Renal

ANATOMY
SYLLABUS
Kidney: (P. 395)
Anterior and posterior relation of right and left kidneys (P. 397), vascular segment and microscopic structure
(P. 301), development (P. 395)
Ureter: (P. 301)
Extent, course in male and female, gross feature & microscopic structure (P. 304), development
Urinary Bladder: (P. 304)
Retropubic space (of Retzius), gross features relations (in males and females) (P. 305), blood supply (P. 305),
nerve supply(P. 305), lymphatic drainage and microscopic structure(P. 307), development
Urethra: (P. 307)
Gross features and relations (in males (P. 307) and females (P. 308)), applied aspects and microscopic
structures (P. 309), development (P. 309)

VI

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VI

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ANATOMY

KIDNEY  Paired, bean shaped, retroperitoneal essential

Past Questions: excretory organ (behind peritoneum)

1. Name the coverings of kidney. Draw a labelled Development of Kidney: [01]

diagram to show the anterior relations of right - Kidney develops from metanephros, caudal
kidney. (1+4=5) [09 Dec] portion of intermediate mesoderm in the
2. Draw a labelled diagram to show the structures sacral region.
related with anterior surface of the left kidney.
Mention its source of development.
(4+1= 5) [09 July]
3. Draw a labelled diagram of coronal section of the
kidney. Mention the positions of renal blood
vessels and different parts of uriniferous tubules.
(5) [08 July]
4. Mention the structures related to the anterior
surface of the right and left kidneys with the help
of suitable labelled diagrams. Add a note on
renal angle. (2 +2 +1 =5) [06 June]
5. Mention the anterior relations of left kidney with
labelled diagram. (3) [05 Dec] VI
6. Describe the left kidney under following
headings: (2+2+1=5) [10 July]
a. Its anterior relation
b. Its posterior relations
c. Its coverings .
7. Draw a labelled diagram to show the posterior
relations of: (3 + 2 =5) [03 Nov]
- Nephrons arises from 2 sources.
a. Right kidney
i. Secretary part (i.e. Bowman’s capsule, PCT,
b. Urinary bladder of male
loop of Henle, DCT):From metanephric
8. Describe with the help of a labelled diagram the
blastema.
anterior and posterior relations of right kidney.
What is the renal angle and its applied ii. Collecting part (i.e. collecting duct, duct of
importance? Bellini): From ureteric diverticulum/bud arising
9. Write short notes on: (2.5× 2 = 5) [02 Dec] from mesonephric duct (Wolffian duct)
a. Congenital anomalies of kidney - Ureteric bud gets capped by metanephric
b. Juxta-glomerular apparatus of kidney tissue which gets dilated to form renal pelvis
10. Draw a diagram of right kidney showing and divides and sub-divides to form major and
structures related anteriorly. (1.5)[13] minor calyces and (1-3) million collecting
11.Draw a diagram of right kidney showing related tubules i.e. ureter, pelvis, major and minor
anteriorly. (1.5)[013] calyces arises from ureteric bud.

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 Anatomy
- Kidney is lobulated in fetal period (with 12
lobules).
- Kidney ascends up to lumbar region with
differential growth of abdominal wall.
- Ascent is evident by the presence of direct
arterial branch to kidney from common iliac
artery which is in sacral region.
Position:
- Located in between level of T12 and L3
vertebra.
- Right kidney is about (1-2) cm lower than left
kidney due to position of massive right lobe of
liver.
Factors keeping kidneys in position:
- Pressure exerted by neighboring viscera which
is maintained by tone of abdominal muscles.
- By deposition of renal fascia and distribution of
renal fat
- Attachment of renal vessels and pelvis of
ureter (pedicles of kidney) to hilum.
Measurement:
- Size: 11 cm (long)  6 cm (wide)  3 cm (thick)
VI - Weight = (130 - 150) gram in female
= (150 -170) gram in male
- Right kidney is shorter and more wider than
left one.
Axis of kidney:
- Longitudinal axis is directed downward and
laterally such that upper pole of kidney is more
medial than lower pole.
- Transverse axis is directed laterally and backward
such that hilum is facing antero-medially.
Note:
- Transpyloric plane passes through the upper part
of the hilum of right and lower part of hilum of left
kidney.
- Being sub-diphragmatic organ, kidney moves with
respiration to an extent of 1.5 cm to 2.5 cm.
- Normally kidney is non-palpable but can be
palpated by bi-manual examination.
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Coverings of the kidneys [09, 10]
(4 coverings) From outside to inside
i. Paranephric fat: It is present around renal fascia.
ii. Renal fascia:
a. It is continuous with fascia transversalis
laterally and medially splits to form thin
anterior layer (fascia of Gerota) and thick
posterior layer (fascia of ZuckerKandl).
b. Both anterior and posterior layer fuses at
upper pole of kidney and resplits to enclose
suprarenal gland and again reunites forming
suspensory ligament of suprarenal gland and is
continuous with sub-diaphragmatic fascia.
c. Both layers are not fused at lower pole of
kidney.
iii. Perinephric fat (adipose capsule): Present deep to
renal fascia and surrounds kidney. If fat gets
dissolved (as in prolonged starvation), kidney falls
down and condition is called as Nephroptosis.
iv. True capsule of kidney: It is fibrous layer covering
entire kidney, renal sinus and pelvis.
Surfaces of Kidney
i. Anterior: Partly peritoneal (i.e. covered by
peritoneum)
ii. Posterior: Entirely non-peritoneal
Borders of Kidney
a. Medial: It presents concavity called as hilum
which is gateway for: (anterior to posterior).
- Renal vein
- Renal artery
- Pelvis of ureter
- A branch of renal artery, a tributary of renal
vein, renal nerve and lymphatics.
b. Lateral: Convex
Poles of kidney:
a. Upper pole
b. Lower pole
BASIC SCIENCE MBBS
 Renal

