Anatomy of the kidney

❖ Retroperitoneal organs on the posterior abdominal wall

❖ The right kidney is pushed downwards by the liver so its upper
Pole is lower than that of the left kidney.

Description

Poles ( Long axis is oblique )

Upper Lower

Nearer to the midline

Borders

Medial Lateral

Concave presents Smooth convex

A Hilum

Surfaces

Anterior Posterior

Post. Relations Similar in both kidneys

❖ Four muscles: diaphragm (superiorly), psoas major, quadratus

lumborum and transversus abdominis.
❖ Four neurovascular structures; subcostal vessels, and subcostal,
iliohypogastric, and ilioinguinal nerves.
❖ Pleura and ribs, the diaphragm separates the upper part of each
kidney from the cost-diaphragmatic recess.
 Ant. relations

Rt. kidney Lt. kidney

1. Right suprarenal gland 1. Left suprarenal gland

2. Second part of duodenum 2. Spleen with lienorenal ligament
3. Right colic flexure 3. Body of pancreas with splenic
4. Right lobe of liver vessels
5. Coils of small intestine 4. Posterior surface of stomach.
with ascending branch 5. Descending colon
of right colic artery 6. Coils of small intestine with
ascending branch of left colic A.

Renal N.

Structures enter or leave the

kidney
Renal Renal
A. V.

Fibrous capsule

The perirenal fat

coverings of
kidney Renal fascia

Pararenal fat

Arterial blood supply of kidney :

❖ Renal A. ---- from abdominal Aorta ---- enters the kidney through hilum
❖ Accessory Renal A. ---- 30% of people
❖ Renal blood flow = 1200 ml ( 20% of CO )

Nerve Supply : Coeliac Plexus ( vasomotor )

 Venous Drainage :
❖ Rt. & Lt. Renal V. ---- IVC
❖ Lt. Renal V. receives Lt. suprarenal & Lt. gonadal V.

Lymph Drainage :
❖ Lateral Aortic lymph nodes

Histology of the kidney

Stroma
• Fibrous C.T covered with
Capsule pere-renal fat

• Minimal C.T
C.T Fiber • Around BV
• Between Uriniferous tubules

• Cells & Fibers

Reticular C.T
• Forms Backgroun & Ag

Parenchyma
Cortex • Cortex Proper
( dark brown • Column of Bertini
or reddish ) • Labyrinth

• 6 - 18 Pyramids show
striations called Rays
Medulla • Collecting Tubules
( grey ) • Loops of Henle
• Vasa Recta
Renal Lobulations :
Lobes : Medullary Pyramid + Columns of Bertini + overlying cortical arch
Lobules : Central medullary ray + Cortical Labyrinth

The Nephron [The functional part]

1-Cortical nephrons: With short loop of Henle
2-Juxta-medullary nephrons: With long loop of Henle

Renal corpuscle: Round structures in cortex 200 : 250 µm in diameter

Components: Function of Renal Corpuscle :

Formation of glomerular filtrate by dialysis through RBB

A- Glomerulus:
❖ Fenestrated capillaries whose pores lack diaphragms
❖ Formed by an afferent arteriole, and drains into efferent arteriole
❖ Intraglomerular mesangial cells ( Pericyte-like cells )
Function of mesangial cells:
1- Phagocytosis of foreign bodies
2- Physical support of glomerular capillaries
3- Renewal of glomerular basement membrane

B-Bowman’s capsule:
Double-walled epithelial capsule with central space called Bowman’s space
Poles of Bowman’s capsule: a- Vascular pole b-Urinary pole
Layers of Bowman`s Capsule :
a- Parietal [Outer] layer: Simple squamous epithelium
b- Visceral [Inner] layer: Formed of Podocytes.
Podocytes
❖ Modified squamous cells
❖ Has cell body with irregular nucleus, rER, Golgi App. And numerous
ribosomes.
❖ Cell body sends long cytoplasmic extension called primary process,
which sends secondary processes end by feet processes implanted on
glomerular basement membrane.
❖ separated from glomerular basement membrane by sub-podocytic
space
Function of Podocytes:
1- A component in renal blood barrier which prevent passage of plasma
albumin and globulin
2- Regulation of glomerular filtration rate: Contraction of podocytes →
Closure of filtration slits → Reduce surface area for filtration
3- Secretion and maintenance of glomerular basement membrane material

