Anatomi Dan Fisiologi Traktus Urinarius Fix

URINARY TRACT:
ANATOMY AND PHYSIOLOGY
UROGYNECOLOGY DIVISION
OBSTETRICS AND GYNECOLOGY

DEPARTMENT
FACULTY OF MEDICINE
INTRODUCTION
• The urinary tract is a contiguous hollow-organ system whose
primary function is to collect, transport, store, and expel
urine periodically and in a highly coordinated fashion
• The urinary tract ensures the elimination of metabolic

products and toxic wastes generated in the kidneys.
Fowler CJ, Griffiths D, de Groat WC. 2008. The neural control of micturition. Nat Rev Neurosci 9:453–466
Elbadawi A. 1996. Functional anatomy of the organs of micturition. Urol Clin North Am 23:177–210.
URINARY TRACT
KIDNEY (RENAL)
URETER
BLADDER
URETHRA
KIDNEY
• Placed retroperitoneally in the abdominal

quadrants
• Paravertebral
Left kidney  T12 - L1 (L1-4)
Right kidney  Inferiorly (½ vertebra)
Right kidney typically positioned slightly more

inferior because liver is forcing down the right
kidney
KIDNEY
• Bean-shaped
• Weight ± 125 - 170 grams
• Size (length x width x thickness) ±
11 x 6 x 3 cm
• The hilum  where the renal artery
enters the kidney
• The parenchyma of the kidney consists of
the outer cortex, and inner medulla
• The main unit of the medulla is the renal

pyramid (8-18 renal pyramids/kidney)
• Apex pyramid  renal papilla  major

calyx  minor calyx  renal pelvis 
ureter
KIDNEY
The kidney tissue is protected by:

• Capsula fibrosa
• Corpus adiposum
• Fascia renalis
• Peritoneum parietale (ventral only)
BLOOD SUPPLY
Renal artery (4)
Segmental artery
Arcuate artery (10)
Interlobular artery (2)
Afferen Arteriole  in
 glomerulus
Afferen Arteriole
Interlobular vein (1)
Arcuate vein (9)
Renal vein (1)
INNERVATION
• PARASYMPATHIS = Vagal nerve/ Nervus.X

• SYMPATHIS = N. Splanchnicus Minor (T10 - 11), N. Splanchnicus
Minimus (T12)
Berek & Novak's Gynecology. Publication Year: 2019 . Edition: 16th Ed.
Mark D. Walters and Mickey M. Karram. Urogynecology and Female Pelvic Reconstructive Surgery, Fourth Edition. Elsevier Saunders, Philadelphia, 2014. 688
URETER
 The urinary conduit leading from the kidney to the bladder

 25 cm in length
 Retroperitoneal
 part abdominal, part pelvic
 The lower half of ureter traverses the pelvis after
crossing the common iliac vessels at bifurcation,
medial to the ovarian vessels
 Descend into the pelvis adherent to the peritoneum
of the lateral pelvic wall and the medial leaf of the
broad ligament
 Enter the bladder base
BLOOD SUPPLY
• Abdominal ureter: renal and ovarica arteries
• Pelvical ureter: common illiac, internal illiac, inferior vesical,

and uterine arteries
INNERVATION
• The innervation is through the ovarian plexus and the vesical
plexus
• Simpatis (T10 – L 1)
• Parasimpatis (S2-S4)
BLADDER
 A hollow organ
 Spherically shaped when
full, that stores urine
 Size varies with urine
volume
 Maximum volume of at
least 300 mL
The bladder is positioned:
 posterior to the pubis and lower abdominal wall

 anterior to the cervix, upper vagina, and part of the cardinal ligament
 Laterally, it is bounded by the pelvic diaphragm and obturator
internus muscle
The bladder is often divided into two areas, which are of physiologic significance:
BASE
DOME
• Consists the urinary trigone
posteriorly and a thickened area
of detrusor anteriorly.
• The remaining bladder area • The three corners of the trigone
above the bladder base are formed by the two ureteral
• Has parasympathetic orifices and the opening of the
innervation and responsible for urethra into the bladder
micturition.
The bladder wall has 4 layers
Mucosa (urothelium)
 Collumnar/transitional epithelium
 Glycosaminoglycan (GAG) layer  protective barrier to prohibit
bacterial adherence, proteases, and ions

Submucosa (Lamina propria)
Muscle
Intermeshing muscle fibers, which allow for rapid expansion during
bladder filling
Serosa
BLOOD SUPPLY
• The blood supply to the bladder is from the superior, middle,

and inferior vesical arteries, with contribution from the uterine
and vaginal vessels
INNERVATION
• The innervation to the bladder is from the vesical plexus, with

contribution from the uterovaginal plexus
URETHRA
The female urethra is about 3 to 4 cm in length