Relations of kidney: Note:

A. Posterior relation:
- It is almost same for both kidneys except at
few points as shown in figure.
[03,10] Renal angle: [MCQ 13 KU]
Renal angle is downward facing angle between
12th rib and erector spinae muscle corresponds to
lower part of kidney.
It has great clinical significances:
- Renal colic pain shoots downward and forward
from renal angle to groin.
- Kocker’s incision is oblique incision done from
renal angle to anterior superior iliac spine to
expose kidney.
B. Anterior relations of Kidney: [06,09, 13]

Upper part of posterior Lower part of posterior

relations relations

1. Diaphragm arising 1. From medial to lateral:

from medial and - Ilio-psoas fascia
lateral arcuate covering psoas major. VI
ligament.
- Anterior layer of
2. Costo-diaphragmatic Right kidney: [06,09]
thoraco-lumbar fascia
recess covering quadratus - Presents 5 areas of impression:
th th
3. 11 and 12 ribs in lumborum. i. Suprarenal area (for right suprarenal gland).
left kidney and 12 th ii. Duodenal area (for 2nd part of duodenum)
- Fascia transversalis
iii. Hepaticarea (for right lobe of liver)
rib only in right covering transversus iv. Colicarea (for right colic flexure/hepatic
kidney. abdominis. flexure of colon)
2. Paranephric fat v. Jejunalarea (for coils of jejunum)
Left kidney: [05,06,09,10]
3. Deep to thoraco-lumbar
- Presents 6 areas of impression:
fascia:
i. Suprarenal area (for left suprarenal gland)
- Subcostal vessels and ii. Splenic area (for spleen)
nerve. iii. Gastric area (for stomach separated by
- Ilio-hypogastric nerve lesser sac)
iv. Pancreatic area (for body of pancreas and
- Ilio-inguinal nerve. splenic vessels)
- Fourth lumbar artery v. Jejunal area (for coils of jejunum)
only in right kidney. vi. Colic area (for left colic flexure/splenic
flexure of colon).

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 Anatomy

Note: - Lieno-renal ligament is attached along the

- Hepatic area, jejunal area, splenic area & gastric areas junction of gastric and splenic areas.
are peritoneal (i.e. covered by peritoneum anteriorly)

Cut-section of kidney: [08]

VI
- It shows 2 main parts:  (2 - 3) minor calyces fuse to form one major
i. Outer cortex: calyx.
 It is reddish granular area consisting of  (2 -3) major calyces fuse to form renal
cortical arches and renal columns pelvis which is funnel shaped dilated part.
 Cortical arches is part of cortex between  From pelvi-ureteric junction, ureter arises.
base of the pyramid & surface of the kidney Blood supply of kidney:
 Area of cortical arch bounded on each side i. Arterial supply:
by inter-lobular blood vessels and
presenting in central axis of a single
medullary ray, is known as lobule of kidney
 Cortical arch with pyramid capped by it
forms lobe of kidney
 Part of cortex lying in between lobes is
called as renal columns
ii. Inner medulla:
 It consists of (8 – 18) renal pyramids which
are pale and conical structures.
 Apex of pyramid is directed towards renal
sinus which is perforated by (16 -20) Ducts
of Bellini and is received by minor calyx.

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Renal artery, branch from abdominal aorta Nerve supply:

 - Sympathetic supply by renal plexus through
Enters through hilum anterior to renal pelvis & coeliac plexus containing fibres from T10-L1.
posterior to renal vein
- Sensory nerve fibres from T10-T12.