Renal Blood Barrier [Filtration barrier]

Barrier between blood in glomerular capillary and space of Bowman’s
capsule

- Structure:
1- Glomerular endothelium
- Fenestrated not covered by diaphragm
- Prevent filtration of RBCs, WBCs & platelets
2- Glomerular basement membrane:
- Fused basal laminae of both overlying podocytes and underlying glomerular
endothelium
- Thick, continuously renewed & the most important component of renal barrier

By E/M: Formed of 3 layers:

Lamina densa: Middle dark layer, formed of Type IV collagen and laminin
2 Lamina rara [Interna and externa]: Pale outer and inner layers, formed of
heparan sulfate
- Prevent filtration of macromolecules [Plasma albumin and globulin] by
repulsion of its negative charge
3- Slit diaphragms between feet processes of podocytes
- Formed of cell-surface proteins [Nephrin and P-cadherin protein]
- All layers allow filtration of micro-molecules [water, glucose and ionic salts]

Renal tubules
1- Proximal convoluted tubule
2- Loop of Henle
3- Distal convoluted tubule

Loop of Henle
Hairpin-like tubule located in medullary tissue (medullary ray and medulla)
1-Descending limb
2-Ascending limb
❖ Both limbs contain - Thick segment ( lined by cuboidal cells )
- Thin segment ( lined by simple sq. cells )
Juxtaglomerular Apparatus : At the vascular pole of renal corpuscles
Components:
1- Juxta-Glomerular cells: Modified smooth muscle cells innervated by
sympathetic nerve fibers & contain acidophilic secretory granules
containing renin.
2- Macula densa [Dense spot]: modified become taller and crowded with
clustered apical nuclei which gives the appearance of a “dense spot”.
- Cells have numerous microvilli and infra-nuclear Golgi apparatus
3-Extra-glomerular mesangial cells [Polar cushions]
Function :
❖ Macula densa acts as osmoreceptors monitoring sodium level and
volume of urine in distal tubules
❖ In hypovolemia or hypotension → Macula densa stimulate adjacent JG
cells to secrete renin [A hormone that regulate blood pressure]
❖ Stimulate Adrenal cortex to secrete Aldosterone

CT & External Passages

1- Collecting tubule : drains urine from the distal convoluted tubule of 5 : 10
nephrons .
- Function: Aids in concentrating the urine [Under effect of ADH]
- Lined by simple cuboidal cells with & Joins with other collecting tubules to
form the
2- large ducts of Bellini[Papillary ducts] : in the medullary pyramids
- Lined by simple columnar epithelium Urinary passage :
3- Renal calyces: Collecting tubules --- calyces

Minor calyx: Funnel-shaped ( one for each pyramid ) Ureters Renal pelvis

major calyx: Four or five per kidney

Urinary bladder Urethra
4 – Renal pelvis: Formed by the union of major calyces
(Both renal calyces & renal pelvis are lined with transitional epith. )
 Physiology of the kidney

• Responsible for Homeostasis (keep internal environment contsnt)

By :

Controlling Regulating
Endocrine function
ECF
Acid-Base Balance Activating Vit. D
Volume Blood Pressure Erythropoetin
Osmotic pressure Renin
Electrolyte content

Excrete waste products Detoxification Gluconeogenes

is
Urea
Creatinine

Glomerular Filtration Rate ( GFR ) : the amount of glomerular filtrate

formed each minute in all nephrons of both kidneys.
- It equals : 125 ml/min - 180 litre/day

Glomerular Capillary Membrane: is formed of 3 layers

1) Capillary endothelium: which have wide pores not barrier for plasma
protein
2) Basement membrane: has no pores, negatively charged repel anions of
plasma (e.g. plasma proteins).
3) Bowman’s capsule epithelium: formed of podocytes with slit pores (25nm)

Filtration Fraction: is the fraction of renal plasma that become filtrate.