URETHRA
The vesical neck is the region of

the bladder that receives and
incorporates the urethral lumen.
 Extends from the bladder to the vestibule, traveling just anterior to the
vagina
 The urethral epithelium has longitudinal folds and many small glands,
which open into the urethra throughout its entire length
 The urethral smooth muscle is composed primarily of oblique and
longitudinal muscle fibers, with a few circularly oriented outer fibers.
PHYSIOLOGY
FUNCTION
• Regulation of the water and electrolyte content of the body.
• Retention of substances vital to the body such as protein and glucose
• Maintenance of acid/base balance.
• Excretion of waste products, water soluble toxic substances and drugs
• Endocrine functions.
Hormones and the Kidney
• Renin increases the production of angiotensin II which is released
when there is a fall in intravascular volume e.g. haemorrhage and
dehydration.
• Aldosterone promotes sodium ion and water reabsorption in the
distal tubule and collecting duct where Na+ is exchanged for
potassium (K+) and hydrogen ions by a specific cellular pump.
• Atrial Natruretic Peptide(ANP) is released when atrial pressure is
increased e.g. in heart failure or fluid overload. It promotes loss of
sodium and chloride ions and water chiefly by increasing GFR.
• Antidiuretic Hormone (ADH) increases the water permeability of the
distal tubule and collecting duct, thus increasing the concentration of
urine.
URINE PRODUCTION
• FILTRATION
• REABSORPTION
• SECRETION
MICTURITION
• Process by which the urinary bladder empties when it becomes filled
• First, the bladder fills progressively until the tension in its walls rises above a
threshold level
• this elicits the second step, which is a nervous reflex called the micturition
reflex that empties the bladder or, if this fails, at least causes a conscious
desire to urinate.
• Although the micturition reflex is an autonomic spinal cord reflex, it
can also be inhibited or facilitated by centers in the cerebral cortex or
brain stem
PHYSIOLOGY OF BLADDER
• The main role of the bladder: collecting urine produced by the kidneys and
excreted through the ureter, and excreting urine through the urethra
• Storage
Intrinsic
• The ability of smooth muscle fibers to
stretch according to the volume of urine
supporting that can be accommodated.
factors: factor
Extrinsic
• Excitatory neurologic stimulus:
contraction of the proximal urethra and
urethral spincter
factor • Inhibitoric neurologic stimuli: inhibits

(relaxes) the detrusor bladder muscle.
Primary innervation by the autonomic, sympathetic and
parasympathetic nervous systems.
Transmission:
• Norepinephrine (the main postganglionic neurotransmitter)
• Stimulates 2 adrenergic receptors:
(a) Alpha receptors (mostly in the urethra and trigone)
(b) Beta receptors (especially in the detrusor muscle)
Blood vessels and have little to do with bladder contraction.
Some sensory nerve fibers also pass by way of
the sympathetic nerves and may be important in the
sensation of fullness and, in some instances, pain .
The sensory fibers : degree of stretch in the bladder wall, reflexes that cause bladder
emptying.
The motoric fibers : innervate wall of the ballder and the detrusor muscle. Also Most important
are the skeletal motor fibers transmitted through the pudendal nerve to the external bladder
sphincter. These are somatic nerve fibers that innervate
and control the voluntary skeletal muscle of the sphincter
MECHANISM OF CONTINENCE
1. The reservoir function of the bladder
2. Functions of the autonomic nervous system
(sympathetic and parasympathetic)
3. Somatic nervous system
4. Bladder muscle integrity
5. Urethra
6. Pelvic floor support structures around the urinary tract
(the levator ani muscle, endopelvic fascia)
NORMAL
Central nervous system can suppress the process of urination and that a person can
voluntarily control when he will urinate or start the urination process
Steers WD. Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol. 2002;4 Suppl 4(Suppl 4):S7-S18.
THANK YOU

Anatomi Dan Fisiologi Traktus Urinarius Fix

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Anatomi Dan Fisiologi Traktus Urinarius Fix

Uploaded by

Copyright:

Available Formats

URINARY TRACT:

ANATOMY AND PHYSIOLOGY

OBSTETRICS AND GYNECOLOGY

• The urinary tract ensures the elimination of metabolic

• Placed retroperitoneally in the abdominal

Right kidney typically positioned slightly more

• The main unit of the medulla is the renal

• Apex pyramid  renal papilla  major

The kidney tissue is protected by:

• PARASYMPATHIS = Vagal nerve/ Nervus.X

 The urinary conduit leading from the kidney to the bladder

• Pelvical ureter: common illiac, internal illiac, inferior vesical,

 posterior to the pubis and lower abdominal wall

 Laterally, it is bounded by the pelvic diaphragm and obturator

 Glycosaminoglycan (GAG) layer  protective barrier to prohibit

bacterial adherence, proteases, and ions

• The blood supply to the bladder is from the superior, middle,

• The innervation to the bladder is from the vesical plexus, with

The female urethra is about 3 to 4 cm in length

The vesical neck is the region of

factor • Inhibitoric neurologic stimuli: inhibits

You might also like