Dr.

Dini Sri Damayanti,Mkes

 The

urinary organs comprise the kidneys, which secrete the urine, the ureters, or ducts, which convey urine to the urinary bladder, where it is for a time retained; and the urethra, through which it is discharged from the body.

1. The Kidneys (Renes)The kidneys are situated in the posterior part of the abdomen, one on either side of the vertebral column, behind the peritoneum, and surrounded by a mass of fat and loose areolar tissue. Their upper extremities are on a level with the upper border of the twelfth thoracic vertebra, their lower extremities on a level with the third lumbar. The right kidney is usually slightly lower than the left, probably on account of the vicinity of the liver

the upper extremity is in relation with the right suprarenal gland. A large area just below this and involving about three-fourths of the surface, lies in the renal impression on the inferior surface of the liver, medial border is in contact with the descending part of the duodenum. The lower part of the anterior surface is in contact laterally with the right colic flexure, medially, as a rule, with the small intestine. The areas in relation with the liver and small intestine are covered by peritoneum; the suprarenal, duodenal, and colic areas are devoid of peritoneum.

the upper part of the medial border is in relation with the left suprarenal gland, the lateral border is a long strip in contact with the renal impression on the spleen. the middle of the anterior surface, marks the site of contact with the body of the pancreas, and lienal vessels. Above this is a small triangular portion, between the suprarenal and splenic areas, in contact with the posteroinferior surface of the stomach. the lateral part is in relation with the left colic flexure, the medial with the small intestine. The areas in contact with the stomach and spleen are covered by the peritoneum of the omental bursa, while that in relation to the small intestine is covered by the peritoneum of the general cavity. The suprarenal, pancreatic, and colic areas are devoid of peritoneum.

 It

lies upon the diaphragm, the medial and lateral lumbocostal arches, the Psoas major, the Quadratus lumborum, and the tendon of the Transversus abdominis, the subcostal, and one or two of the upper lumbar arteries, and the last thoracic, iliohypogastric, and ilioinguinal nerves.

The lateral border (margo lateralis; external border) is convex, and is directed toward the postero-lateral wall of the abdomen. On the left side it is in contact at its upper part, with the spleen. The medial border (margo medialis; internal border) is concave in the center and convex toward either extremity. The fissure is named the hilum, and transmits the vessels, nerves, and ureter. Above the hilum the medial border is in relation with the suprarenal gland; below the hilum, with the ureter.

.The kidney is invested by a fibrous tunic, smooth covering to the organ. The tunic can be easily stripped off. The kidney is dense in texture, but is easily lacerable by mechanical force.

The renal calyces, from seven to thirteen in number, are cup-shaped tubes, each of which embraces one or more of the renal papill; they unite to form two or three short tubes, and these in turn join to form a funnelshaped sac, the renal pelvis. The renal pelvis, wide above and narrow below where it joins the ureter, is partly outside the renal sinus.

The medullary substance (substantia medullaris) consists of a series of redcolored striated conical masses, termed the renal pyramids The cortical substance (substantia corticalis) is reddish brown in color and soft and granular in consistence. The parts dipping in between the pyramids are named the renal columns (Bertini), while the portions which connect the renal columns to each other and intervene between the bases of the pyramids and the fibrous tunic are called the cortical arches).

15

blood vessel Glomerulus is composed of two parts: a central glomerulus of vessels, and a membranous envelope, the glomerular capsule (capsule of Bowman), which is the small pouch-like commencement of a renal tubule.

This capillary net-work is derived from a small arterial twig, the afferent vessel, which enters the capsule, and the resulting vein, the efferent vessel, emerges from the capsule at the same point. The afferent vessel is usually the larger of the two The glomerular or Bowmans capsule, which surrounds the glomerulus, consists of a basement membrane, lined on its inner surface by a layer of flattened epithelial cells, which are reflected from the lining membrane on to the glomerulus, at the point of entrance or exit of the afferent and efferent vessels.

At their junction with the glomerular capsule they exhibit a somewhat constricted portion, which is termed the neck. Beyond this the tubule becomes convoluted, and pursues a considerable course in the cortical substance constituting the proximal convoluted tube. They now enter the medullary substance, suddenly become much smaller, quite straight in direction, and dip down for a variable depth into the pyramids, constituting the descending limb of Henles loop. Bending on themselves, they form what is termed the loop of Henle, and reascending, they become suddenly enlarged, forming the ascending limb of Henles loop, and renter the cortical substance.

it ends in a convoluted tube, which resembles the proximal convoluted tubule, and is called the distal convoluted tubule The straight or collecting tubes commence in the radiate part of the cortex, where they receive the curved ends of the distal convoluted tubules. In the medulla the tubes of each pyramid converge to join a central tube (duct of Bellini) which finally opens on the summit of one of the papill; the contents of the tube are therefore discharged into one of the calyces.