Urine = Filtration – Reabsorption – Secretion

Forces causing glomerular filtration:
Forces help the filtration :
(1) Hydrostatic pressure of glomerular capillary (HPGC)(60 mmHg)
In case of renal
(2) Colloidal Osmotic Pressure of Bowman’s capsule (COBC) (zero)
failure COBC will
-Why HBGC is the highest capillary pressure all over the body? have value

because:
a- Renal A. arises directly from the abdominal aorta.
b- Afferent arterioles are short & straight branches.
c- Diameter of the efferent arteriole is 1/3 that of the afferent, which
raises the pressure & increase the resistance
Forces oppose the filtration :
(1) Colloidal Osmotic Pressure of Glomerular capillary (COGC) = 32mmHg
(2) Hydrostatic pressure of Bowman’s capsule (HPBC)(18 mmHg)

Factors affecting GFR:

[1] Changes in glomerular hydrostatic pressure (GHP): By
A) Afferent arteriolar dilatation leads to increase HPGC → increase GFR

B) Afferent arteriolar constriction leadsto decrease HPGC → decrease GFR.

C) Moderate Efferent arteriolar constriction HPGC → slight increase of GFR

D) Severe efferent arteriolar constriction → increase in colloidal osmotic pressure (O.P) →
decrease GFR ( paradoxical decrease ) in GFR despite elevated HPGC.

[2] Changes in glomerular colloidal osmotic pressure (OPGC)

Increase in OPGC (as in dehydration) leads to decrease GFR.
Decrease in OPGC (as in hypoproteinemia) leads to increase GFR

[3] Increase hydrostatic pressure in Bowman’s capsule (HPBC):

As in urinary tract obstruction → decrease GFR.
[4] Increase colloidal osmotic pressure in Bowman’s capsule (OPBC):
As in increased glomerular membrane permeability → increase GFR

[5] Changes in Arterial blood pressure ABP & or renal blood flow :
GFR is kept constant despite of changing ABP between 90 - 200 mmHg. By
Autoregulation of GFR.

How to determine the GFR ? By inulin clearance (we inject inulin I.V.)
why inulin?
- neither reabsorbed nor secrete - not toxic
- not metabolized - not stored by kidney
- easy measured - Amount filtered = Amount excreted in urine
Calculation
C×P=U×V
C is volume of cleared plasma/min
P is the concentration of the substance in plasma
U is the concentration of substance in urine
V is the volume of urine/min.
C=U×V
P
Acid base balance: kept constant by balance between Intake of H+ &
output of H+
Normal PH of blood = 7.35(venous) - 7.45(arterial)
It becomes fatal if it
decrease than 6.8 OR increase than 8
Sources of H+ ion concentration are:
1-food
2-lactic acid in severe exercise
3-metabolism of food ( CHO , PTn , Fat )
4-diabetes mellitus
H+ ion concentration in body is kept constant by:
Chemical Buffers --- During seconds
lung mechanism --- Takes minutes
kidney mechanism -- Hours to Days ( Slow, Hormonal & Complete )
According to blood PH it can excrete variable amount of H+ ion in urine
in case of ACIDOSIS in case of ALKALOSIS
H+ excretion in urine H+ excretion in urine
Urine is acidic (PH = 4.5) Urine is alkaline (PH = 8)
This is done by :
❖ H+ secretion
❖ formation of titratable acids
❖ excretion of NH3
 H+ secretion 1- secondary active secretion ( In PCT & thick ascending loop
of henle )
Na-K pumb CAE
H2CO3 H2O+CO2
Peritubular
3Na+ Lumen
capillary
2K+
HCO3 H+ Na+

Basal Luminal
Border Border

❖ Na-K will pumb 3Na out and 2K in ( active transport )

❖ Na concentration will decrease inside the cell
❖ Na will pass from lumen to the cell ( passively ) & H+ will pass from the
cell to the lumen ( to maintain electric neutrality )
❖ This H+ will bind with dietary HCO3 forming H2CO3 which breaks into
H2O & CO2 to decrease acidity of the urine .

