Chapter 4

Urinary System

Yan Kong, PhD

kongyan420@163.com
Urinary System
 Kidneys Kidney

 Ureters Ureter

 Urinary bladder
 Urethra
Bladder

Urethra

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 Urinary System Functions
 Removal of waste product from the body

 Kidneys - produce urine;

 Ureter Kidney
- transport urine from kidneys to
Ureter
urinary bladder;
 Bladder
- store urine and expel it into urethra;
 Urethra Bladder
- discharge urine from body. Urethra

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 Kidneys

Ureters

Urinary bladder

Urethra
 Urinary System Functions
 Removal of waste product from the body
Blood flow

 Kidneys
- filter blood plasma
- excrete the toxic metabolic wastes
(mainly urea and uric acid)
- produce urine
Glomerulus
Urine
Renal tubules
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 Urinary System Functions
 Removal of waste product from the body
Produce, convey, store & excrete → Urine
 Regulate blood volume and pressure
Kidney
( by regulating water output)
 Regulate the electrolyte balance (e.g. Ureter
sodium, potassium and calcium)
 Regulate the acid-base balance
( blood pH ) Bladder
 ……
Urethra

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 Section 1 Kidney
I . Features of kidneys
 Bean-shaped
(solid organ);
 Reddish brown color;
 Each kidney weighs
about 140 g;
 About 10 cm long, 5 cm
wide, and 4 cm thick (adult).

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Adrenal
gland

Kidney
 Superior and inferior pole;

 Anterior and posterior surface;

 Lateral surface is convex;

 Medial surface is concave

and has a slit (hilum).

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  Hilum of the kidney
 A deep vertical slit on the medial surface;
 Structures passing through the hilum Hilum
- Renal artery & vein Renal
artery
- Renal pelvis
- Renal lymphatics
- Renal nerves Renal
vein
Front to back: Renal
pelvis
Renal vein → Renal artery → Renal pelvis
Top to bottom:
Renal artery → Renal vein → Renal pelvis

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 II . Location of kidneys
 Retroperitoneal organs on the
posterior abdominal wall;
Inferior
vena cava Peritoneum
Diaphragm
Kidney
Adrenal
gland Adrenal
gland
Right
kidney

Right Left
kidney kidney
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 Lie in the posterior abdominal wall;

Diaphragm

Kidney
Posterior
Anterior abdominal
abdominal wall
wall

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II . Location of kidneys
 Lateral to the vertebral column;
 At the level of vertebrae T12 to L3;
 The right kidney is slightly lower than the left.

Left
Right kidney
kidney
T12

L3 Rib XII
Left Right
kidney kidney

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  Clinical Focus
Costovertebral angle / kidney region
 Acute angle formed between the
twelfth rib and the vertebral column (or
the lateral border of the erector spine);
 Surface projection of the hilum;
Rib XII
 Percussion pain can be elicited when
the person has kidney inflammation.

CV angle

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 III . Structure of kidney
Parts on coronal section:
Renal
 Renal cortex (outer) cortex
Renal
Hilum
medulla
 Renal medulla (inner) Renal
sinus

 Renal sinus
 Medial cavity that extends
from the hilum into the kidney.

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 Renal
medulla
Renal
column
 Renal cortex
 Outer part; Renal
cortex Hilum
 A continuous band of pale tissue;
 Completely surrounds the renal medulla;
Renal
 Renal column - extensions of the renal sinus
cortex project into the inner aspect of
the kidney;

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 Renal
Renal cortex
column
 Renal medulla Pyramid in
renal medulla
 Inner part (usually appears darker);
Hilum
 Renal pyramid – extended renal Renal
columns divide the renal medulla papilla
into discontinuous aggregations of Renal
sinus
triangular shaped tissue;
 Renal papilla - apical projection of
the pyramid toward the renal sinus;

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 Renal
 Renal sinus Renal cortex
column
 Medial cavity that extends from Renal
pyramid
the hilum into the kidney. Renal
 Minor calyx - structure that papilla Hilum
receives urine from the collecting Minor
ducts of the renal pyramids, calyx
Major
surrounds the papilla. calyx
 Major calyx - several minor calices Renal
converge to form a major calyx. pelvis

 Renal pelvis - two or three major

calices converge to form the funnel-like Ureter
renal pelvis; connect to the ureter.
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 IV . Coverings of kidneys
Each kidney is enclosed in the following layers of fascia and fat:
 From inside outwards:
Fibrous
Fibrous capsule capsule
Adipose
Adipose capsule capsule
Renal
Renal fascia fascia

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 Fibrous capsule (true capsule)
Fibrous
 Innermost layer; capsule
 Intimately adherent to the kidney;
 Covers the entire organ;
 A thick fibroconnective tissue capsule.