Divides to give anterior and posterior trunk Microscopic structure of kidney:
 - Each kidney consists of around 1 million of
Anterior trunk divides to give 4 segmental arteries uriniferous tubules each of which is again
(Apical, upper anterior, lower anterior and lower formed of:
branches) while posterior trunk continues as a
1. Nephron (secretary part) and
single posterior segmental artery
2. Collecting part (collecting duct & duct of Bellini).

Each segmental artery divides to give lobar 1. Nephron: [08]
branches - It is structural and functional unit of kidney.
 - U-shaped tube (50-55) mm long consisting of
Each lobar arteries divides to form 2 interlobar
one dilated blind end called as Bowman’s
arteries
capsule while other end opens to collecting

part and is called as renal tubule.
Interlobar arteries divide to form arcuate arteries at
cortico-medullary junction which runs along base of
pyramid

Each arcuate artery divides to give interlobular
arteries running towards capsule of kidney.
 VI
Several afferent arterioles arises from each
interlobular artery

Forms glomerular capillary plexus
- Sometimes, accessory renal artery may be
present that supply upper or lower pole of
kidney directly without passing via hilum.
ii. Venous drainage:
- Renal vein formed by corresponding tributaries
emerges one from each kidney via hilum.
- Right renal vein directly drains to inferior
venacava.
- Left renal vein drains to inferior venacava after
receiving drainage of left gonadal vein and left
suprarenal vein.
iii. Lymphatic drainage
- Lymphatics drains into para-aortic lymph
nodes located near to the level of origin of
renal arteries i.e.L2 level.
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 Anatomy

a. Bowman’s Capsule: Juxta glomerular apparatus: [02]

- It is dilated blind end of nephron which is It consists of:
invaginated by tuft of capillaries called as I. Macula densa:
glomerulus. - It represents modified epithelial cells of portion
of DCT lying in close proximity to afferent
- It has outer parietal layer lined by
arteriole and having closely aggregated nuclei.
squamous epithelium and inner visceral
- It senses increase in Na+ concentration in
layer lined by large polyhedral podocytes
tubular fluid and sends tubulo-glomerular
containing foot processes/pedicels. feedback to decrease GFR.
- In between 2 layer, Bowman’s II. Juxta glomerular cells (JG cells):
space/capsular space is present filled with - These cells are modified smooth muscle fibre
glomerular filtrate. of tunica media of afferent arteriole close to
b. Renal tubule: macula densa.
It consists of 3 parts: - JG cells are innervated by post ganglionic
sympathetic nerves, the stimulation (by macula
i. Proximal convulated tubule (PCT)
densa cells) of which excites renin release.
 It is lined by simple cuboidal epithelium - Some JG cells liberate renal erythropoetic
with brush borders (microvilli) and cells factor which helps in maturation of
shows basal striations showing that cells erythrocytes
are actively absorptive and secretary in - JG cells act as negative baroreceptors.
function. III. Lacis cells/Cells of Polkissen:
ii. Loop of Henle: - Polyhedral cells between vascular pole of
nephron and DCT.
 It is U-shaped with thin descending limb,
lower thin ascending limb and upper
VI thick ascending limb as shown in figure.
 Lined by simple squamous epithelium
and simple cuboidal epithelium in thin
and thick portion of loop of Henle
respectively
 Loop of Henle is surrounded by
peritubular capillary plexus while in case
of juxtamedullary nephron, vasa recta is
also present around loop of Henle.
iii. Distal convulated tubule (DCT):
 Lined by simple cuboidal epithelium.
 Devoid of brush borders and possess
basophilic cytoplasm.
2. Collecting part:
- It consists of collecting ducts and duct of
Bellini. Note:
- Collects glomerular filtrate from several Interstitial cells of Renal Medulla:
nephrons, enters renal papilla and drains to - Produces small amount of prostaglandins that
minor calyces. counter-regulates vasoconstricting action of ADH
- Lined by simple cuboidal epithelium. and thus regulates blood flow to medulla.

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Histology of Kidney: - Pancake kidney: When both kidney are fused

completely.
- Lobulated kidney: If lobulation persists.
- Both kidneys lying on one side or just one above
another.
- Kidney in sacral region: Due to failure of ascent.
- Kidneys in lower lumbar: Due to incomplete ascent.
- Kidneys in thoracic region: Due to excess ascent.
- Both kidneys in opposite side with 2 ureters
crossing.
- Hilum directed forward: Due to non-rotation of
kidney.

