezbsorption of sodium and chloride; consequently, NaCl concentration Hes cfferent arterioles 'y macula densa, Macula densa increases renin secretion and constricts 'ncreasing GFR. This process is explained in Figure 13.10.ition Anatomy Pysilogy and Health Educati Arterial pressure af) Figure 13.10 Autoregulation of glomerular fitration rate. Tubular reabsorption Tubular reabsorpric i a during its pases 2” Fefers to the qualitative and quantitative changes in the glomerd Psssage through the tubular portion of the nephron till the collecting duct. Large quantit: a rs nets feb clectrolytes and other substances are selectively reabsorbed (accor! . ip PCT. The substance er oushout the renal tubule, but the maximum reabsorption takes place The folloug. nett &° teabsorbed pass into the blood in peritubular capillaries. 0 . ae nae two mechanisms are involved in tubular reabsorption: A is process nero I involves the movement of molecules against electrochemic S energy, which is derived from ATP. al gradientThe Urinary System _E rption: It involves the movement of molecules along the electrochemical gradient. ¢ reabso es not need energy. passive Fea 2 Mgrs do i seabsorption of the substances occurs in almost all the segments of the tubular portion of the tron 1. Pc g The mumel g The cells of PCT reabsorb the following: > Glucose: 100% active reabsorption by sodium-glucose transport proteins and GLUT. The reabsorption of glucose is so efficient that appearance of only a trace of glucose in urine suggests diabetes mellitus. The condition in which glucose is not reabsorbed by the kidney is called glucosuria (glucose in urine). cells lining PCT are well adapted for reabsorption of materials from filtrate as they bear ous microvilli that increase the surface area for reabsorption. > Oligopeptides, proteins and amino acids: 95% active reabsorption; only 5% appears in urine. > Some urea is reabsorbed by diffusion and the rest remains in the filtrate for removal in urine. > Electrolytes: Sodium and potassium ions are reabsorbed actively by Na-H antiport, Na-glucose symport and sodium channels. The reabsorption of these ions from tubule reduces the concentration of filtrate, and an equivalent amount of water is passed into the peritubular capillaries by osmosis. The chloride ions are reabsorbed by passive diffusion. > Bicarbonate ions: 99.9% bicarbonate ions are reabsorbed, which play a role in the maintenance of the acid-base balance. 2. Loop of Henle The first wide part of the descending limb is imperme: second partis freely permeable to water; thus, water is hypertonic as it reaches the ascending limb. The ascending limb is impermeable to water along its entire electrolytes (sodium, potassium, chloride) and urea. The electrol transport as well as by diffusion, which makes the filtrate hypotonic to plasma DCT. able to ions, water and urea, whereas the drawn out by osmosis, making the filtrate length while it is permeable to lytes leave the filtrate by active as it passes into 3. DCT and collecti lecting ducts ; val codium from the filtrate under the influence of Q The DCT and collecting ducts actively reabsorb s See the adrenal hormone aldosterone. The aldosterone makes the walls of DCT and collecting “esodi orption causes the uptake permeable to ions, leading to reabsorption of sodium. This sodium a i aauictmace of of an osmotically equivalent amount of water and thus plays @ water and urine output. Q Bicarbonate ions are also reabsorbed in DCT.Anatomy, Physiology and Health Education 4 Tubular secretion Some substances are not filtered during glomerular filtra tion due to either cit lage contact time in the glomerulus. Such substances are secreted into the tubule from = ne ° eg and thus get cleared from the body through urine, ular, Cig, These substances include the following: Q Some drugs (penicillin, aspirin) and foreign substances are actiy, ely secreted in Per, Q Creatinine, ammonia, potassium and hydrogen ions are secreted in PCT and Dep, The most important tubular secretion is th: DCT as removal of hydrogen and ammonia acid-base balance), le secretion of protons (HY) and ammonia plays a vital role in mai eet intaining the Tormal blood pl (ts The H*ions are secreted into PCT and DCT by the sodium-hydrog in exchange for Na*) and ATP-driven proton pump. The H* en antiport pump (secretion of the following buffers: Secreted into the renal tubule. Combines wit 1. Bicarbonate to form carbonic acid (H* + 2. Ammonia to form ammonium ions (H* + NH, ———» NH,’) 3. Hydrogen Phosphate to form dihydrogen phosphate (H+ HPO —_, H,PO;) HCO; + .co) Carbonic