2-primary active secretion: In DCT & CD

Cl-

❖ HCO3 will pass from the cell to peritubular capillaries and Cl- will pass
to the cell ( to maintain electric neutrality )

❖ H+ Will be excreted by H+ ATPase

Bind with NH3 to form NH4 or phosphate buffer to reduce urine acidity
❖ It is stimulated by aldosterone hormone
formation of titratable acids: in DCT & CD

Na2HPO4

NaH2HPO4

❖ H+ will bind with Na2HPO4 to form NaH2HPO4 which is titratable acid

reduces acidity of the urine .

Excretion of NH3:DCT & CD(best in chronic acidosis)

H2CO3 H2O+CO2
Lumen
Peritubular HCO3 H+
Capillary Glutamine, glycine,glutamic acid----
NH3 --glutaminase enzyme-----NH3
Fat soluble

❖ HCO3 will pass from the cell to peritubular capillaries and NH3 will pass
to the cell
❖ H+ will pass from the cell to the lumen to bind with NH3
❖ NH3 accept H+ and form NH4 which diffuses trapping of Cl-
❖ NH4 + Cl- = NH4Cl ( slight acidic )
❖ Excrete large amount of H+ with minimal change in PH
Autoregulation
In case of ACIDOSIS
• Increase H+ will increase passage of HCO3 from cells to peritubular
Capillaries so CO2 will keep binding with H2O to form H2CO3
• H2CO3 breaks to HCO3 and H+
• H+ bind with NH3 to form NH4 which is lipid insoluble
• No inhibition of glutaminase enzyme so more formation of NH3
On H+ decrease
No H+ to bind to NH3 in lumen ---- increase NH3 ( lipid soluble )
Diffuse back to cell & inhibit Glutaminase enzyme

Na+ Reabsorption
Na+ equals 90% of osmotically active particles in extracellular fluid “ECF”
so, determine extracellular fluid volume.
Mechanism:
1) At basal border: primary active, against electrochemical gradients.
• Na+ is actively pumped, by Na-K ATPase from inside tubular cells
of P.C.T across basal border to intercellular space
• This creates a negativity inside the cell (-70 mv)
2) At luminal border : passive
The pump creates passive diffusion of Na+ from tubular lumen into
Tubular cells down an electrochemical gradient.
Sites of Na+ reabsorption in the nephron : 96-99% of Na+ is reabsorbed.
1) At proximal tubules: 65 – 67 % obligatory
Primary active reabsorption of Na+
• In upper half: coupled by co-transport of glucose, and H+ secretion by
Counter transport ( for electric neutrality )
• In lower half : - Na+is reabsorbed, accompanied with
- Cl-, HCO3 reabsorption , passive by electrical gradient.
- H2O reabsorption, passive by osmotic gradient
 2) At loop of Henle: Only in ascending limb, 30% of filtered Na+ is
reabsorbed (No Na+ channels in descending limb) obligatory
• In the thin part, Na+ reabsorption is limited ( Passive )
• In the thick part, Na+ reabsorption (25%) is active, Cl- is secondary to it
3) At distal convoluted tubules + collecting tubules: 3 – 5 % Facultative
• Under the control of aldosterone, variable amounts of Na+ are reabsorbed
associated with → Cl-, HCO3 reabsorption passively
→ K+, H+ secretion (counter transport)

Regulation of Na+ excretion :

