Urology I

Omar Hirsi
 Outline
• Anatomy:
 Kidney and adrenals
 Ureters
 Bladder and prostate
 Penis
 Scrotum and testes
 Kidney and Adrenal
 Paired retroperitoneal organs
 Covered posteriorly by zuckerkandl fascia and Gerota’s fascia
anteriorly

 Posterolaterally : quadratus lumborum

 Posteromedially : psoas muscle
 Anteriorly : peritoneum
 Left kidney : spleen ; superolaterally
 Right kidney : liver; superior and anteriorly
• Second part of duodenum; close proximity to the right renal
vessels.. ..kocherized
• Renal arteries are single vessels…aorta, no anastomotic
arterial flow

• Right renal artery… posterior to vena cava, longer

• Ocassionally; accessory renal artery..lower pole
• Renal veins: course anteriorly to renal arteries
 Left passes anterior to aorta, much longer, hence preference
for transplant.
 Left has more collateral drainage..gonadal, adrenal

• Collecting system: several major and minor calyces,

• Renal pelvis tapers into the ureteropelvic junction..ureters
• Adrenal glands:
 Superomedial to the kidneys within Gerotas
fascia
 Can be adherent during inflammation and
tumour
 Arterial supply:inferior phrenic, aorta and
small branches from the renal arteries
 Right adrenal vein..short <1cm, avulsed
Ureters
Muscular structure, course
anterior to psoas muscle

Enter the bladder at the base

and run oblique..ureteral
orifice; close to bladder
outlet

Blood supply: proximal…

medial direction
Distally from the lateral
aspect

Significance: ureteric injury

and repair
 Bladder and prostate
• Urinary bladder is extraperitoneal
• Portion of the bladder dome is adjacent to peritoneum…
ruptures?

• Relations are dependent on degree of filling

• Sigmoid colon may become adherent and
fistulize..diverticulitis
 Prostate
• Prostate is in continuity with the bladder.
• Has significant smooth muscle, can provide urinary
continence.

• Puboprostatic ligament: often results in proximal urethral

injury…traction from pelvic fracture
• Denonvilliers fascia..prevents invasion of rectum
 Penis
• Composed of 3 main bodies, fascia, neurovascular
and skin.
Corpora cavernosum..paired cylinder-like.
• Main erectile structures
• Proximally: Lie medial aspect of inferior pubic rami
• Distally; fuse and form the pendulous penis
• Consists of tough outer layer; tunica albuginea and
spongy sinusoidal tissue
• The sinusoidal tissue is innervated by the cavernosal nerves…
from hypogastric plexus
• Play critical role in erection

• They travel immediately adjacent to the prostate…damaged in

radical prostatectomy
• Corpus spongiosum, covers urethra.. Spongy
• Glans penis is in continuity with corpus spongiosum..remains
soft in Priapism
• Surrounding all 3 bodies: outer dartos fascia
and inner Buck’s fascia
• Dorsal nerves of the penis from pudendal…
sensation to skin
• Dorsal penile arteries
• Neurovascular injury during Sx..permanent
erectile dysfunction
 Scrotum and testes
• Capacious structure that contains testes and
epididymes
• Can accumulate significant hematoma: basket
ball
• Layers: dartos fascia, external spermatic,
cremasteric, and internal spermatic fascia.
• Beneath are the tunica vaginalis(parietal and
visceral…hydrocele
• Outer layer of testes is the tunica albuginea
• Blood supply enters the testes at the superior pole..via
spermatic cord

• Cord carries 3 separate sources of blood supply: testicular

artery, cremasteric artery, deferential artery
• Interuption of one doesn’t cause testicular ischemia

• Fowler-stephen orchiopexy…1st stage and second stage

• Varicocele…dilation of spermatic veins
THANK YOU!