- It is covered by capsule. - Hilum directed anteromedially: Due to incomplete

rotation.
- It shows several tufts of capillaries called as
- Hilum directed anterolaterally: Due to reverse
glomerulus surrounded by glomerular capsule.
rotation.
- Cortex shows presence of DCT, PCT and
- Congenital polycystic kidney: Due to failure of
collecting ducts which are lined by simple
contact of secretory part & collecting part of
cuboidal epithelium.
nephrons.
- PCT has simple cuboidal epithelium with
- Aberrant renal arteries: Renal arteries arising
presence of brush border epithelium and
from abnormal level (instead of L2 level) due to
slightly darker unlike DCT due to presence of
basal striations.
incomplete or partial ascent of kidney. VI
- DCT has simple cubiodal epithelium without URETER
brush borders and basal striations and thus
Past Questions:
lighter than PCT.
1. Write the extent, normal constrictions, course
- Medulla shows number of collecting ducts with
and arterial supply of male ureter.
cuboidal epithelium and loop of Henle with
(1 +1 +2 +1 = 5) [03 June]
thin flattened cells.
2. Give the extent, sites of constrictions of ureter
- In between tubules and glomeruli, blood
and relation of its pelvic part. (3) [11 July]
capillaries and interstitial connective tissues
3. Describe pelvic part of female ureter under
are present.
following headings: (1 +1 +1 +2 = 5) [05 June]
Applied Aspects: a. Extent
Developmental anomalies of kidney: [02] b. Course
- Agenesis: One or both kidneys absent. c. Relations
- Duplication: Presence of additional kidney in 1 d. Applied anatomy
side (separate or fused to normal kidney). 4. a. Draw a well labelled diagram about
- Horse-shoe kidney: Lower poles (sometimes upper histological structure of ureter. (2)
poles) are fused  ascent is not complete due to b. Name 3 congenital defects of development of
restriction by inferior mesenteric artery. kidney. (3) [02 Dec]

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 Anatomy

5. Describe ureters on the following headings. ii. At pelvic brim.

(5 × 1 = 5) [07 July] iii. At site of crossing by vas deferens or broad
a. Commencement, termination and length ligament of uterus.
b. Parts and constrictions. iv. At site of piercing urinary bladder
c. Nerve supply v. At site of opening to interior of urinary bladder
d. Arterial supply Relations [05]
e. Source of development i. Renal pelvis:
6. Write short notes on: [04 June] Right ureter:
a. Histological structure of ureters - Anteriorly
Extent [03, 05]  Renal vessels,
- It is muscular tube extending from kidney to  2nd part of duodenum.
urinary bladder measuring about 10 inches (25
- Posteriorly - psoas major
cm) in length.
Left ureter:
Parts and course [03, 07, 11]
- Anteriorly
It consists of 3 parts:
 Renal vessels
i. Renal pelvis: Funnel shaped dilated upper part of
ureter formed by union of (2 - 3) major calyces.  Pancreas, jejunum, peritoneum.

ii. Abdominal part of ureter: Passes downward and - Posteriorly - Psoas major.
slightly medially and enters pelvic cavity by ii. Abdominal part of ureter:
crossing bifurcation of common iliac artery. Right ureter Left ureter
iii. Pelvic part of ureter:
VI Anteriorly:
It also consists of 3 parts:
- Parietal peritoneum - Parietal peritoneum
a. 1st vertical part: Extends from bifurcation of
common iliac artery, passes downward and - Right gonadal vessels - Left gonadal vessels
laterally and ends at the level of ischial spine. - Right colic vessels - Left colic vessels
b. 2nd oblique part: Passes forward and medially - Ileocolic vessels - Sigmoid colon
above levator ani, base of muscle from ischial - Terminal part of ileum - Sigmoid mesocolon
spine to superolateral angle of UB. - Root of mesentery
c. 3rdintravesical part: Has oblique course lying in - 2nd and 3rd part of
musculature of UB. duodenum
Note: Posteriorly (both right and left ureters):
Right and left ureter opens in interior of urinary
- Psoas major
bladder at 2.5 cm apart in empty state and 5 cm
apart in distended urinary bladder. - Tips of transverse process of vertebrae
- Genitofemoral nerve
Constrictions of ureter [03, 07, 11]
Medially:
These are present at 5 places:
i. Pelvi-ureteric junction at level of lower pole of - Inferior venacava - Left gonadal vein
kidney. - Inferior mesenteric vein.