(1) Rate of tubular flow & GFR :
• Slow rate of flow → increase tubular reabsorption of Na+.
• decrease GFR which initiates tubuloglomerular feedback mechanism
• Increase GFR →increase Na+ filtered → increase Na+ reabsorbed → slight
increase in Na+ excretion
N.B proximal tubules reabsorb constant % of filtered load of Na+ &H2O so it
has no transport maximum ( T.M ) but distal tubules has T.M as it reabsorb
variable amount of Na+ ( Facultative )
(2) Pressure Naturesis (Effect of increased “ABP” on Na+ excretion) :
Increase ABP → increase Na
(3) Concentration gradient:
reabsorption is determined by 2 factors:
• Concentration gradient → increase Na+ in proximal tubules →
increasereabsorption of Na+
• The time that the fluid remains in the tubule: The more the time,
the more the reabsorption
(4) Sympathetic stimulation:
• increase Na+ reabsorption
• direct on PCT & thick ascending loop of Henle
• increase renin & angiotensin II
 (5) Hormones:
Aldosterone: Acts on distal tubules & cortical collecting tubules
-Increases Na+ & Cl- reabsorption
-Increases K+ & H+ secretion.
Mechanism : induces synthesis of protein that increase number of
open channels in luminal border & increase Na+-K+ATPase at base.
Angiotensin II: leads to Na+ retention & ++ aldosterone
Direct effect on PCT (++ Na-K pump & H+ pump)
Constrict efferent arteriole (-- hydrostatic press & ++ osmotic Pressure of
peritubular capillaries)
Glucocorticoids: Na+ reabsorption through their weak mineralocorticoid
effect.
Sex hormones especially Estrogen: Na+ reabsorption as they have
Contraceptive bills containing estrogen increase
mineralocorticoid effect (before menses)
BP causing headache
Atrial Natriuretic peptide “ANP”: Na+ excretion
- increase GFR by relaxation of mesangial cells & VD of Afferent arteriole &
VC of efferent arteriole
- inhibits renin secretion.
- direct on collecting duct (inhibits Na-K+ pump & Na+ channels)

Glucose reabsorption: Complete ( all amount filtered is reabsorped )

( secondary active ) reabsorption In proximal convoluted tubule (upper half)
• no energy direct from ATP
At luminal border:
• A carrier (termed SGLT-2 = sodium dependant glucose transporter)
binds both Na+ & glucose at the luminal brush border
• Na+ diffuses along electrochemical gradient & glucose actively against
concentration gradient.
At basal border:
• By facilitated diffusion, passive, the glucose passes to the extra cellular
fluid & blood.
• The carrier needed here is not Na+ dependent. It is termed (GLT-2)
glucose transporter.

Tubular load “TL”of glucose: the total amount of glucose that is filtered in
glomerular filtrate/min = (125 mg/min)
“TL” = GFR × concentration of glucose/ml plasma
125 ml/min × 1 mg glucose/ml plasma [100 mg/100 ml]

Glucose Renal Threshold: the maximal concentration of glucose in plasma

above which glucose appears in urine.
• Normal glucose plasma level = 70-110 mg%; Up to 180 mg%, all
glucose filtered is reabsorbed.
• The glucose appears in urine at a plasma concentration above 180
mg% in venous blood & 200 mg % in arterial blood.

Tubular Maximum of Glucose “TMG” : the maximal amount of glucose

which can be reabsorbed/min = 300 mg/min in female & 375 mg/min in male
• glucose reabsorption reaches a maximum rate called Transport
Maximum for glucose (TMG) when the carrier for glucose is completely
saturated.
Glucosuria : appearance of detectable amount of glucose in urine.
Causes:
1- Diabetes Mellitus: decrease insulin → increase blood glucose above 180
mg% → increase tubular load of glucose above TMG.
2- Stress Hormones : they lead to hyperglycemic glucosuria
3- Renal Glucosuria : This is a hereditary disease in which the number of
glucose carrier decreases or the affinity of the carrier towards glucose is
reduced. This lower renal threshold &TM to about 100 mg%.
4- Other monosacchrides as galactose , xylose & fructose, they depress its
transport. This is called “competition for transport”
5- Oubain which block Na -K ATPase
6- Phlorizin which blocks sugar access to the carrier protein.

Water Reabsorption
About 180 liter/day of fluid filtered by both kidneys & Urine volume is about
1 liter/day . [ 179 liter of H2O are reabsorbed / day (99%) ]
H2O reabsorption in kidney is 2 types.

