Lecture 11 - The Genitourinary System

The kidney -retroperitoneal

extends from
organ
-
[12-13
-
contains a
medially located hilum (portal of
entry/exit for venal vessels, nerves and lymphatics
-

internally the hilum is continuous with renal sinus.

Posterior relations of the kidneys:

·on the
right side has its
upper pole
at rib is level,left & lith IS
the
· has s
segments each, which receive separate arterial supply. (significant)
xin mout
· consist of medulla and cortex, contains
1-2 million nephrons, which are the
anatomic and functional units of kidney.
· each
nephron consistof a corpuscle,
renal
a
proximal convoluted tubule, Henle's loop
and a distal convolutedtubule.

Functions:

manenga
er
1) Filters blood
produce
to urine
2) Reabsorbs nutrients, essentialions and water (most in PCU)
3) Excrete urine and foreign substances

dinin
the
4)
Regulates salt, ion electrolytel
balance. and water
Produce vasoactive substance (angiostenin ill that
3)
regulate P.
6) Produce renin by juxtaglomerular cells, which convert plasma tubule
to which is converted to
angiostenin angiostenin I,
(Act enzyme)
angiostenin I by enzymes in lungs
7) Angiostenin II, a vasoconstrictor, increase P and stimulate
the
aldosterone production by supravenal cortex.

The Parts of the kidney The - Cortex

Form the outer cart of the and alsoprojects
I kidney
-

into
medullary junction between renal pyramids as
renal columns.
-
Contain renal corpuscles and proximal anddistal CT.
-
The renal corpuscle consist of glomerulus surrounded by
a
glomerular Bowman Capsule which is the
invaginated blind end of nephron.
The Medulla
·forms the inner
part of the kidney.
of
· consist 8-12 renal pyramid which contain straighttubules (Henle loops) and collecting tubules.
· the apex of the renal pyramid, the renal papillar, fits into the
cup shaped minor calyxon which
there is 10-25
openings.

Minor Calyces
Receive urine from the collecting tubule and empty
into a
major calyses, turn
which
· or more in
empty
an upper dilated
into
portion of the ureter, the renal pelvis.
Renal fascia
· The kidney is invested
by a firm, fibrous renal capsule which is surrounded by renal fascia which divides
the fatinto a regions.
The perivenal fatlies in the between the renal capsule and renal fascia, and the
·
perinephric space
pararenal fatlies external to renal fascia.

& -
Blood Supply to the kidneys
the blood to the kidney by the renal
supply is
-

branches from the porta

arteries, paired
-
Has arterial segments including the superior, N
anterosuperior, antero inferior, interior and
posterior segments, that are the end
arteries (do not anastmosel

Venous renal rein which lies

drainage
-

anterior the renal arteries

to -

tributary
to the IC-the longer leftrenal vein
anterior to the aorta.
·pass
 The Creter
· is a muscular tube that begins with the
renal pelvis, extending from the
kidneyto the
urinary bladder.

·
Is retroperitoneal, descends on the transverse

processes of the LV and the

psoas muscle.

· Is crossed anteriorly by the gonadal vessels, and

the bifurcation ofthe common iliac
a
crosses (near
crossing iliac
atery
artery. May be obstructedby renal calculi bifurcation to ext and int)
where joins the
it renal pelvis, where it
crosses the pelvic brim over the distal and
of the where it
common iliac artery, or
enters the wall of the bladder. --
urinary

instead of

helps surgeons.
uterine artery
CrOSS
anterior to
I wreter.
CNSS
urether
superior

Blood Supply to the Prefer

a) the ureters receive arterial branches from adjacent vessels as they pass toward the bladder:the
renal auteries supply the upper end.
b) the middle part receive branches from the abolominal aorta, the testicular or ovarian arteries, andthe
may
common iliac arteries
1 in the pelvic cavity, the ureters are supplied by one or more arteries from branches of the internal
iliac
artery.
the veins ofthe ureters drain into the renal find testicular or ovarian veins.
6)

e) lymphatic drainage ofthe ureters follow a pattern similar to that of the arterial supply.
Al lymph from upper part drains into lumbar nodes;middle part into common iliac nodes inferior pt
and

intoexternal and iliac nodes.

9) innervated lumbar
by (sympathetic) and pelvic (PS) splanchnic nerves.
The Urinary Bladder
-
locatedwithina fatfilled retropubic space.
-
Varies in size, shape and position

Empty 4 sided
pyramid;resides in true pelvis
-

Full- ovoid;protrudes anteriorly and

superiorly into the abolominal cavity

Puboresical or puboprostatic ligaments:

neck is fixed located
·
approx 3-4cm behind the
-

lower margin of the

symphsis publis
o
surrounding fat within
retropubic space.

