Urology

The subject of urology

Anatomy of the Human Urogenital System

 Urology
Introduction
 Urology studies :
 Male genitourinary system
 Woman's urinary system
 The human kidney
General anatomical references
 A pair of retroperitoneal organs
 Weight: ~140 g (150 g. In men, 135 g. In women)
 Size:
 in length : 10-12 sm
 in width : 5-7 sm

 in thickness : 3 sm

 Location
 Projection to the spine column : T11-L3
 Because of the inferior displacement of the right kidney by
the liver, the right kidney sits 1 to 2 cm lower than the left
kidney
Kidney structure
parenchyma
 The medulla:
 a darker inner region
 Represented as
pyramids
 The apex of the
pyramids forms the
renal papilla - which
is cupped by an
individual minor
calyx
 The cortex:
 a pale outer region
 extends downward
between the
individual pyramids
to form the columns
of Bertin
 Kidneys
Surface Anatomy and Relationships:
 Renal (Gerota) fascia:
 surrounded by a layer of condensed fat called the
paranephric fat and serves as an anatomic barrier to the
spread of malignancy
 The Gerota fascia encasing the kidneys, adrenal
glands, and abdominal ureters is closed superiorly and
laterally
 Because it is open inferiorly, abnormal process may
spread to the pelvic cavity
Posterior relationships of the kidneys
Anterior relationships of the kidneys
 Renal Vasculature
 The renal arteries arise from the aorta at the level of the intervertebral
disk between the L1 and L2 vertebrae below the junction of the
Superior mesenteric artery.
 The right renal artery passes behind the Inferior vena cava.
 Renal artery branches:
1. Each artery divides into five segmental end
arteries that do not anastomose significantly
with other segmental arteries. Therefore
occlusion or injury to a segmental branch will
cause segmental renal infarction.
2. Interlobar arteries
3. arcuate arteries
4. Interlobular arteries
5. afferent arterioles
6. glomerulus
7. efferent arterioles
 Renal Veins:
 The renal venous drainage correlates closely with the
arterial supply
 Vasa recta and the peritubular capillaries drain into the
renal vein
 The renal veins drain into the Inferior Vena Cava

 The left renal vein receives the left suprarenal

(adrenal) vein and the left gonadal (testicular or
ovarian) vein
 homonymous blood vessels on the right side drains
straight into the Inferior Vena Cava.
Hillum of the kidney, structures:
 Renal Vein
 Renal Artery
 Ureter
 Renal artery and
vein located in front
of the pelvis of the
kidney and
proximally to the
Ureter
 The Nephron - The functional unit of the kidney
 The nephron (Bowman capsule, glomerulus)
 tubules (Proximal convoluted tubule, Henle loop, Distal convoluted
tubule, Collecting tubule)
 Functions of the kidneys and urinary tract
 Excretion - by which metabolic waste is eliminated from
an organism. Participates in whole-body homeostasis,
regulating acid-base
balance, electrolyte concentrations, extracellular fluid
volume, and blood pressure
 Endocrine
 Synthesis of renin
 Erythropoietin
 Prostaglandins

 Metabolic
 Activation of Vit. D
 Catabolism of hormones
 Regulation of body fluid
 The body fluid is divided :
 Intracellular

 Extracellular

 Plasma

 Intersticial fluid

 Transcellular fluid
Osmoregulation and Osmotic Balance between cells and
environment
 Transmembrane transport of substances into the cell
 Passive - is a movement of ions and other atomic or
molecular substances across cell membranes without
need of energy input
 active - is the movement of molecules across a
membrane against the concentration gradient. Active
transport requires cellular energy to achieve this
movement
 Na+ - The most important Extracellular ion

 K+ - The most important Intracellular ion

 Kidney physiology
Urine formation
1. Filtering – Glomerular
2. Reabsorption - process by which
the nephron removes water and solutes from
the tubular fluid (pre-urine) and returns them to
the circulating blood
3. Secretion - The movement of substances from the
blood to the tubules through the cells (active
transport) or to the intercellular space (passive
transport)
4. Excretion - Movement of the final product resulting
from filtration, secretion and reabsorption into tubes
 The Ureter
 Length = 22-30 sm
 Layers
 Transitional epithelium

 Lamina propria

 Muscular layers

 An inner longitudinal layer of muscle

 An outer circular or spiral layer of muscle

 Adventitia
 containing blood vessels, lymphatic vessels, and veins
Anatomical relationships of the ureter
 Started from the Ureteropelvic segment , which is located behind the
renal artery and vein, and then posteriorly, both ureters descend
anterior to the psoas major muscle
 Anteriorly the right ureter separates to the ascending colon, appendix
and mesenterium of the colon.
 The left ureter is in close relationship with descending colon, sigmoid
colon and their mesenteric shield.
 Near the bladder, two-thirds of the ureter, the gonadal blood vessels
cross the ureter anteriorly
 At the pelvic inlet, it crosses the common iliac vessels near their
bifurcation
 The terminal ureter runs forward, accompanied by the neurovascular
bundle of the bladder and passes the anterior vaginal fornix just
before entering the bladder. This close proximity of the ureter to the
uterine vessels is the cause of ureteral injuries during gynecologic
procedures.
Segmentation and Nomenclature
 abdominal ureter - from the renal pelvis to
the pelvic brim
 pelvic ureter - from the pelvic brim to the
bladder
 intravesical or intramural ureter - within the
bladder wall
Blood supply and lymphatic drainage
 Arterial branches approach medially to the
ureter in the abdominal cavity
 In the pelvic cavity – Laterally
 Upper segment of the ureter – From
branches of Renal artery, gonadal,
abdominal aorta and common iliac arteries.
 Distal ureter – Blood supply comes laterally
from the superior vesical artery, a branch of
the internal iliac artery.
 Urinary bladder
 Hollow muscular organ
 Capacity in Norm 450-500 ml.
 Layers:
 Mucosal – transitional epithelium
 Connective tissue
 Muscular tissue- Detrusor
 The three openings, two ureteric orifices, and the
internal urethral orifice mark the triangular area
called the trigone of the bladder.
Topographic Anatomy of the Male Urinary Bladder and
Prostate
 Prostate
 Glandular and fibrotic-muscular organ
 Normal prostate is about 20 gr.
 Includes prostatic part of urethra(about 2.5 sm.
length)
 Ejaculatory ducts passes through the prostate, and
open into the uretra at the seminal colliculus.
Transrectal biopsy of the
prostate. Benign prostatic
hyperplasia
Prostate zonal anatomy:
•Transition zone - The most common site of
benign prostatic hyperplasia
•Peripheral zone - The most common place for
prostate cancer
 Testicle and Epididymis
 The average adult testicle size: 4 × 3 × 2.5 sm.
Penile and men’s urethra