Aorta gives off right and left renal arteries Renal arteries divides into 5 segmental arteries as enters hilus of kidney Segmentals branch into lobar arteries Lobars divide into interlobars Interlobars into arcuate in junction of medulla and cortex Arcuates send interlobular arteries into cortex to glomerular arterioles

25

They have small ganglia developed upon them, and are derived from the renal plexus, which is formed by branches from the celiac plexus, the lower and outer part of the celiac ganglion and aortic plexus, and from the lesser and lowest splanchnic nerves. They communicate with the spermatic plexus, a circumstance which may explain the occurrence of pain in the testis in affections of the kidney.

The lymphatics of the right kidney drain into lymph nodes located between the inferior vena cava and the aorta, lateral paracaval nodes, and anterior and posterior inferior vena caval lymph nodes. They also drain upward toward the right diaphragm, and downward to the common iliac lymph nodes. Other pathways are into the thoracic duct or crossing the midline into the left lateral aortic lymph nodes.

The ureters are the two tubes which convey the urine from the kidneys to the urinary bladder, 25 to 30 cm. It runs downward and medialward in front of the Psoas major and, entering the pelvic cavity, finally opens into the fundus of the bladder.

The abdominal part (pars abdominalis) lies behind the peritoneum on the medial part of the Psoas major And crossed obliquely by the internal spermatic vessels. It enters the pelvic cavity by crossing either the termination of the common, or the commencement of the external, iliac vessels.

The pelvic part (pars pelvina) runs at first downward on the lateral wall of the pelvic cavity. Finally, the ureters run obliquely for about 2 cm. through the wall of the bladder and open by slit-like apertures into the cavity of the viscus at the lateral angles of the trigone.

 Vessels

and Nerves.The arteries supplying the ureter are branches from the renal, internal spermatic, hypogastric, and inferior vesical. The nerves are derived from the inferior mesenteric, spermatic, and pelvic plexuses.

 The

urinary bladder is a musculomembranous sac which acts as a reservoir for the urine; and as its size, position, and relations vary according to the amount of fluid it contains

In front this fascial attachment is strengthened by a few muscular fibers, the Pubovesicales, which extend from the back of the pubic bones to the front of the bladder; behind, other muscular fibers run from the fundus of the bladder to the sides of the rectum, in the sacrogenital folds, and constitute the Rectovesicales. The vertex of the bladder is joined to the umbilicus by the remains of the urachus which forms the middle umbilical ligament, a fibromuscular cord, broad at its attachment to the bladder but narrowing as it ascends. Anteriorly there are three folds: the middle umbilical fold on the middle umbilical ligament, and two lateral umbilical folds on the obliterated hypogastric arteries.

The anterior angle of the trigonum vesic is formed by the internal orifice of the urethra: its postero-lateral angles by the orifices of the ureters The lateral parts of this ridge extend beyond the openings of the ureters, and are named the plic ureteric; they are produced by the terminal portions of the ureters as they traverse obliquely the bladder wall.

The bladder is composed of the four coats: serous, muscular, submucous, and mucous coats. The serous coat (tunica serosa) is derived from the peritoneum. The muscular coat (tunica muscularis) consists of three layers of unstriped muscular fibers: an external layer, composed of fibers having for the most part a longitudinal arrangement (musculi pubovesicales); a middle layer, in which the fibers are arranged, more or less, in a circular manner; and an internal layer, in which the fibers have a general longitudinal arrangement (Detrusor urin muscle.)

The submucous coat (tela submucosa) consists of a layer of areolar tissue, connecting together the muscular and mucous coats, and intimately united to the latter.

The mucous coat (tunica mucosa) is thin, smooth, and of a pale rose color. The loose texture of the submucous layer allows the mucous coat to be thrown into folds or rug when the bladder is empty. Over the trigonum vesic the mucous membrane is closely attached to the muscular coat, and is not thrown into folds, but is smooth and flat.