acid is converted to capacity of blood, Hydrogen ions This mechani ich maintait fering CO, and H,O, and CO, is reabsorbed, which maintains eee are excreted in the urine as ammonium salts and hydrogen pl sm maintains the acid-base balance of body fluids. Tubular seeretion has a minor role in the function of human kidneys in normal Pathological States such as decreased bl lood pressure when the filtration pressure Corain level and filtration stops, the urine is formed only by tubular secretion. _ Thus, by the Processes of glomerular fil is formed in the nephron. The volume of filtrate because of tubular Teabsorption ADH. tions. Hower condi pps in on, use F secretion, tration, tubular reabsorption and ee ‘i bn urine is very less compared to the ee alow) and the countercurrent mechanism (pole of kidneys in homeostasis Maintenance of water level in the body Kidneys play a pivotal role in maintaining the water balance in the body. Decreased water level in plasma Stimulates posterior pituitary lobe to release ADH ADH increases the permeability of DCT and collecting ducts to water Leads to water reabsorption from the DCT and collecting ducts and yunt of concentrated urine production of a reduced amor ‘ative reabsorption. This type of water reabsorption in the presence of ADH is called facult ADH is not secreted; thus, permeability of the DCT an production of abundant dilute urine. nsin-aldosterone system mikes the water level in plasma is normal, lecting ducts to water decreases, leading to Maintenance of blood pressure and electrolyte palance (Renin-angiote 8): The kidneys maintain the blood pressure and electr tem (RAAS)- « H ‘alled renin-angiotensin-aldosterone syst yte balance jn the body with the help of a systerEducation ogy and Health ion of blood pressure and comprises the following fan rays a vital role in the regulation = RAAS plays a vita proteins g Renin 1g Angiotensinogen 2 Angiotensin | aan as angiotensin-converting enzyme (ACE) kas akey olen he RAAS as Anenzyme known ens I. Aldosterone isa steroid hormone released TeRAN as otensin I to form angen water and cectotyte balance, at rey of RAAS and its subsequent physiological effects is explained in Figure 13,1) ation f Converts al cortex The activ Renin-angiotensin-aldosteron system ‘Sympathetic activity Tubular Na+ Clr ("=> reabsorption Liver | @ and k* excretion, |] cy-4 | H,Oretention | { Adrenal gland: 4 sisal | @cortex ‘Angiotensinogen —-> Angiotensin |---> Angiotensin ll -—— > Aldosterone i fa secretion io VA Decrease in | Renin Vy circulating volume fea pertusion® \\ increases. Perfusion (jurtaglomerular >| \\ @ P of the juxtaglomerular ara >A Arteriol baie) ay \ "ascent, anparais ees a \ increase in blood | \ Pressure ‘Arteriole | \ | { Kidney \Q, je al “ADH secretion { Pituitary gland: 1 Posterior lobe 4 eo | Collectin’, duct: t H,0 absorptionr The Urinary System pel maintains renal homeostasis by the following three principal ways: ates the reabsorption of Na’, Cl and water in the PCT, ae its the adrenal cortex to release aldosterone, a hormone that acts on the renal tubule to eat » more Na’ a and Cl and secrete more K*. The reabsorption of Na‘ and CI, in turn, decreases ate ; seater exeretion, which increases blood volume, , ca pect vasoconstrictor, thus increasing glomerular blood Pressure, thereby regulating lar filtration rate, .d blood volume also stimulates the posterior pituitary lobe to release ADH, which causes psorption in the DCT and collecting ducts, water real spe various roles of kidney in the maintenance of homeostasis have been summarized in Figure Decreased blood ‘low to kidneys production of renin CSS) glomerular Pressure Incteased systemic Increased eystomk blood volume Increased stimulation of thirst centres Increased ADH production Increased sympathetic ‘motor tone Figure 13.12 Role of kidney in the maintenance of homeostasis.FEE Anatomy, Physiology and Health Education URETERS ters natomy of ure Al Y Jong tubular structures that extend from the renal pelvis of the kidney to comet The Ureler fthe urinary bladder. Each ureter is about 10-12 in, (25-39 em) longand ose i posterior s : in diameter. , min ofthe urinary bladder, the ureters curve medially and A the eee bladder, When he urinary bladder fils with urine and pressure inthe bladder ie openings into ureters get compressed and serve as a valve to Prevent the bakten these oblique urine. ass obliquely through the Posty lor Histology of ureters / Each ucteris composed of the following thre layers of the tissue: a Inner layer: Mucosa is made up of transitional epithelium that can