Reabsorption of H2O in different tubular segments :

(1) Proximal convoluted tubules :
• 65 % is obligatory reabsorbed secondary to active transport of solutes
as Nacl, glucose, amino acids.
• It occurs through H2O channels called aquaporin-1(protein in nature)
located at luminal border of tubular cells of PCT.
(2) Loop of Henle:
• 15% of H2O is reabsorbed by descending limb only. ( obligatory )

(3) Distal convoluted tubule : ( Facultative ) 3-5 %

• 7% of H2O is reabsorbed.
(4) Late distal tubule & collecting duct [ cortical & medullary]:
• Under effect of antidiuretic hormone (ADH) : variable 13%
 • It acts on H2O channels called aquaporin-2 located in the principal cells
at luminal border.
N.B: Aquaporin-3 is located at basolateral membrane of collecting duct for
transport of urea, glycerol & water.

Anatomy of the Ureters

Definition: The ureters (right and left) are retroperitoneal muscular tubes
which covey urine from kidneys to the urinary bladder.

Dimensions: The ureter is about 10 inches (25 cm) and has 2 parts;
abdominal and pelvic, each is 5 inches long. It is about 3 mm in diameter.

Course of the ureter:

The abdominal part: begins from the lower end of the renal pelvis, descends
downwards and medially on psoas major muscle towards the pelvic brim and
crosses the end of the common iliac artery to become the pelvic part.
The pelvic part: descends downwards and backwards till the ischial spine,
then forwards on pelvic floor and here it is crossed (in male) by the
vas deferens from lateral to medial side fig.9) the female is crossed from
lateral to medial side by the uterine artery,below the root of the broad
ligament.

( Bony relations )
Arterial blood supply:
Abdominal part receives branches from renal artery, abdominal aorta,
gonadal and common iliac arteries
Lymph drainage: lateral aortic lymph nodes.
Nerve supply:
The ureter receives sympathetic fibers from T11, 12, L1 segments of spinal
cord. Sensory fibers from the ureter enter the spinal cord through the same
segments. Ureteric colic begins in the loin and is referred to groin, scrotum or
labium majus through cutaneous nerves.

Histology of the Ureters

• Muscular tube connecting the renal pelvis and the urinary bladder
• Formed of mucosa, musculosa & adventitia
• Lined by transitional epithelium
• Upper two-thirds has two smooth muscle layers [inner longitudinal and
outer circular]
• Lower third has additional third outer longitudinal layer

Anatomy of the Urinary

bladder

Definition: Urinary bladder is a hollow viscus with strong muscular walls

which acts as a reservoir for urine.

Site : The site of the bladder differs with age and the amount of urine it
contains.
• In infants : the bladder (even when empty) lies in the abdomen (it is an
abdominal organ).
 • At 6 years of age : the bladder begins to enter the enlarging pelvis.
• After puberty : the bladder lies within the lesser pelvis (now it is a
pelvic organ).

Shape of the bladder : Empty bladder : has the shape of three-sided

pyramid with its apex anteriorly.

Description and Relations of the Urinary Bladder :

1) Apex of the bladder
Is continuous with the median umbilical ligament.
2) Base of the bladder (fundus)
-It is directed posteroiorly.
-Its superolateral angles receives the ureters.
Relations :

3. Superior surface : Is covered by peritoneum and related to :

4) Inferolateral surface : not covered by peritoneum.

related to :
• Body of pubis.
• Levator ani.
• Obturator internus.
5) Neck of the bladder : the lowest and most fixed part of the bladder.
In the male : it is continuous with the urethra at the internal urethral meatus
and rests on the upper surface of the prostate.
In female : it is continuous with the urethra and rests in the pelvic fascia.
At the junction of the neck and urethra, sphincter vesicae is present.
Peritoneal Covering of the Bladder :
• Only the upper surface is covered by peritoneum.
• The peritoneum leaving the bladder is loosely attached to the
suprapubic part of anterior abdominal wall.
• The distended bladder lifts this peritoneum from the abdominal wall,
so instruments could be introduced into the distended bladder without
injury to the peritoneum (suprapubic cystostomy).