The arteries supplying the bladder are the superior, middle, and inferior vesical, derived from the anterior trunk of the hypogastric. The obturator and inferior gluteal arteries also supply small visceral branches to the bladder, and in the female additional branches are derived from the uterine and vaginal arteries. The veins form a complicated plexus on the inferior surface, and fundus near the prostate, and end in the hypogastric veins. The nerves of the bladder are (1) third and fourth sacral nerves, and (2) the hypogastric plexus.

extends from the internal urethral orifice in the urinary bladder to the external urethral orifice at the end of the penis. Its length varies from 17.5 to 20 cm.; and it is divided into three portions, the prostatic, membranous, and cavernous, the structure and relations of which are essentially different. The prostatic portion (pars prostatica), the widest and most dilatable part of the canal, is about 3 cm.

The membranous portion (pars membranacea) is the shortest, least dilatable, and, with the exception of the external orifice, the narrowest part of the canal. It extends downward and forward, with a slight anterior concavity, between the apex of the prostate and the bulb of the urethra, perforating the urogenital diaphragm about 2.5 cm. The membranous portion of the urethra is completely surrounded by the fibers of the Sphincter urethr membranace; on either side near its termination are the bulbourethral glands.

The cavernous portion (pars cavernosa; penile or spongy portion) is the longest part of the urethra, and is contained in the corpus cavernosum urethr. It is about 15 cm. long, and extends from the termination of the membranous portion to the external urethral orifice. The lining membrane of the urethra, especially on the floor of the cavernous portion, presents the orifices of numerous mucous glands and follicles situated in the submucous tissue, and named the urethral glands (Littr).

The male genitals include the testes, the ductus deferentes, the vesicul seminales, the ejaculatory ducts, and the penis, together with the following accessory structures, the prostate and the bulbourethral glands

.The testes are two glandular organs, which secrete the semen; they are suspended in the scrotum by the spermatic cords. At an early period of fetal life the testes are contained in the abdominal cavity, behind the peritoneum. Before birth they descend to the inguinal canal, along which they pass with the spermatic cord, and, emerging at the subcutaneous inguinal ring, they descend into the scrotum

The Scrotum is a cutaneous pouch which contains the testes and parts of the spermatic cords. It is divided on its surface into two lateral portions by a ridge or raph or septum of scrotum The scrotum consists of two layers, the integument and the dartos tunic. The Integument is very thin, of a brownish color, and generally thrown into folds or rug. It is provided with sebaceous follicles, the secretion of which has a peculiar odor, and is beset with thinly scattered, crisp hairs, the roots of which are seen through the skin.

 The

Dartos Tunic (tunica dartos) is a thin layer of non-striped muscular fibers, continuous, it sends inward a septum, which divides the scrotal pouch into two cavities for the testes, and extends between the raph and the under surface of the penis, as far as its root.

The arteries supplying the coverings of the testes are: a. pudendal branches of the femoral, a .inferior epigastric. The veins follow the course of the corresponding arteries. The lymphatics end in the inguinal lymph glands. The nerves are the ilioinguinal and lumboinguinal branches of the lumbar plexus, pudendal nerve

 funiculus

spermaticus extends from the abdominal inguinal ring to the back part of the testis. The left cord is rather longer than the right, consequently the left testis hangs somewhat lower than its fellow.

Structure of the Spermatic Cord.The spermatic cord is consist of a. spermaticus, a.vas deferent, plexus pampiniformis, lymphatic vessel, nerve the spermatic plexus from the sympathetic,vas deferent duct.

 The

epididymis consists of a central portion or body; an upper enlarged extremity, the head (globus major); and a lower pointed extremity, the tail (globus minor), which is continuous with the ductus deferens the duct of the testis.

The testis is invested by three tunics: the tunica vaginalis, tunica albuginea, and tunica vasculosa. The Tunica Vaginalis (tunica vaginalis propria testis) is the serous covering of the testis, derived from the saccus vaginalis of the peritoneum.

 The

Tunica Albuginea is the fibrous covering of the testis. It is a dense membrane, of a bluish-white color, composed of bundles of white fibrous tissue which interlace in every direction

The Tunica Vasculosa is the vascular layer of the testis, consisting of a plexus of bloodvessels, held together by delicate areolar tissue.

 The

glandular structure of the testis consists of numerous lobulesis estimated by Berres at 250, and by Krause at 400. Each lobule is contained in one of the intervals between the fibrous septa which extend between the mediastinum testis and the tunica albuginea, and consists of from one to three, or more, minute convoluted tubes, the tubuli seminiferi.

 The

ductus deferens, the excretory duct of the testis, is the continuation of the canal of the epididymis. It is enters the pelvic cavity, then crosses in front of the ureter. and runs medialward and slightly forward between the fundus of the bladder and the upper end of the seminal vesicle.