stretch, 3 Middle layer: Muscular layer is made up of two layers of smooth muscle. Q Outer layer: Fibrous layer is made up of fibrous tissue that forms the outer covering of ureters, Functions of ureters ‘The ureters serve to propel the urine from the kidney into the urinary bladder. The urine is carried through the ureters primarily by peristaltic contractions of the smooth muscusr ‘alls ofthe ureters, but gravity and hydrostatic pressure also contribute. These peristaltic waves ries ‘be calyees ofthe kidney and pass to the urinary bladder about 1-5 times per minute URINARY BLADDER Anatomy of the urinary bladder It is 2 hollow, distensible (collapsible) pear-shaped sac located in the lower or pelvic region ofthe abdominal cavity, just behind the symphysis pubis. Pen ‘i : a ‘ jina and inferior In males itis directly anterior to the rectum, whereas in females it is anterior to the vagina an to the uterus, ‘mbles a deflated bal ‘ ightly filled with loon when empty but assumes a spherical shape when slightly filed w the urine volume in ty js 700-8 creases, it becomes pear shaped and the average capacity is 70 Histology of the urinary bladder The wall ofthe urinary bladder Itreser urine. As Consists of the following three tissue layers: wut posed of transitional epithelium; it consists of rugae smucos!) @ Inner layer (mucosa) is com that help in the di Q Middle layer of these detrus Sor muscles Q Outer layer ig composedThe Urinary System id eior of the urinary bladder has three openings: the two posterior openings from two ureters e miFees) and the single anterior opening to the urethra (urethral orifice guarded by internal i pincer). These three orifices form a small triangular area called the trigone. The internal tl gphinoter is made up of detrusor muscle (smooth muscle fibres) and is present at the junction of ie er and wets Thi sphincter sno unde voluntary contol ig 13.13) i Ureter Detrusor muscle: Peritoneum ‘Submucosa: Rugae ‘Ureteral opening Mucosa Fibrous connective tissue Internal urethral orifice: Extemal urethral orifice Figure 13.13 Structure of the urinary bladder. Functions of the urinary bladder Iiserves as the reservoir for urine, that is, it stores the urine prior to its exretion out of the body. Ithelps expel the urine out of the body through the urethra. Anatomy of the urethra Urethrais a small tubular structure leading from the floor of the urinary bladder (internal urethral orifice) to the exterior of the body. ; In females, the urethra lies behind the symphysis pubis and opens atthe external urethra! once between the clitoris and the vagina. It is quite short, (only about 3-5 cm long in Se tip of cnly urine, In males, urethra (about 20 em) courses through the prostate gland and ope Nt the pens atthe external urethral orifice (guarded by external urethral sphint. eee in aes: it carries urine and spermatic fluid. For further details, see the chapt ystem, URETHRA - | { | | Histology of the urethra sed of the following three tissu | both males and females, the wall of urethra is comp. a an ice & Mucosa, which consists of stratified squamous epithelium that continues YT soa nerves | Q Submucosa, which consists of the spongy connective tissue that contains lo Q Muscle layer, which forms the intemal and external urethral sphincter layers:Education ‘Anatomy, Physiology and Health incter is composed of smooth muscle fibres and elasig . 1 sphi habegs tissue, It The inter ue exter trethral sphincter is composed of skeletal mule, ae Und involuntary control. Ud voluntary control. thra in male and female is shown in Figure 13.14, ‘The uret 7 i—uroter Urinary bladder \ Trigone Prostatic urethra Prostate gland = Bulbourethral gland ‘Membranous U Penile urethra Penis) urethral orifice | xtemal urethral orifice- @ © Figure 13.14 (a) Urethra in male; (b) Urethra in female. Functions of the urethra |i serves as a channel through which the urine is expelled out of the body. In males, the urethra also serves as the channel through which semen is discharged out of the body. a . jcturitic ination. is voided from the urinary bladder is called micturition Nota reflex, In grown-up children and adults, it can be contro The process by which urine the result of the micturition Some extent, MICTURITION REFLEX The impulses that init called he it a F aw in jex are nictriion refen tte# Conscious desire to expel urine by triggering 2 spinal ine and foisted starts when the ; tors situs ; The Teflex inside the bladder increases, T| walls of the urinary bladder ay inary bladder is filled with about 300-400 mL 0 he increase in pressure stimulates