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 Renal

iii. Pelvic part of ureter [11]

VI

In its vertical course, c. Vesical veins surrounding terminal part of

Posteriorly: ureter.
- Internal iliac artery and its anterior trunk In female:
- Internal iliac vein a. Broad ligament of uterus.
- Lumbosacral trunk and sacroiliac joint. b. Uterine artery.
Laterally:
c. Supravaginal part of cervix.
- Obliterated umbilical artery
d. Anterior to vagina.
- Obturator nerve and blood vessels
- Inferior vesical artery Blood supply:
- Middle rectal arteries a. Arterial supply: [03, 07]
- In female, uterine and vaginal arteries. - Upper 1/3 portion: By branches from renal
In its forward course of pelvic part of ureter, it is artery mainly and also from gonadal or colic
related to,
arteries.
In male:
- Middle 1/3 portion: By branch from aorta
a. Ureter crosses vas deferens superiorly near
mainly.
base of UB.
b. Seminal vesicle

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 Anatomy

- Lower 1/3 pelvic portion: By branches from Development

vesical artery, middle rectal artery & uterine Arises from ureteric bud from mesonephric duct
vessel.
Applied Aspects:
- All branches forms plexus at surface of
Developmental Anomalies of Ureter:
ureter and supply.
- Partially or completely duplicated ureter.
b. Venous drainage: Corresponding named veins.
- Abnormal sites of opening of ureter instead of
c. Lymph drainage:
urinary bladder such as urethra, ductus deferens,
- Upper part: Paraaortic lymph node
rectum, vagina, etc.
- Middle part: Common iliac node
- Upper end of ureter may be blind.
- Lower part: Internal and external iliac node.
- Hydroureter: Due to obstruction of urine flow,
Nerve supply: ureter is dilated.
- Sympathetic supply: From spinal segment T10 - - Presence of valves or diverticula in ureter.
L1 via renal, gonadal.
- Parasympathetic: By vagus and pelvic splanchnic URINARY BLADDER
nerve and superior hypogastric plexus.
Past Questions:
Histology of ureter [02, 04] 1. Describe the urinary bladder under the following
headings: (2 +2 +1 =5) [03 Nov]
a. Trigonum vesicae (Internal trigone)
b. Nerve supply and its importance in micturation
c. Arteries supplying it.
2. Give an account of the urinary bladder under the
following headings: (1 +1 +1 +2 = 5) [03 June]
VI a. Location with capacity
b. Peritoneal covering with applied importance
c. Ligaments
d. Blood supply
3. Write short notes on: (2 +3 = 5) [04 June]
a. Trigone of urinary bladder
b. Transitional epithelium

It is composed of:
- Outer tunica adventitia: Fibrous coat
containing loose connective tissue and
numerous blood vessel.
- Middle smooth muscular layer:
 Consists of outer circular and inner
longitudinal muscle layer.
 In lower portion, additional outer
longitudinal layer may be present.
- Inner mucous membrane: It consists of (4-5)
cells thick transitional epithelium. The mucous
membrane is thrown in fold giving star shaped
appearance to lumen in transverse section.
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 Renal

Shape: 3. Superior upward surface:

- It is tetrahedral hollow muscular walled organ.
- It has 4 surfaces: One superior, 2 inferolateral
and base
- It has 6 borders.
- It has 1 apex and 1 neck.
Location: [03]
- In empty state, it lies in lesser pelvis.
- In distended state, it lies in abdomino-pelvic
region.
- In children, the bladder is abdomino-pelvic,
even when empty. This is because, the pelvic
cavity is small and the bladder neck lies at the
level of upper border of symphysis pubis.
- Neck of urinary bladder is 2 inches below and
behind lower border of pubic symphysis.
- In male, completely peritoneal and related to
coils of sigmoid colon and ileum.
- In female, only anterior part is related to coils
of sigmoid colon & ileum but posterior part is
related to supravaginal part of cervix.
4. Inferolateral downward surface and laterally:
- Pelvic surface of body of pubis.
- Fascia covering levator ani & obturator internus.
- Space of Retzius with vesical venous plexus and
retropubic fat.
5. Neck downwardly continues as urethra:
- Puboprostatic ligament in male and pubovesical
ligament in female is attached to fix urinary
bladder in position.

Capacities: [03] Ligaments of urinary bladder:

a. True ligaments:
- Ranges from 120 ml to 320 ml (average = 220 ml)
- Sense of feeling of bladder first starts at a - Formed by condensation of pelvic fascia and
capacity of 100 to 150 ml. consists of fibrous connective tissue with
smooth muscle fibers.
- First desire of micturition appears at a capacity
of 150 to 250 ml. - 9 in number.

- Physiological capacity of distention of bladder: Extends VI

True ligaments
i. In normal adults: 250 to 450 ml From To
ii. In newborn: 20 to 50 ml Tendinous
Side of
- Painful sensation above 450 ml 1. A pair of lateral arch of
urinary
- Micturation beyond voluntary control: On ligaments obturator
bladder
collection of about 800 ml fascia
Note: Anatomical capacity of bladder means volume 2. 2 pair of puboprostatic/ Back of Neck of
of urine just before rupture of bladder. It is about 1 pubo-vesical ligament body of urinary
liter or more (Medial and lateral) pubis bladder

Parts and Relations: Apex of

3. Median umbilical
urinary Umbilicus
1. Apex directed forward: ligament
bladder
- Attached to median umbilical ligaments which
extends upto umbilicus. Each side of
4. A pair of posterior true
base of Lateral pelvic
2. Base directed backward and downward: ligament (contains
urinary wall
- In male, a pair of seminal vesicle, ampulla of prostatic venous plexus)
bladder
vas deferens and rectovesical pouch.
Note: Median umbilical ligament is the remnant of
- In female, upper part of anterior vaginal wall
allantois.
and supravaginal part of cervix.

