David Fu

1. The Urinary SystemSchool of Basic Medical Science of Jiujiang University David Fu

2. Urinary System Functions To excrete the waste products, such as urea and uric acid, excess water and some inorganic salts, so as to regulate the composition of the internal environment of the body, in terms of water content, osmotic relations and acid-base balance. The female urethra is an urinary duct, while the male urethra serves urinary and genital functions.

3. ★ Composition • Two kidneys－produce urine • Two ureters－convey urine from kidneys to the urinary bladder • One urinary bladder－receives and stores urine temporarily • One urethra－carries urine from the urinary bladder to the outside of the body .

4. Kidney Each kidney has two extremities, two surfaces and two borders. General features • Bean-shaped, reddish-brown organs • Superior extremity－broader and thinner • Inferior extremity－narrower and thicker • Anterior surface－convex • Posterior surface－flat • Lateral border－convex

5. Medial border－concave • Renal hilum ★－a vertical slit on the medial border of kidney, the structures which enter and leave the renal hilum is called renal pedicle, including the renal vein, renal artery, renal pelvis, lymphatic vessels and nerves • Order of structures in the renal pedicle from anterior to posterior－V. A. P. from superior to inferior－A. V. P.

6. Location of kidneys • Liebehind the parietal peritoneum against the muscles of the posterior abdominal wall. one on each side of the vertebral column high up on the posterior abdominal wall, upper pole nearer to media plan than lower pole. • The right kidney is lower about a half body of vertebra than the left one, possibly because of its close relationship to the liver. • Generally in female it is lower than in male. It is higher in adult than in child. In newborn child the inferior extremity of kidney may be at the level of the iliac crest.

7. Left kidney lies at the level from the lower border of T11 to L2; the 12th rib is behind its middle part of the post surface • Right kidney lies slightly lower than the left kidney, at the level from the lower border of T12 to L3; the 12th rib is behind its upper part of the post surface • Renal hilum is at the level of L1, about 5cm lateral to the posterior median line of the body • Renal region★－in clinic the area between 12th rib and the lateral margin of the erector.

8. Relationships of kidneys • Superiorly－superarenal gland • Posteriorly • Three muscles • Diaphragm (pleural cavity) • Psoas major • Quadratus lumborum • Three nerves • Subcostal • Iliohypogastric • Ilioinguinal • Medial • Left kidney－abdominal aorta • Right kidney－inferior vena cava

9. Anteriorly • Left kidney • Stomach (superior), • Pancreas (middle), • Loops of intestine and left colic flexure (inferiorly) • Right kidney • Right lobe of liver (superior) • Right colic flexure (inferior) • Descending part of duodenum (medially)

10. Structure of the kidney • Renal cortex • renal columns • Renal medulla • Renal pyramids: 15～20 • Renal papilla • Papillary foramina • Minor renal calices (7 ～ 8) • Major real calices (2～3) • Renal pelvis

11. Renal sinus －which is the renal hilum leads into a space within the kidney, the renal sinus is occupied by the renal vessels, minor renal calices, major renal calices, renal pelvis and some adipose tissue

12. Coveringsof the kidney • Fibrous capsule －a strong fibrous capsule which strips easily from a normal kidney surface but adheres firmly to an organ that has been inflamed

13. Fatty renal capsule －a thick adipose connective tissue capsule, surrounds the fibrous capsule. It acts as a shock absorber to protect the kidney from jolting and jarring • Renal fascia －on outside, surrounds both the kidney and suprarenal gland, holding these organs in place

14. What is the difference between renal hilum & renal sinus? • Outline a major calyx & the border between cortex & medulla.

15. Renal segments • The kidney is divided into five vascular segments and each is supplied by a branch of the renal artery; between the segments there is no anastomosis. • The segments are • Superior segment • Superior anterior segment • Inferior anterior segment • Inferior segment • Posterior segment

16. ectopic kidney renal transplantation renal calculus or kidney stone horseshoe kidney

17. Ureters • Muscular tube, about 25cm long • Three parts • Abdominal part－descend on the psoas major behind the peritoneum • Pelvic part－in females, passes 2cm lateral to the neck of uterus and lies below the uterine artery • Intramural part－passes obliquely through the bladder wall for1.5～2.0 cm long

18. Three constrictions ★ • At the junction of the ureter and the renal pelvis • Where it crosses the pelvic inlet and iliac arteries • Where it pierces the bladder wall obliquely (at intramural part)

19. Stone in ureter uronephrosis

20. Relation of abdominal part of ureter • Anterior to right ureter • Descending part of duodenum • Right colic vesseles • Iliocolic vesseles • Testicular vesseles • Terminal part of ileum • Right to right ureter • Cecum • Vermiform appendix • Anterior to left ureter • Duodenojejunal flexure • Left colic vesseles • Testicular vesseles

21. Anatomy of Urinary Bladder • Hollow, in the adult the normal capacity of the urinary bladder is from 300 ml to 500 ml

22. Urinary Bladder General features • Pyramidal in shape when empty, having • Apex, • Fundus • Body of bladder • Neck

23. Interior of bladder • Mucous membrane folded, except for trigone of bladder • Trigone of bladder★－smooth triangular area at inner surface of the funds of bladder, formed by internal urethral orifice anteriorly and two ureteric orifices laterally, in this area absents submucosal layer, where the mucous membrane is firmly adherent to the muscular coat, and is always smooth • Interureteric fold －muscular elevation, between ureteric orifices.

24. Location • In the adult, it lies in the lesser pelvis, behind the pubic symphysis, in front of seminal vesicle, ampulla ductus deferentis and rectum in the male, and in front of uterus and vagina in the female. • In the young child the empty bladder projects above the pelvic inlet

25. Location • In the adult, it lies in the lesser pelvis, behind the pubic symphysis, in front of seminal vesicle, ampulla ductus deferentis and rectum in the male, and in front of uterus and vagina in the female. • In the young child the empty bladder projects above the pelvic inlet

26. Urethra Female urethra • Relatively short (about 5cm long), wide and straight • Opens into vaginal vestibule

27. Male urethra Three parts • Prostatic part－lies within the prostate and is the widest and most dilatable portion of urethra. • Membranous part–lies within the urogenital diaphragm surround by the sphincter of urethra • Cavernous part－transverse the length of cavernous body of urethra Posterior urethra－prostatic part and membranous part Anterior urethra –-cavernous part

28. Within prostatic part • Urethral ridge • Prostatic utricle • The orifices of the ejaculatory ducts

29. Three constrictions • At the internal urethral orifice • At the membranous part • At the external orifice of urethra Three enlarged parts • At prostatic part • At bulb of urethra • At navicular fossa of urethra

30. Two curvatures • Subpubic curvature－concave upward • Prepubic curvature －concave downward cystoscopy catheterization

31. Which constrictions and curves are to go through essentially when lithecbole of renal pelvis in male?