Week 11

The urinary system – urine transportation, storage and elimination

11a: ureters, bladder, urethra

Ureters: Urine transportation

- 2 – left and right ureters (one from each of the kidney’s)
- Transport urine from renal pelvis to urinary bladder
- Thick-walled, narrow tubes (can vary in diameter from 1mm-10mm long)
- Retroperitoneal
- At the base of the urinary bladder - ureters curve medially and then pass obliquely
through the wall of the posterior aspect of the urinary bladder
- Peristaltic contraction, hydrostatic pressure gradient and gravity help urine pass through
- No anatomical valve at the opening to the urinary bladder – only a physiological valve
- Pressure of increased urine compresses oblique openings
 Infection possible if not working properly (microbes can travel up the ureters from
bladder to infect kidneys)

Histology of the Ureter:

- Three layers of tissue form the wall of the ureters
 mucosa, muscularis, adventitia
- mucosa – deepest
 a transitional epithelium
  known for considerable stretch capability - variable volume
 Mucus secreted by the mucosa protects the cells from solute concentration of
urine pH  really important because the cytosol of the cells of the ureter walls
have a very different pH than that of the urine concentration within the lumen
 have collagen and elastin fibers as well as some lymphatic tissues
- muscularis:
 Inner longitudinal smooth muscle (opposite to GI tract where longitudinal muscle in
outer)
 Outer circular smooth muscle
 function = peristalsis (rhythmic contractions of smooth muscle within the
muscularis layer, pushing urine from the kidneys down to the bladder)
- adventitia – outer layer
 Areolar connective tissue
 Contains blood vessels, lymphatic vessels, nerves that serve muscularis and mucosa
layers
 blends in with the surrounding connective tissue and anchors ureters in place

Urinary bladder
- Hollow, distensible, muscular organ – capable of stretch
- Within pelvic cavity – posterior to pubic symphysis
 In males: directly anterior to the rectum
 in females: anterior to the vagina and inferior to the uterus
- Held in place by folds of peritoneum
 - Shape depends on contents volume (empty = collapsed, slightly distended = spherical
shape, full = pear-shaped and rises higher in abdominal cavity)
- the urinary bladder capacity: 700 to 800 milliliters
 Smaller in females because the uterus occupies the space just superior to bladder

Urinary bladder: Trigone

- Trigone (small triangular area): floor of bladder
- Posterior corners of triangle: contain two ureteral openings
- Anterior corner: internal urethral orifice (opening to urethra)

Histology of bladder
- 3 layers: mucosa, muscularis and serosa
- MUCOSA: distensible due to transitional epithelium and rugae (folds in mucosa)
 Deepest
 mucous membrane composed of transitional epithelium
 has an underlying lamina propria
- MUSCULARIS: three layers of smooth muscle (inner and outer longitudinal, middle
circular)
 Circular fibers: form internal urethral sphincter
 Inferior to the internal sphincter is external sphincter = skeletal muscle (voluntary
control)
- SEROSA: layer of areolar tissue continuous with ureters
 Most superficial
  on the posterior and inferior surfaces
- Over the superior surface of the urinary bladder is a layer of peritoneum

Micturition: urine elimination

- Voiding the bladder (urination)
- Combo of voluntary and involuntary contractions
- When the volume in the bladder exceeds about 400mL, the pressure in the bladder
increases and triggers stretch receptors
- a sensory neuron goes to the spinal cord, and these impulses go to the micturition
center (in the sacral spinal cord around S2 to S3), and trigger a spinal reflex called the
micturition reflex
- Micturition reflex: P increases in bladder = stretch receptors on outer bladder wall 
sensory neurons transmit nerve impulse to  spinal cord  cerebral cortex
- Parasympathetic motor to urinary bladder (contraction) and internal sphincter
(relaxation)
 in this reflex arc, parasympathetic motor impulses from the micturition center will
propagate back to the urinary bladder wall and the internal urethral sphincter
 these nerve impulses will cause contraction of the detrusor muscle (the muscularis
layer), as well as relaxation of the internal urethral sphincter muscle
- Somatic motor neurons = external sphincter (skeletal muscle)
 simultaneously the micturition center will inhibit somatic motor neurons, which
innervate the skeletal muscle in the external urethral sphincter
 - upon contraction of the bladder wall and relaxation of the sphincters, urination will take
place
 urinary bladder filling actually causes the sensation of fullness that initiates a
conscious desire to urinate before the micturition reflex actually even occurs
 although emptying of the urinary bladder is what we're calling a reflex, it's in early
childhood when we go through potty training, we learn to initiate it and stop it
voluntarily
 through learned control of external urethral sphincter muscle, as well as certain
muscles of the pelvic floor, the cerebral cortex can initiate micturition or delay its
occurrence for a limited period of time so you have control over when you go to the
bathroom