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 Anatomy
b. False ligaments:
- Formed by peritoneal folds (7 in number)
1. Anteriorly:
- Median umbilical fold.
- A pair of medial umbilical folds.
2. Laterally:
- A pair of lateral false ligament.
3. Posteriorly:
- A pair of sacro-genital/posterior false ligament.
Bladder bed:
- It consists of following structures upon which
urinary bladder rests:
i. Symphysis and body of pubis , Fascia of lavator
ani and obturator internus muscles, and
retropubic fat.
ii. Ampulla of rectum or anterior wall of vagina
iii. Base of prostate or superior fascia of
urogenital diaphragm.
Interior of Bladder:
- A number of temporary mucous fold called rugae
are present in the entire bladder wall except
internal trigone.
VI
- These folds disappear when bladder is distended.
Trigone vesicae/Internal trigone: [03,04]
- It is the smooth triangular area on interior of
posterior wall of urinary bladder where apex is
formed by internal urethral opening (crescentric)
and base is formed by interureteric ridge
connecting 2 openings of ureter.
- In male, just behind internal urethral orifice,
projection is present called as uvulae vesicae
formed by median lobe of prostate.
- 2 ureteric openings are 2.5 cm apart which on
urinary bladder distention can become 5 cm
apart.
Structures of trigone (from within outward):
i. Mucous membrane of transitional epithelium
(tensed)
ii. Trigonal muscle of Bell
iii. Loose areolar sheeth (fascia of Waldeyer)
iv. Detrusor muscle of bladder
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Peculiarities of trigone:
i. It is most fixed and dependent part of bladder
ii. Trigone is richly supplied with blood vessels
and nerves
iii. Trigone is mesodermal (from mesonephric
ducts) whereas rest of bladder mucosa is
developed from endoderm (of cloaca)
Blood supply of urinary bladder:
a. Arterial supply: [03]
i. Mainly superior and inferior vesical artery,
branches from anterior trunk of internal iliac
artery (in female, internal iliac artery replaced
by vaginal artery and uterine artery).
ii. Additional supply by obturator and inferior
gluteal artery.
b. Venous drainage:
- Vesical venous plexus drains blood to prostatic
venous plexus which then runs along posterior
ligament of urinary bladder and drains to
internal iliac vein.
c. Lymphatic drainage:
- Mainly drains to external iliac lymph node as
follow:
i. Anterior group of lymph node: Apex and
inferolateral surface.
ii. Intermediate group of lymph node: Superior
surface.
iii. Posterior group of lymph node: Base of
urinary bladder.
- Few drains to internal iliac lymph node and
para-aortic nodes.
Nerve supply: [03]
Sympathetic:
- (T11-L2) segments via superior hypogastric plexus.
- Relaxes detrusor muscle and contracts trigone
vesicae and sphincter vesicae.
Parasympathetic:
- (S2 - S4) segments via pelvic splanchnic nerve.
- Contracts detrusor muscle and proximal
urethral muscle.
BASIC SCIENCE MBBS
 Renal

Somatic fibres: Applied Aspects:

- (S2-S4) segments via pudendal nerve - Developmental Anomalies:
voluntary supply to sphincter vesicae (in
- Urinary bladder may be absent or duplicated.
external urethral sphincter)
- Absence of sphincter vesicae (internal urethral
Sensory fibres:
sphincter).
- Pain sensation by mainly parasympathetic and
- Presence of septa in cavity of urinary bladder.
partly by sympathetic nerve.
- Hourglass bladder: Constriction of middle part of
Microscopic structures: [04]
urinary bladder forming upper & lower compartment.
- Urinary bladder may communicate with rectum.
- Ectopia vesicae: Cavity of bladder opens to the
surface of body due to failure of migration of
mesoderm in lower abdominal region and rupture
of thin ventral/anterior wall of urinary bladder
formed by ectoderm and endoderm only.

