Urinary System

Urinary System
ANATOMY-HISTOLOGY DEPARTMENT
MEDICAL FACULTY BRAWIJAYA UNIVERSITY
1.
2.
Functions
Kidneys (ren)
◦
◦
◦
3.
4.
5.
Positions
Renal blood vessels
Renal structures
Ureters
Urinary bladder (Vesica
urinaria/VU)
Urethrae
Excretion:
1.
◦
2.
◦
3.
◦
removal of organic wastes from body fluids
Elimination:
discharge of waste products
Homeostatic regulation:
of blood plasma volume and solute concentration
1.
2.
3.
4.
Ren
Ureter
Vesica urinaria
Urethra

Organs that excrete urine
2. Urinary Tract
► Organs
that eliminate urine:
 ureters (paired tubes)
 urinary bladder (muscular sac)
 urethra (exit tube)
Feature like soya bean;

11 X 6 X 3 cm, weight=±150 gr (♂) and ±135 gr
(♀); smooth surface (fetuslobulated);
lower pole is palpable in full inspiration (thin
individu)
◦
◦
Position:

◦
◦
◦
◦
◦
Regio abdomen posterior.
Lateral columna vertebra
Retroperitoneal.
Between Vertebra T.XII – Vertebra L.III
Ren dextra usually slightly inferior than sinistra
(why?)
“Dokter, pinggang saya sakit. Apakah saya
terkena sakit ginjal?” Keluhan ini pasti
sering disampaikan pada saat Anda di
tempat praktek dokter. Tetapi apakah sakit
pinggang selalu diartikan bahwa terjadi
sakit ginjal? Apakah setiap penyakit ginjal
akan memberikan keluhan nyeri pinggang?
Renal projection
Renal relations syntopi
3.
3. Renal protection
1.
2.

Anterior:
◦ Hilum: 5cm from
midline, medial from
the tip costae 9th
 Dex: under
transpyloricum plane
 Sin: over transpyloricum
plane

Posterior:
◦ Hilum: lower border of
processus spinosus
vertebrae lumbalis 1st
& ±5 cm from midline.

Anterior:
◦ Right kidney:
 Superior: gld. Suprarenal
 Anterior (3/4 surface):
lobus dex hepar 
impressio
 Medial: duodenum pars
descendens
 Inferolateral: flexura
colon dex
 Inferiomedial: intestinum
tenue
Renal relations

Anterior:
◦ Left kidney:
 Superior: left suprarenal
gland
 Anterior-lateral: spleen
 Anterior-medial:
stomach
 Anterior (central):
pancreatic body and
splenic vessels.
 Inferior-lateral: left colic
flexure
 Inferior-medial: jejenum
Renal relations

Posterior:
◦ Superior: diaphragma
and lig. arcuata
medial&lateral
◦ Inferior:
 Medial: M. psoas major
 Intermedia: M. quadratus
lumborum
 Lateral: aponeurotic
tendon M. transversus
abdominis
◦ A/V/N subcostalis,
N. iliohypogastrica,
N. Ilio-inguinalis
1.
Capsula renalis
◦
2.
capsula adiposa/perirenal fat
◦
3.
Adipose tissue surround renal
capsule ( >>ren inferior)
Fascia renalis
◦
4.
Collagen fibers covers outer surface
organ
fibrous outer layer anchors kidney to
surrounding structures
Corpus adiposum
pararenalis/pararenal fat
◦
Adipose tissue posterior to fascia
renalis
Capsula renalis
Fascia renalis
(lamina
anterior &
posterior
Corpus adiposum
perirenalis
Corpus adiposum
pararenalis
Tranversal section
Coronal section
Pararenal fat (corpus
adiposum pararenalis):
Jaringan lemak dibagian
belakang fascia renalis
Arteri Renalis



Branch of aorta abdominalis
A. renalis gives:
◦ a. suprarenalis inferior
 note: a. suprarenalis superior and media
from a. phrenica inferior and aorta
abdominalis
◦ Branches to the perinephric tissue, renal
capsule, pelvis and proximal part of the
ureter
Near the hilum a. renalis divides into divisi
anterior and divisi posterior  a. segmentalis