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 Adipose capsule (perinephric fat)
Adrenal
gland
 Intermediate layer; Fibrous
capsule
 A layer of adipose tissue; Adipose
capsule
 Cushions the kidney and holds it in place; Renal
fascia
 Surrounds the kidney and adrenal glands.

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 Anterior renal
fascia

 Renal fascia (Gerota’s fasica, false capsule)

Transversalis
fascia
 Anterior and posterior layers;
Posterior renal
 Surround the kidney (and adrenal fascia
glands) and perirenal fat; Diaphragmatic fascia
 Laterally – two layers fuse with Adrenal gland
each other and connect with the Anterior renal
fascia
transversalis fascia;
 Superiorly – two layers fused and Fibrous capsule
blend with the diaphragmatic fascia; Adipose capsule
 Inferiorly - open to the pelvis;
 Medially - open to great vessels; Posterior renal
fascia
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V . Renal blood supply andAbdominal
segment aorta Renal artery

 Supplied by a renal artery arising

from the abdominal aorta;
 Take about 20% of the cardiac
output to supply organs (less than
1% of total body weight);
 About one liter of blood circulates
Segmental Lobar Interlobar Arcuate
thorough both kidneys per minute; artery artery artery artery
 Renal artery → segmental branches Afferent
arteriole Produce
→lobar arteries → interlobar arteries blood Urine
→ arcuate arteries → afferent
arterioles. Efferent
arteriole Renal glomerulus
filter the blood 22
 Section 2 Ureters
Renal
pelvis
 Muscular tubes that transport urine Abdominal
part Psoas
from the kidneys to the bladder; major
 About 25 cm long; Iliac
vessels
Pelvic
 Three parts: part Bladder
- Abdominal part
- Pelvic part
Ureter
- Intramural part Bladder
Ureters pierce obliquely
the wall of the bladder.
Intramural
part
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  Three narrows of the ureter Renal
pelvis
Abdominal
 First point - ureteropelvic junction part Psoas
major
Iliac
 Second point - where the ureters Pelvic vessels
cross the common iliac vessels at the part Bladder
pelvic brim.
 Third point - where the ureters
enter the wall of the bladder. Ureter
Bladder
 Kidney stones can become
lodged at these constrictions.
Intramural
part
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 Clinical Focus Renal Stones (Calculi)
 Renal stones may form in the kidney
and then pass down the ureters to the
bladder.
 Cause significant pain (typically
distributes on the side of the insult
radiating from “loin to groin.”).
 The ureters narrow is a common
location for renal stones to become
lodged and cause pain.
 A stone may also result in blood in the
urine, vomiting, or painful urination.
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 Section 3 Urinary bladder
 A muscular sac (reservoir) on the
floor of the pelvic cavity;

 Varies in size, shape, position and

relations (according to its content and
the state of the neighbouring viscera).
 Normal capacity: 300-500 ml

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I . Features and location
 Three-sided pyramid like shaped (empty bladder);
 Situated in the pelvic cavity (empty);
 Inferior to the peritoneum and posterior to the pubic symphysis.

Uterus Rectum
Rectum

Bladder
Prostate Pubic Vagina
penis symphysis
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 Ureter
 Four parts:
Body
Apex
- connected with the umbilicus by
the median umbilical ligament; Base
Apex
Base (fundus)
- Triangular posteroinferior surface; Neck
Body Median
umbilical
ligament Prostate
Neck Urethra
- lower most fixed part.

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Empty bladder Full bladder
 II . Structure of the wall of bladder
Intra-ureteric
fold Opening of
ureters
 Mucosal lining
Ureter
 Opening of ureters

 Internal urethral orifice

Base

Internal
urethral
orifice
Urethra

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  Clinical Focus
Trigone of urinary bladder Opening of
ureters
 A triangle on the inner
surface of the base of
the urinary bladder.
 Defined by the openings Trigone
of the urethra and two
ureters.
 Mucosal lining on the
Internal
trigone is smooth urethral
(elsewhere is folded); orifice

 This is a common site of bladder infection.

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Section 4 Urethra

Urethra

 Begins from internal urethral orifice of the bladder and ends with
an external opening in the perineum.
 Women - short, about 5 cm long.
 Men - long, about 20 cm, and bends twice along its course.
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