URETHRA
Past Questions:
1. Mention the different parts of male urethra.
Name the widest and most dilatable part.
Wall of urinary bladder shows following features. Mention its development and two
i. Inner mucous membrane: developmental anomalies. (1+1+2 +1 =5) [08 Dec]
- Are thrown into folds (in empty urinary bladder) 2. Describe the subdivisions and course of male
and flattened (in distended urinary bladder) urethra. What is ‘hypospadias’ and what are its VI
- Lined by transitional epithelium. causes? (3 +2 = 5) [04 Nov]
ii. Middle muscle layer: 3. Write brief description of parts of male urethra.
- Consists of outer and inner longitudinal Mention development of each part.
muscle layer with thick circular/oblique fibres (5) [02 June]
in between called as Detrusor muscle which on 4. Mention the features in prostatic part of male
contraction helps to empty bladder. urethra with the help of labelled diagram.
iii. Outer serous layer:
(2) [05 Dec]
Development:
Development of UB Source Male urethra
1. Transitional Vesico-urethral canal (cranial part) Extent, Parts and Course [04,08]
epithelium. Therefore ENDODERMAL. - It extends from internal urethral orifice at neck
of urinary bladder to external urethral orifice
2. Trigone Absorption of mesonephric duct
epithelium at the tip of glans penis.
Therefore MESODERMAL.
- It forms passage for urine and semen.
3. Detrusor muscle Splanchnopleuric mesoderm
- (18 -20) cm or 8 inch long, 6 mm wide and
4. Apex of urinary Allantois (endodermal), proximal consists of 3 parts:
bladder part i. Prostatic part of urethra
5. Median umbilical Atrophied and obliterated lumen ii. Membranous part of urethra
ligament of allantois (distal part of allantois)
iii. Spongy part of urethra

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 Anatomy

- Extends from urogenital diaphragm to tip of

glans penis.
- Shows 2 dilated fossa.
a. Intrabulbar fossa: At bulb of penis 
Trapezoid in cross section.
b. Terminal navicular fossa: At glans penis.
Female urethra
 4 cm long extending from internal urethral orifice
to external urethral orifice in vestibule.
Glands around female urethra:
i. Urethral glands (Litter's glands)
ii. Paraurethral glands/Skene’s gland (corresponds to
prostate gland in male)
iii. Greater vestibular gland:
- Compound racemose gland lying behind
i. Prostatic part (3 cm) [05] bulb of vestibule in superficial perineal
- Prostatic urethra is the widest and most pouch and opens by duct on either side of
dilatable part of male urethra vagina.
- Corresponds to bulbourethral glands in
- Extends from internal urethral sphincter to male.
pelvic fascia of urogenital diaphragm. iv. Urethral lacunae.
- Fusiform in coronal section and posterior part - Lacuna magna is largest and situated on the
shows following features: dorsal wall of commencement of terminal
a. Urethral crest: Median longitudinal mucous fossa. It is guarded by mucous fold called
fold produced due to trigone of UB. Valvule of Guerin
VI Blood supply:
b. Colliculus seminalis/Verumontanum:
Male Female
Rounded elevation at middle of crest and
Arteries:
bears 3 orifices of: 1 prostatic utricle and 2
i. Urethral artery  from Superior vesical artery
ejaculatory ducts. Prostatic sinuses are
internal pudendal artery
mucous gutters on lateral side of urethral
ii. Dorsal penile artery Vaginal artery
crest where prostatic glands open by
Veins:
numerous ducts.
i. Anterior part of urethra
ii. Membranous part (Anterior wall = 2 cm 
and Posterior wall = 1.25 cm) Dorsal vein of penis
- Least dilatable part 
Prostatic venous plexus
- Part of urethra lying within urethral diaphragm

or deep perineal pouch.
Vesical venous plexus
- Has oblique course and stellate lumen in cross 
section. Internal iliac vein
- Surrounded by sphincter urethrae muscle ii. Posterior part of urethra
forming external urethral sphincter. 
iii. Spongy part (15 cm): Prostatic and vesical venous plexus
- It is situated inside corpus spongiosum and 15 
cm long. Internal iliac vein