Haute, asis,sterinterInfantgar
-

portion.
-
Has a neck, which is the area where the
fundus and the interolateral surfaces come
together, leading the
into urethra.
-
the trigone is two orifices of the
bounded by
ureters and the internal urethral orifice,
ground which is a thick circular layer called
the internal sphincter (sphincter vesicae)
-
Has bundles of smooth muscle fibres that, as a
whole, are known as detrusor muscle of the bladder.

The Bladder:Inferior Section

Bladder trignoe:
Smooth area of the bladder in the non distended state.
1) Ureters the posterior, interolateral of the bladder.
open into aspect
-

2) Urethra-commences the
at neck of the bladder as the internal urethral orifice.

Internal urethral sphincter:

located at neck of bladder
·

detrusor muscle (smooth muscle)

·

·
autonomic innervation.

Sphincter Grethrae (FUD):

· ass with membranous urethra
·
skeletal muscle
· innervated by pudenal nerve
Blood Supply/Venous drainage of bladder:
-
main are branches of the internal iliac arteries.
superior visceral arteries supply anterosuperior parts of bladder.
-

-
in males, fundus and neck of bladder are supplied by the inferior vesical arteries
-
in females, the inferior vesical arteries are replacedby the vaginal arteries which send small
the posterointerior
branches to
parts of the bladder
the obiturator and inferior also small branches to the bladder.
-

gluteal arteries supply

its
-
venous blood is drained by prostatic
or vesical plexus of rein, which empties into the
internal iliac vein
in both sexes, the lymphatic vessel the external iliac
to
lymph nodes, whereas those
pass
-

from the fundus

pass to the internal iliac lymph nodes

Innervation
·
Vesical and prostatic plexus
·
parasymphatic nerves (pelvic splanchnic nerve originating from Sc-S4 stimulates to contractthe
musculature (detrusor) of the bladder wall, relaxes the internal urethral sphincter and then
promotes
I emptying.
· the sympathetic nerve relaxes the detrusor and constrictthe IUS.

The Male Urethra

exitfor
Is a muscular tube, provides semen (sperms and glandular secretion.

Blood the urethra the bladder's

Supply
the
-
in
neck and prostatic urethra are supplied
of the inferior
by the
prostatic branches
vesical and middle rectal arteries.
the intermediate and sponyparts are supplied
the internal pudenal artery.
by
Venous/Lymphatic drainage
the lymphatic
vessels drain mainly into the
internal iliac
lymph nodes.
hymphatic vessels from spony rrethra pass
to

deep inguinal lymph nodes.

Nerves of male urethra are derived from the
prostatic nerve
plexus.
 The female urethra
the short female urethra of the
passes anterointeriorly from the internal urethral orifice urinary
·

bladder posteriorly, and then tothe public symphysis to the external urethral orifice in the vestibule
of the
vaging.
· the urethra lies anterior to the vagina
· the urethra with the thru pelvic diaphram.
passes vaging
· Urethral gland are present, particularly in its
superior part;
the pararethral gland are homologues the
to
prostate.
· these glands have a common
paravrethral
duct, which opens
lone on each side) near the external urethral orifice.
·
the inferior half of the urethra is in the peritoneum.

Urethra urethral orifice

is
approximately 4cm in length. External
into vestibule. UTI due to short urethra,
opens more common

to
proximity vaging and anus;intercourse.

Vasculature -

suppliedby internal pudenal and vaginal arteries.

-
the follow arteries and have similar name.
vein
-
most
lymphatic vessel from urethra pass to the sacral and internal iliac lymph nodes.
a few vessels drain into
-

inguinal lymph nodes.

Innervation -
vesical and
pudenal nerve. Termination receives somatic afferents.

The supravenal cortexsecretes corticosteroids

and androgens and the medulla secretes
epinephrine and norepinephrine.
The supravenal artery arise from 3 sources:
-

superior supravenal arteries (6-8) from the

inferior phrenic
artery -

-
middle supravenal arteries (or more) from
the abolominal porta near the origin of the
SMA.
- inferior supravenal
artery (or more from
the renal
artery.

The venous
drainage of the supravenal gland is into a large supravenal vein.
-
The short
rightsupravenal vein drains into the IVC, longer is joined oftenby the inferior phrenic
vein, empties intothe left renal vein.
-
the supravenal lymphatic vessels arise from a
plexus deep to the capsule of the gland and from
from lumbar lymph
one in its medulla. The
lymph passes
nodes.