Departemen Fisiologi

Fakultas Kedokteran USU

REGULATION OF URINE
CONCENTRATION AND VOLUME
• The kidneys make adjustments to keep the solute
concentration of body fluids constant at about
300 mOsm, the normal osmotic concentration of
blood plasma.
• Maximum and minimum urine osmolalities in
humans are about 1,200 to 1,400 mOsm/kg H2O
and 30 to 40 mOsm/kg H2O, respectively.
• The kidneys accomplish this feat using
countercurrent mechanisms.
– The countercurrent multiplier is the interaction
between the flow of filtrate through the ascending
and descending limbs of the long nephron loops of
juxtamedullary nephrons.
– The countercurrent exchanger is the flow of blood
through the ascending and descending portions of the
vasa recta.
Medullary Osmotic Gradient
 OSMOTIC DIURESIS
• The presence of large quantities of unreabsorbed
solutes in the renal tubules causes an increase in
urine volume called osmotic diuresis.
• Osmotic diuresis is produced by the administration
of compounds such as mannitol and related
polysaccharides that are filtered but not
reabsorbed. It is also produced by naturally
occurring substances when they are present in
amounts exceeding the capacity of the tubules to
reabsorb them. For example, in diabetes mellitus
• It is important to recognize the difference
between osmotic diuresis and water diuresis.
• In water diuresis, the amount of water
reabsorbed in the proximal portions of the
nephron is normal, and the maximal urine flow
that can be produced is about 16 mL/min.
• In osmotic diuresis, increased urine flow is due to
decreased water reabsorption in the proximal
tubules and loops and very large urine flows can
be produced.
• The water diuresis produced by drinking large
amounts of hypotonic fluid begins about 15
min after ingestion of a water load and
reaches its maximum in about 40 min.
• The act of drinking produces a small decrease
in vasopressin secretion before the water is
absorbed, but most of the inhibition is
produced by the decrease in plasma
osmolality after the water is absorbed.
 Ureter
• The ureter plays an active role in transporting urine.
• Incoming urine distends the ureter and stimulates its
muscularis to contract, propelling urine into the
bladder. (Urine does not reach the bladder through
gravity alone).
• The strength and frequency of the peristaltic waves are
adjusted to the rate of urine formation.
• Both sympathetic and parasympathetic fibers innervate
each ureter, but neural control of peristalsis appears to
be insignificant compared to the way ureteral smooth
muscle responds to stretch.
 Ureter
• Most calculi are under 5 mm in diameter and
pass through the urinary tract without causing
problems.
• However, larger calculi can obstruct a ureter and
block urine drainage.
• Increasing pressure in the kidney causes
excruciating pain, which radiates from the flank
to the anterior abdominal wall on the same side.
• Pain also occurs during peristalsis when the
contracting ureter wall closes in on the sharp
calculi.
 BLADDER
• FILLING
• The walls of the ureters contain smooth muscle
arranged in spiral, longitudinal, and circular
bundles, but distinct layers of muscle are not
seen.
• Regular peristaltic contractions occurring one to
five times per minute move the urine from the
renal pelvis to the bladder, where it enters in
spurts synchronous with each peristaltic wave.
• The ureters pass obliquely through the
bladder wall and, although there are no
ureteral sphincters as such, the oblique
passage tends to keep the ureters closed
except during peristaltic waves, preventing
reflux of urine from the bladder.
• A moderately full bladder is about 12 cm (5
inches) long and holds approximately 500 ml
(1 pint) of urine, but it can hold nearly double
that if necessary.
• When tense with urine, it can be palpated well
above the pubic symphysis.
• The maximum capacity of bladder is 800-1000
mL and when it is overdistended, it may burst.
• EMPTYING
• The smooth muscle of the bladder, like that of
the ureters, is arranged in spiral, longitudinal,
and circular bundles.
• Contraction of the circular muscle, which is
called the detrusor muscle, is mainly
responsible for emptying the bladder during
urination (micturition).
• Muscle bundles pass on either side of the
urethra, and these fibers are sometimes called
the internal urethral sphincter, although they
do not encircle the urethra.
• Farther along the urethra is a sphincter of
skeletal muscle, the sphincter of the
membranous urethra (external urethral
sphincter).
• Micturition is
fundamentally a
spinal reflex
facilitated and
inhibited by higher
brain centers and,
like defecation,
subject to voluntary
facilitation and
inhibition.

 The first urge to void is felt at a bladder volume of about

150 mL, and a marked sense of fullness at about 400 mL.
• During micturition, the perineal muscles and
external urethral sphincter are relaxed, the
detrusor muscle contracts, and urine passes
out through the urethra.
• The bands of smooth muscle on either side of
the urethra apparently play no role in
micturition, and their main function in males
is believed to be the prevention of reflux of
semen into the bladder during ejaculation
 Urethra
• Saluran berdinding tipis yang memindahkan
urine dari kandung kemih ke luar tubuh degan
gerak peristalsis.
• Panjang : pria=8 inchi, wanita=1½ inchi.
• Pengeluaran urine diatur oleh dua katup
(sphincters)
– Internal urethral sphincter (tanpa
sadari/involuntary)
• External urethral sphincter (disadari/voluntary)
 Neuroanatomy of
Lower Urinary Tract
 MICTURITION REFLEX
Bladder fills

+
Stretch receptors

Spinal Cord
+
Parasympathetic
nerve

Internal urethral
Bladder contracts
sphincter opens

Only the external urethral sphincter is controlled voluntarily

Figure 26.21
 Urination: Micturation reflex
Rugae folds

Detrusor
a-Adrenergic
receptors

Hypogastic nerves (L1, L2, L3)

Sympathetic

Pelvic nerve
Visceral afferent pathway

Fundus

Sacral
Parasympathetic

(S1, S2, S3)

Sacral
Pudential nerves
Skeletal muscle
Figure 19-18: The micturition reflex
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