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Nerve supply:
i. Prostatic plexus in male supplies smooth
muscles of prostate and prostatic urethra
ii. Parasympathetic supply by (S2-S4) segment.
iii. Somatic nerve supply by (S2-S4) segment
through pelvic splanchnic nerve
Lymphatics:
Male Female
i. Prostatic & membranous i. Internal & external
urethra: Internal iliac
iliac lymph nodes.
lymph nodes
ii. Anterior urethra: Deep
inguinal lymph nodes.
Microscopic structure:
Wall consists of:
a. Inner mucous membrane: Consist of lining
transitional epithelium resting on connective
tissue in proximal part of urethra near urinary
bladder while in distal part of urethra, it is formed
by pseudo-stratified squamous epithelium.
b. Submucosa: Consist of loose connective tissue.
c. Muscle layer: Outer circular and inner longitudinal
smooth muscle layers.
Development of Urethra (Male): [02]
- Derived from caudal part of vesico-urethral
sinus and urogenital sinus.
i. Prostatic part:
- Above opening of prostatic utricle (except
posterior wall): Derived from vesico-urethral
canal i.e. endodermal.
- Posterior wall of urethra above opening of
prostratic utricle: Derived from absorbed
mesonephric duct i.e. mesodermal.
- Below opening and prostatic utricle: Derived from
definitive urogenital sinus i.e. endodermal.
ii. Membranous part:
- Endoderm of urinogenital system.
iii. Penile part:
- Glandular part including navicular fossa and
external urethral meatus  Ectodermal
epithelium of genital tubercle.
- Rest proximal portion  Phallic part of
urogental sinus.
Development of Urethra (Female):
- Anterior wall: From urethral part of vesico-
urethral canal.
FAST TRACK
Renal
- Posterior wall: From absorbed Wolffian/
mesonephric duct.
Applied Aspects:
Developmental anomalies of urethra: [04,08]
i. Hypospadias: Urethral opening on the ventral or
undersurface of penis due to incomplete fusion of
urethral folds.
Causes:
- Testosterone deficiency or inability of body to
respond to testosterone.
- Progesterone therapy during pregnancy.
ii. Epispadias:
- Urethral opening on dorsal surface of penis.
[MCQ 2013]
- Associated with ectopia vesicae.
Applied Aspects: [05]
th
i. The angle between lower border of 12 rib and
outer border of the errector spinae is called as
renal angle which is the site for eliciting
tenderness in kidney. [MCQ 2013]
ii. One common congenital condition of kidney is
polycystic kidney disease, which leads to
hypertension.
VI
iii. Ureteric colic pain due to stones starts initially at
loin which then radiates towards groin and
external genital organs i.e. cutaneous areas
supplied by segments mainly T11 to L2 which also
supply ureter.
iv. Ureteroceles is cystic dilation of lower end of
uterus.
v. Acute injury to the cervical or thoracic segments of
spinal cord leads to state of spinal shock, which
causes relaxation of urinary bladder and contraction
of sphincter vesicae resulting distention of urinary
bladder and dribbling of urine. This causes reflex
contraction of urinary bladder in every 2-4 hours
once it is full called as Autonomic Reflex
Bladder/Neurogenic bladder dysfunction.
vi. Catheter (rubber tube) is passed into the bladder
through urethra in case of retention of the urine in the
bladder and process is called as catheterization.
vii. Hypospadias is common anomaly in which urethra
opens ventrally on the undersurface of penis or in
perineum.
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 Anatomy

SPECIAL POINTS FOR MCQs

1. Kidneys are retro-peritoneal lying on the side of psoas muscle.
2. Kidneys are not lying parallel, with the upper poles being approximately 2 cm from midline and
the lower poles approximately 3.5 cm from the midline.
3. Posteriorly, right kidney is related to 12th rib whereas left kidney is related to 11th and 12th rib.
4. Ureter is 25cm long and is totally retroperitoneal.
5. Ureter enters true pelvis after crossing iliac vessels.
6. Ureter changes its direction at the point of ischial spine.
7. Urethra is 18-20cm in length.
8. Prostatic part of urethra is the most dilatable part which contains urethral crest, colliculus
seminalis, prostatic sinuses, prostatic utricle.
9. Brodel’s bloodless line is the line along convex border of the kidney where territories of anterior
and posterior branches of renal artery meet.
10. Structures at the hilum of kidney from anterior to posterior are renal vein, renal artery and renal
pelvis [@VAP].
11. Ureter develops from ureteric diverticulum arising from mesonephric duct
12. Structures passing anterior to ureter are ductus deferens in male and uterine artery in female.
VI 13. Median umbilical ligament of urinary bladder is formed by remains of urachus.
14. Medial umbilical folds of urinary bladder are remnants of the obliterated umbilical arteries .
15. Juxta-glomerular apparatus consists of juxta-glomerular cells (secretes renin), macula densa (Na+
sensor cells ) and agranulated Lacis cells.
16. Horse-shoe kidney: Lower poles are fused in front of L4 vertebra.
17. Renal angle lies in between 12th rib and erecter spinae muscle. [MCQ 2013]
18. The narrowest part of the ureter is at the uretero-vesical junction.
19. Juxta-glomerular cells are modified smooth muscle cells of afferent arterioles.
20. Empty urinary bladder is tetrahedral in shape while full urinary bladder is ovoid in shape.
21. Shortest of the male urethra is membranous part of urethra
22. Cowper’s gland are found in membranous part of urethra.
23. Urorectal septum separates the cloaca into rectum and urogenital sinus.
24. Urachus fistula is patent allantois.
25. Least dilatable part is the membranous part of urethra.
26. Renal collar is formed by the splitting of left renal vein and encircling the aorta.

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