the stretch receP nd urethra (Fig, 13.15).The Urinary System —_ qetch receptors transmit sensory (afferent) impulses to the micturition centre located at st psf the sacral spinal cord. This initiates a spinal reflex called micturition reflex. In (S37 micturition centre in the spinal cord sends the parasympathetic nerve impulses (via pene) towards the bladder and internal sphincter, resulting in the contraction of the detrusor relaxation of the internal sphincter so that urine enters the urethra from the bladder. rine enters the urethra, the stretch receptors in the urethra are stimulated, which again send vards the micturition centre, thereby inhibiting somatic motor neurons (pudendal nerve). temal sphincter relaxes and micturition takes place. layed to parasympathetic NS Excitation of stretch receptors: Pelvic nerves Rel when ~300 mL of urine — i Pelvic nerves Micturition [<———_— Pudendal impulses nerve inhibited Figure 13.15 Micturtion reflex. | : | WSS aa STEM | a ] | URINARY TRACT INFECTIONS | are the microbial infections that are more common in females due othe shorter length of urethra, f | poms include painful urination, frequent urination, bed-wetting and low back pain. etn “mmation of ureters (ureteritis), bladder (cystitis), urethra (urethritis) and kidney (pyel il is isseric sae and E, coli. The susceptible microorganisms include Streptococcus faecalis, Neisseria gonorriae SLOMERULONEPHRITIS The inflammation of glomerulus is called glomerulonephritis. ena ‘ "is often associated with the allergic reaction to the toxins produced by ae so ndition resulting “1 be an acute esponse followed by streptococcal sore throat or can be a chron kidney failure, Symptoms include inflammation of glomerulus and haematuria. POLYCYSTIC DISEASE «neji lisa gente disorder characterized by the formation of ysts (Huid-filled eaves) and collecting tubule.Physiology and Health Education Anatomy, | ally become large, they exert pressure on the walls of DCT As the oysts gradually 0" sis and may eventually lead to renal failure, Oct * ing in is ia and ne‘ resulting in ischaemi ; ; ‘Symptoms include urinary tract infections, haematuria and large abdominal mise PYELONEPHRITIS Itrefers to the microbial infection of the renal pelvis of the kidney, infection results inthe formation of abscesses, which is usually folloy, The spread ofthe i fever and groin pain. by malice Be NEPHROTIC SYNDROME 2 ‘Nephrotic syndrome is a condition characterized by hyperlipidaemia, Proteinuria, oedema an hypo |. buminaemia. Itaffects both adults and children and is associated with several glomerular diseases, ‘ACUTE RENAL FAILURE Itrefers to the condition in which the kidney function is dented reversibly, characterized by decrexed glomerular filtration. The reasons associated with acute renal failure may include decreased blood flow due to sevee shock, glomerulonephritis, tubular necrosis, tumour of urinary bladder and tumour of uterus, Symptoms include oliguria (decreased urine output) or anuria (urine output of less than 50 ml). CHRONIC RENAL FAILURE Itisa condition in which the kidney function is dented irreversibly, characterized by irreversible dele in glomerular filtration rate (GFR). More than 75% of the kidney function is lost due to chronic pyelonephritis, glomeruloneiis hypertension or diabetes mellitus, As Patients with end-stage renal failure require haemodialysis and have to undergo Kiar t= RENAL CALCULI These are also known as stones (calculi), he re Precipitation of various substances such as oxalates,urates, phosphates and the formation of stones in the kidney and urinary bladder. TUMOUR OF THE URINARY BLADDER The development of tumour, both benign and malignant, is the major disease ofthe Ofen there are multiple tumours, which may lead to severe pathophysiologic!The Urinary System NEPHROPTOSIS OR FLOATING KIDNEY =. Iti the inferior displacement or slipping of the kidney from its normal position. It mainly occurs when the kidneys are not held properly by the adjacent organs or its fat covering, This condition can block the urine flow and put pressure on the kidneys. It is more common in thin people. OTHER DISEASES OF URINARY SYSTEM Uraemia: It is the condition of high level of urea in blood due to severe kidney malfunction. Polyuria: It is characterized by excessive urine formation due to certain conditions such as diabetes mellitus and glomerulonephritis. Cystitis: It is the inflammation of the urinary bladder and is caused mainly due to bacterial infection. 4, Pyelitis: It is the inflammation of the renal pelvis mainly caused by bacterial infection.