Surgical Anatomy of

The GenitoUrinary
System
KIDNEY AND URETER
 Abdominal Wall
 Superficial Abdominal Muscle
- Lateral Group :
External oblique muscle
Internal oblique muscle
Transversus abdomini
- Medial Group
Rectus abdominis
Pyramidalis
 Retroperitoneal Space
 The space between the posterior parietal
peritoneum and the posterior abdominal
wall.
 It is bounded superiorly by the diaphragm,
 It blends inferiorly with the connective-
tissue stratum of the subperitoneal space
 The Adrenal Gland

 The adult adrenal glands are 3 to 5 cm in

greatest transverse dimension and weigh
approximately 5 g
 The adrenal is divided into the medulla
and the cortex.     
 The adrenal cortex is composed of three
distinct areas: the zona glomerulosa, zona
fasciculata, and zona reticularis.     
 Arterial supply to the adrenal comes from
branches of the inferior phrenic artery,
aorta, and renal artery.   ▪   
 Venous drainage of the adrenal varies by
side, with the right adrenal vein directly
entering the IVC and the left adrenal vein
draining into the left renal vein.
 Each layer has a different function, with
the glomerulosa producing
mineralocorticoids (e.g., aldosterone), the
fasciculata producing glucocorticoids (e.g.,
cortisol), and the reticularis synthesizing
sex steroids (androgens).
 Kidney
 Paired organs with bean-shaped structure
 Adult kidney weighs 120-170 g
 The kidneys generally measure 10 to 12 cm vertically,
5 to 7 cm transversely, and 3 cm in the anteroposterior
dimension
 The left kidney is approximately at the vertebral level
T12 to L3, and the right slightly lower
 The concave surface : renal hilum
 artery
 vein
 ureter
 Lymphatic
 nervus
 Location in abdominal cavity, lie in a
retroperitoneal position
 The structure surrounding the
kidneys
 Posteriorly, the diaphragm covers the
upper third of each kidney, with the 12th
rib crossing at the lower extent of the
diaphragm
 Medially the lower two thirds of the kidney
lie against the psoas muscle
 Laterally the quadratus lumborum and
aponeurosis of the transversus abdominis
muscle are encountered
The structure of the kidney
 The functional unit of the kidney is the
nephron
 The essential components of the nephron
include the renal or malpighian corpuscle
(glomerulus and Bowman's capsule), the
proximal tubule, the thin limbs, the distal
tubule, and the connecting segment or
connecting tubule.
 Renal vasculature
 The renal pedicle classically consists of a
single artery and a single vein that enter
the kidney via the renal hilum
 Renal Lymphatic
 The intrarenal lymph vessels of the kidney
accompany the arteries to the renal sinus
and present in the hilum as prevascular,
retrovascular, and intervascular bundles.
Pelvicaliceal system
 The Ureters
 The ureters are bilateral tubular structures responsible
for transporting urine from the renal pelvis to the bladder
 They are generally 22 to 30 cm in length with a wall
composed of multiple layers
BLADDER, PROSTATE
and URETHRA
Urinary
bladder

(Ross and Wilson, anatomy and

physiology, 2004)
Urinary bladder
 The urinary bladder is a saccular organ
for storage of urine. The avarage
capacity of bladder is 600-800 cc
 The shape of the urinary bladder is
determined by the volumeof urine it
contains. An empty urinary bladder is
pyramidal;
 as it fills, it becomes ovoid and bulges
upward into the abdominal cavity.
Urinary bladder relation with another organs
(Ross and Wilson, anatomy and physiology,
2004)
  Anatomically, urinary bladder has 3 surface
 Superior surface lokus minoris of bladder
 Infero lateral surface
 Posterior surface
 The urinary bladder located just posterior to
the symphysis pubis, anterior to the rectum
 In females, the urinary bladder is in contact
with the uterus and vagina.
 In males, the bladder is related posteriorly to
seminal vesicle, vasa deferentia, ureter. The
prostate is positionedbelow the urinary
bladder.