Clinical connection: incontinence

- Lack of voluntary control over micturition (in adults)
 in infants and children under two to three years old, incontinence is completely
normal
 neurons to the external urethral sphincter muscle are actually not completely
developed
 voiding will happen whenever the urinary bladder is sufficiently distended and
will stimulate the micturition reflex
- 4 types: stress, urge, overflow and functional incontinence
 STRESS – the most common type
 Most common in young, middle- aged females
 Weakness of deep muscles of the pelvic floor
 Any physical stress that increases abdominal pressure causes leakage (something
like coughing, laughing, exercising, lifting heavy objects and certainly pregnancy,
will cause a leakage of urine from the urinary bladder)
 URGE
 Most common in older people
 Abrupt and intense urge to urinate
 Involuntary loss of urine
 Often caused by irritation of the bladder wall sometimes by infection, kidney
stones, stroke, MS, SCI or anxiety
 OVERFLOW
 Involuntary leakage of small amounts of urine
 Caused by some blockage or weak contractions of urinary bladder musculature
 when urine flow is blocked, for example from an enlarged prostate in males or a
kidney stone, or the urinary bladder muscles can no longer contract, the bladder
becomes overfilled and the pressure inside increases until small amounts of
urine actually dribble out
 Overfilled = P increase = leakage
 FUNCTIONAL
 Inability to “make it” to the bathroom in time
 Stroke, arthritis, AD
- Treatment depends on the type of incontinence
 Kegel exercises
 Bladder training
 Medication
 Possibly surgery
Urethra
- Tube from internal urethral orifice in the floor of the bladder to the exterior of the body
- Terminal portion of urinary system
- Passageway for discharging urine (and semen in men)

Male vs Female Urethra

- Males:
 the urethra extends from the internal urethra orifice to the exterior, but its length
and passage through the body are considerably different and quite long compared
to females
 the male urethra: prostate  through deep perineal muscles  through the penis
 consists of a deep mucosa and a superficial muscularis
 subdivided into three anatomical regions
1. the prostatic urethra: passes through the prostate
2. the intermediate or membranous urethra (shortest portion): passes
through deep perineal muscles.
3. the spongy urethra (longest portion): passes through the penis
 prostatic urethra
 contains the openings of ducts that transport secretions from the prostate and
the seminal vesicles that both neutralize the acidity of the female reproductive
tract, as well as contribute to sperm motility and viability
 also has ducts from the vas deferens which deliver sperm into the urethra
 the openings of the ducts of the bulbourethral glands actually empty into the spongy
urethra, and they deliver an alkaline substance prior to ejaculation that neutralizes
the acidity of the urethra. So, the glands will also secrete mucus, which lubricates
the end of the penis during sexual arousal
- females
  much less complicated and much shorter than compared to males
 lies directly posterior to the pubic symphysis
 the opening of the urethra to the exterior is the external urethral orifice and is
located between the clitoris and the vaginal opening

Aging and the urinary system

- Kidneys: decrease in size (1/3 weight  from an average of nearly 300g at age 20 to less
than 200 grams by about age 80), decreased blood flow, and therefore filter less blood
(~50%)
 By age 80, 40% of glomeruli are not functioning and thus filtration, reabsorption,
and secretion all decrease
 Kidney stones and acute and chronic inflammation increases with age
 because the sensation of thirst also diminishes with age, older individuals are more
susceptible to dehydration
- Bladder: reduction in size and capacity, and weakening of the muscles
 UTI’s, polyuria (excessive urine production), nocturia (excessive urination at night),
dysuria (an increased frequency of urination or even painful urination), incontinence
and hematuria (blood in the urine) - all more common with increasing age