UROLOGY

EMERITA C. MENDOZA, R.N., M.D.

Functions of the Urinary System
• To produce urine
• To store urine
• To discharge urine
• To maintain homeostasis by:
– excreting metabolic wastes
– ridding the body of excess H2O & salts
– helping to regulate pH
 Excretion
• Metabolic wastes in the
form of urine • Muscular system –
• Deaminates N-compounds phosphocreatine
-> ammonia -> urea metabolized to
creatinine and sent to
• Also nucleic acid -> uric
kidneys
acid, and sends to kidneys
LOCATION
OF THE
KIDNEYS

T12-L3, in
Gerota’s fascia
LOCATION OF THE KIDNEYS
• It is known as a RETROPERITONEAL
organ.
CROSS SECTION OF THE KIDNEY
• Outer renal cortex
• Inner renal medulla
• pyramids
• papilla
• columns
• collecting ducts
• Hilus
• minor calyx
• major calyx
• renal pelvis (pyelo-)
 The Ureters
• 28-34 cm
Which is longer, R or L ? • renal pelvis ->
• proximal ureter (renal
artery, vein) ->
• mid ureter
(testicular/ovarian artery,
vein)
• -> distal ureter (superior
vesical artery, vein) ->
• ureterovesical (UVJ)
junction -> urinary
bladder
Sites of Ureteral Narrowing

• 1) At the ureteropelvic
junction
• 2) At the pelvic inlet
• 3) At the bladder in
the ureterovesical
junction

Note: The ureters

descend anterior to
the psoas muscle.
The Urinary Bladder
• Ureteral orifices
• Areas:
• fundus - apex
• body
• trigone - base
• neck
• Urachus = median umbilical
ligament
• Volume: 500 ml
• Composed of the detrusor
muscle
The Micturition Reflex
• “trampoline effect”
• Urinary bladder stretch
receptors initiate reflex
to CNS
• Causes the external
urethral sphincter to
relax to allow urination
• Occurs when the bladder
fills up to 300ml
The Prostate
• lobular gland
• 2 prostatic ducts
• fascia of Denonvilliers
• secretes lubricant
• What is BPH ?
• Diagnostics via DRE,
PSA
• Surgery: TURP
The Spadias
• Congenital :
• Hypospadias
• dorsal hood,
• chordee,
• proximal meatus
• Epispadias (defect in the
dorsal urethra)

• Sx: e.g., Magpi repair

(Meatal advancement with
glansplasty)
Trace the path of urine

• renal pelvis ->

• ureter ->
• urinary bladder ->
• urethra
FUNCTIONAL UNIT OF THE KIDNEY

• Nephron
• renal corpuscle
– glomerulus
– Bowman’s capsule
• renal tubule
– Proximal convoluted
tubule (PCT)
– Loop of Henle
– Distal convoluted
tubule (DCT)
Formation of Urine
• Glomerular filtration
• Tubular reabsorption
• Tubular secretion
GLOMERULAR FILTRATION RATE (GFR)

• Blood from renal arcuate

artery -> afferent
arterioles -> glomerular
capillaries -> glomerulus
-> Bowman’s
• Filtrate: plasma with
dissolved substances is
filtered into Bowman’s
• Glomerular filtration is
not selective
TUBULAR REABSORPTION
• 99% of filtrate is returned
to the blood
• -> renal tubules (PCT ->
loop of Henle -> DCT) ->
collecting ducts
• Reabsorption is highly
selective for glucose,
amino acids, other
needed substances
• Filtrate retains wastes,
excess H2O & salts
TUBULAR SECRETION
• Occurs in the collecting
ducts
• Important for regulating
• [K+] in blood
• [H+] in blood
 collecting ducts  (as
urine) minor calyx 
major calyx  renal
pelvis  ureter 
urinary bladder
Note that the
filtrate flows
opposite to
the direction
of blood flow

This is called
counter-
current flow
FILTRATE FLOW
• Bowman’s capsule 
• Proximal convoluted
tubule
 Descending loop of
Henle 
• Ascending loop of Henle

• Distal convoluted tubule

• Collecting tubule
The Juxtaglomerular Complex (JG
Complex)

• Functions related to
pressure via renin
production & Na
metabolism (secondary
controls of urine volume)
Primary Regulation of Urine Volume

• ADH from
pituitary gland
(posterior lobe)
• ADH makes the
DCT &
collecting ducts
more
permeable to
H2O
Blood Pressure Regulation
The Glomerulus
• Filtration unit of the
kidney.
• Electron microscopy is
needed for diagnosis
• Main pathologic signs
are:
– proteinuria
– hypoalbuminemia
– edema
– hyperlipidemia
 Principal Waste Products in the
Urine Filtrate

• H2O • Waste products are

• CO2 cleared through the
glomerulus but not
• Nitrogenous wastes:
reabsorbed in the
• urea tubules
• uric acid • Lab measurements are
• creatinine BUN, creatinine
 Composition of Urine
• H2O (96%) • The following should NOT be
• Nitrogenous wastes: present:
• urea (2.5%) – blood
• uric acid – glucose
• creatine – albumin
• creatinine – ketones
• ammonia (rash) – pus
• Salts(1.5%): Cl, Ca, P – bacteria
• Traces of other – casts
substances
 REMEMBER THE FF:
• Basic anatomy of the kidneys: nephron,
glomerulus
• Location of the kidneys
• Substances produced by the kidneys
• Sites of narrowing in the ureters
• Processes of urine formation: filtration (GFR),
reabsorption, secretion
• Abnormal substances in urine
• Renin-angiotensin mechanism