Van de graaf, human anatomy, 2004; Smith, general urology, 2004; Basuki, dasar-
dasar urologi, 2007
Histology of urinary bladder
Van de graaf, human anatomy, 2004
 Blood supply
 The arterial supply to the urinary bladder
comes from the superior and inferior
vesicular arteries, which arise from the
internal iliac arteries and by smaller
branch from obturator and inferior gluteal
arteries.
 Blood draining the urinary bladder enters
a vesicular venous plexus and then
empties into the internal iliac veins.
Van de graaf, human anatomy, 2004
 Urethra
 The tubular urethra (yoo-re'thra˘) conveys
urine from the urinary bladder to the outside
of the body.
 Two muscular sphincters surround the
urethra. The involuntary smooth muscle
sphincter, the superior of the two, is the
internal urethral sphincter, which is formed
from the detrusormuscle of the urinary
bladder.
 The lower sphincter, composed of voluntary
skeletal muscle fibers, is called the external
urethral sphincter
 Female urethra
Van de graaf, human anatomy, 2004;
 Female urethra
 The urethra of the female is a straight
tubular organ, about 4 cm (1.5 in.) long,
that empties urine through the urethral
orifice into the vestibule between the labia
minora.
 The urethral orifice is positioned between
the clitoris and vaginal
 The female urethra has a single function:
to transport urine to the exterior.
Van de graaf, human anatomy, 2004
Male urethra

Van de graaf, human anatomy,

2004;
 Male urethra
 The urethra of the male serves both the
urinary and reproductive systems. It is
about 20 cm (8 in.) long, and is S-shaped
because of the shape of the penis.
 Three portions can be identified in the
male urethra: the prostatic part, the
membranous part, and the spongy part

Van de graaf, human anatomy, 2004

 Cont’d
 The prostatic part of the urethra is the
proximal portion, about 2.5 cm long, that
passes through the prostate located near
the neck of the urinary bladder.
 The portion of the urethra receives
drainage from small ducts of the prostate
and two ejaculatory ducts of the
reproductive system.

Van de graaf, human anatomy, 2004

 Cont’d
 The membranous part of the urethra is
the short portion (0.5 cm) that passes
through the urogenital diaphragm and
proximal portion of the penis.
 The external urethral sphincter muscle is
located in this portion.

Van de graaf, human anatomy, 2004; Smith, general urology, 2004;

 Histology of urethra
Van de graaf, human anatomy, 2004
 Prostate

Smith, general urology, 2004;

 Prostate
 The prostate is a fibromuscular and glandular
organ lying just inferior to the bladder.
 The normal prostate weighs about 20 g and
contains the posterior urethra, which is about 2.5
cm in length.
 It is supported anteriorly by the puboprostatic
ligaments and inferiorly by the urogenital
diaphragm
 The prostate is perforated posteriorly by the
ejaculatory ducts, which pass obliquely to empty
through the verumontanum on the floor of the
prostatic urethra just proximal to the striated
external urinary sphincter .
Van de graaf, human anatomy, 2004; Smith, general urology, 2004;
 Prostate
 According to the classification of Lowsley,
the prostate consists of 5 lobes: anterior,
posterior, median, right lateral, and left
lateral.
 According to McNeal (1972), the prostate
has a peripheral zone, a central zone, and
a transitional zone; an anterior segment;
and a preprostatic sphincteric zone .
Van de graaf, human anatomy, 2004; Smith, general urology, 2004;
 Histology of prostate
Van de graaf, human anatomy, 2004
 Blood supply & innervation
 Blood is supplied to the prostate from
branches of the middle rectal and inferior
visceral arteries.
 The venous return forms the prostatic
venous plexus, along with blood draining
from the penis. The prostatic venous
plexus drains into the internal iliac veins.
 The prostate has both parasympathetic
(S2-4) and sympathetic (T10-L2)
innervation arising from the pelvic
plexuses.
Van de graaf, human anatomy, 2004; Smith, general urology, 2004;