Interior of the Urinary Bladder :

Trigone of the bladder :
- It is the small triangular area which lies between the orifices of the ureters
and the internal urethral meatus.
- Has the following special features :
• Its superior boundary is formed by the interureteric crest (ridge) which
connects the two ureteric orifices.
• Its mucous membrane is always smooth and firmly adherent to the
underlying muscle. It is very sensitive and vascular, so that, in
cystoscope it appears red violet in colour.

Capacity of the Bladder :

• Average capacity of adult bladder is about 300 ml.
• Distension of the bladder by 500 ml may be tolerated. Beyond this,
distension of the bladder is painful.

Arterial Blood Supply :

- In the male : by superior and inferior vesical arteries.
- In the female : by superior vesical and vaginal arteries.
Venous Drainage :
- Begins by the vesical venous plexus, embedded on the inferolateral surfaces
of the bladder → vesical veins which end in the internal iliac veins.
Lymphatic Drainage :To internal and external iliac lymph nodes.(slide 43)
Nerve Supply : By vesical nerve plexus, derived from the inferior
hypogastric plexus, it contains the following fibres :
• Parasympathetic efferents (S2, S3, S4) : motor to the detrusor muscle,
inhibitory to sphincter vesicae (they produce micturation).
• Sympathetic efferents : are inhibitory to detrusor and stimulant to
sphincter vesicae (they aid distension of the bladder).
• Sensory afferents : record bladder distension and pain sensation

Histology of the Urinary

Bladder

• Lined by transitional epithelium specialized to provide for distension of

the organ
• Has thick muscular wall contains three interlacing layers of smooth
muscle and a mixture of collagen and elastic fibers

Anatomy of the Urethra

Male Urethra : is about 20 in lentgh and has 4 parts

Parts of the Urethra :
1) First part : preprostatic part of urethra
Length : 1 cm.
Site: between neck of the bladder and the base of the prostate and is
surrounded by internal urethral sphincter which is formed of smooth muscle
[Inner longitudinal and outer circular layers]
- Lined by transitional epithelium
 2) Second part : prostatic part of urethra
Length : 3 cm.
Site: traverses prostate from base to apex and is the widest and most
dilatable part of the urethra.
Special features :
• Urethral crest : is a median longitudinal elevation in the mucous
membrane of its posterior wall.
• Seminal colliculus (verumontanum) is a prominence at the middle of
the crest. It has three openings : the opening of the prostatic utricle
in its middle, and the openings of the two ejaculatory ducts on the
sides.
• Prostatic sinuses : each is a depression on the side of the urethral
crest. Each receives 15 - 20 prostatic ducts.
• Lined by transitional epithelium
3) Third part : membranous part of urethra
Length : 2 cm.
Site : runs in deep perineal pouch (see perineum) and is the least dilatable
and (with the exception of external meatus) is the narrowest part of the
urethra.
• Receives the openings of two bulbourethral glands [Cowper’s
glands]
• It is surrounded by external urethral sphincter [Formed of striated
muscle]
• Lined by stratified or pseudo-stratified columnar epithelium
4) Fourth part: spongy part of urethra
Length : 15 cm.
Site : It traverses corpus spongiosum of the penis and ends at the external
urethral meatus at the tip of the glans penis.
Special features :
• At its beginning, it dilates in bulb of penis to form intrabulbar fossa.
• At its termination, it dilates in the glans penis to form the
navicularis fossa.
The external urethral meatus is a vertical slit, about 6 mm long. It is the
narrowest part of urethra, and a calculus may lodge there.
Has two types of mucous glands:
1- Intraepithelial glands
2- Glands of Littre (urethral glands): in subepithelial connective tissue
[Secrete mucus for lubrication]
Lined proximally by stratified columnar epithelium which changes it to
nonkeratinized stratified squamous epithelium at fossa navicularis

Vessels of the urethra :

Urethra receives its blood and nerve supply from those of prostate and penis.
Female Urethra :
Length : 4 cm.
Extent, Course, Relations
• It begins at the internal urethral meatus at the neck of the bladder. It
traverses the deep perineal pouch to end at the external urethral
orifice.
• It is embedded in the anterior wall of the vagina.