 Lastly,

it is directed downward to the base of the prostate, where it becomes greatly narrowed, and is joined at an acute angle by the duct of the seminal vesicle to form the ejaculatory duct.

 Structure.The

ductus deferens consists of three coats: (1) an external or areolar coat; (2) a muscular coat which in the greater part of the tube consists of two layers of unstriped muscular fiber(3) an internal or mucous coat, which is pale, and arranged in longitudinal folds.

 are

two lobulated membranous pouches, placed between the fundus of the bladder and the rectum, serving as reservoirs for the semen, and secreting a fluid to be added to the secretion of the testes. it is usually about 7.5 cm.

 The

vesicul seminales are composed of three coats: an external or areolar coat; a middle or muscular coat thinner than in the ductus deferens and arranged in two layers, an outer longitudinal and inner circular; an internal or mucous coat, which is pale, of a whitish brown color, and presents a delicate reticular structure.

 Vessels

and Nerves.The arteries supplying the vesicul seminales are derived from the middle and inferior vesical and middle hemorrhoidal. The veins and lymphatics accompany the arteries. The nerves are derived from the pelvic plexuses.

The ejaculatory ducts are two in number, one on either side of the middle line. Each is formed by the union of the duct from the vesicula seminalis with the ductus deferens, and is about 2 cm. long.

 Structure.The

coats of the ejaculatory ducts are extremely thin. They are: an outer fibrous layer, which is almost entirely lost after the entrance of the ducts into the prostate; a layer of muscular fibers consisting of a thin outer circular, and an inner longitudinal, layer; and mucous membrane.

 is

a pendulous organ suspended from the front and sides of the pubic arch and containing the greater part of the urethra. It is composed of three cylindrical masses of cavernous tissue bound together by fibrous tissue and covered with skin. Two of the masses are lateral, and are known as the corpora cavernosa penis; the third is median, and is termed the corpus cavernosum urethr.

The Corpora Cavernosa Penis form the greater part of the substance of the penis. Just before it meets its fellow it presents a slight enlargement, named by Kobelt the bulb of the corpus cavernosum penis. The Corpus Cavernosum Urethr (corpus spongiosum) contains the urethra.

The root (radix penis) of the penis is triradiate in form, consisting of the diverging crura, one on either side, and the median urethral bulb. Each crus is covered by the Ischiocavernosus, while the bulb is surrounded by the Bulbocavernosus.

 The

body (corpus penis) extends from the root to the ends of the corpora cavernosa penis, and in it these corpora cavernosa are intimately bound to one another. The glans penis, the expanded anterior end of the corpus cavernosum urethr. It is separated from the body by the constricted neck, which is overhung by the corona glandis.

 The

integument covering the penis is remarkable for its thinness, its dark color, its looseness of connection with the deeper parts of the organ, and its absence of adipose tissue. At the root of the penis it is continuous with that over the pubes, scrotum, and perineum. At the neck it leaves the surface and becomes folded upon itself to form the prepuce or foreskin.

 Vessels

and Nerves.from the dorsal arteries of the penis branch of internal pudenda arteri

 The

nerves are derived from the pudendal nerve and the pelvic plexuses. On the glans and bulb some filaments of the cutaneous nerves have Pacinian bodies connected with them, and, according to Krause

The prostate is a firm, partly glandular and partly muscular body, which is placed immediately below the internal urethral orifice and around the commencement of the urethra. It is presents for examination a base, an apex, an anterior, a posterior and two lateral surfaces.

 Structure.The

prostate is immediately enveloped by fibrous capsule, It consists of glandular substance and muscular tissue

Vessels

and Nerves.The arteries supplying the prostate are derived from the internal pudendal, inferior vesical, and middle hemorrhoidal. Its veins form a plexus ,they receive in front the dorsal vein of the penis, and end in the hypogastric veins. The nerves are derived from the pelvic plexus.

 The

bulbourethral glands are two small, rounded, and somewhat lobulated bodies, of a yellow color, placed behind and lateral to the membranous portion of the urethra, between the two layers of the fascia of the urogenital diaphragm.

 The

excretory duct of each gland, nearly 2.5 cm. long, passes obliquely forward beneath the mucous membrane, and opens by a minute orifice on the floor of the cavernous portion of the urethra about 2.5 cm. in front of the urogenital diaphragm.

 Henry

Gray (18211865). Anatomy of the Human Body. 1918.