◦



◦
◦
◦
◦

A. renalis  a. segmentalis
Renal vascular segmentation (by Graves 1956)
1.
2.
3.
4.
5.
Apical
Superior (anterior)
Inferior
Middle (anterior)
Posterior
A. lobaris (one for each pyramid)  divides
into 2-3 a. interlobaris  a. arcuata
 a. interlobularis
diverge radially into the cortex
Some perforate surface as perforating artery 
rami capsulares
 a. afferent  a. efferent
 peritubular capillary plexus (around PCT &
DCT in the cortical nephron)
 vasa recta (arteriolae rectae in the
juxtamedullary nephron)
 v. interlobularis
A relatively avascular longitudinal zone along the
convex renal border, because it is the border
between two areas of arterial distribution.
improved method of nephropexy using a suture.
1.
2.
3.
4.
5.
Hilus renalis
Sinus renalis
Capsula renalis
Cortex renalis
Medulla renalis
a. Pyramida renalis
 Papilla renalis (ductus Bellini)
b. Columna renalis (columna
Bertini)
6.
7.
8.
Lobus renalis
Calyx minor  Calyx major
Pelvis renalis
Fig. Renal structures
Polus Superior lebih
lancip dari polus
inferior
Hilus : VAU
Anterior: V.renalis
Medial: A.renalis
Posterior:
Ureter/ pelvis renalis



Descending or excretion pyelography
Ascending or retrograde pyelography
Normal capping of the minor calyces
clinically important obliterated
hydronephrosis
U
R
E
T
E
R


Seorang laki-laki usia 38 tahun datang dengan
keluhan nyeri hebat berulang di daerah pinggang
kiri dan terasa menjalar ke punggung atas. Nyeri
diikuti mual dan muntah. Pada pemeriksaan
didapatkan Tekanan Darah 120/85 mmHg dan
nyeri tekan/ketok pinggang +.
Pemeriksaan urin menunjukkan adanya eritrosit :
15-20/lp, dan kristal +++. Pemeriksaan
radiologis BNO : gambaran hydronephrosis dan
batu radiopaque pada area hilus renalis



What is the most likely diagnosis?
What is the likely anatomical mechanism for
this disorder?
From the sign and symptomps, what
structure is likely affected?



Diagnosa : Nephrolithiasis
Nephrolithiasis is common, with a lifetime
prevalence of 10% in men and 5% in women.
Most patients present with moderate to
severe colic, caused by the stone entering the
ureter. Stones in the proximal (upper) ureter
cause pain in the flank or anterior upper
abdomen. When the stone reaches the distal
third of the ureter, pain is noted in the
ipsilateral testicle or labia.
P
a
r
s
a
b
d
o
m
i
n
al
Pars pelvica

Pars abdominal
◦
◦
◦
◦

Posterior to the peritoneum
Medial to anterior of m. psoas major
Crosses anterior n. genitofemoralis
Obliquelly crossed by a/v. testicularis (ovarica)
Pars pelvica
◦ Posterolaterally on the lateral wall of pelvis minor,
along anterior border of incisura ischiadica major
until spina ischiadica and turns anteromedially into
fibrous adipose tissue above m. levator ani to reach
base of vesica urinaria.




Lies along the tips of
proc.transversus
Crosses in front of
art.sacroiliaca
Swings out to the spina
ischiadica
Passes medial to the VU
1. at the pelvicureteric junction
2. where the ureter
crosses the pelvic
brim
3. where the ureter
enter into the
bladder (narrowest
of all)
NOTE:

Male ureter:
◦ Crossed
anterosuperiorly from
lateral to medial by
ductus deferens
◦ Anterior to the upper
pole of vesicula
seminalis




Begin at renal pelvis
Sweep along ureter
Force urine toward urinary bladder
Every 30 seconds
Blood supply
◦ A. renalis, aorta, a. iliaca communis, a. vesicalis
Nerve supply
◦ T11 to L2 segments of the spinal cord via the plexus
renalis, hypogastrica, and pelvica
◦  excessive distension and spasm of the ureter
caused by calculus; spasmodic; mainly innervated by
T11-L2  branch: N. iliohypogastrica; N.
ilioinguinalis; N. genitofemoralis, the pain may be
spread from the loin to the groin and scrotum and
labium majus to proximal anterior of thigh.
Vesica urinaria (VU)

Empty: tetrahedral / pyramid in shape
◦ Apex: anterior, connected by urachus to the umbilicus.
◦ Basis/fundus (posterior surface):
 Male: related to the rectum separated by recessus rectovesical
 Female: related to the anterior wall of vagina & cervix of uterus
separated by recessus vesicouterine
◦ Superior surface: covered by peritoneum
◦ Inferolateral surface: separated by the adipose
retropubic pad from pubis and lig.
puboprostatic/pubovesical.

Fills: ovoid
◦  above umbilicus
►
Is a triangular area bounded by:
openings of ureters (ostium ureteris dex-sin)
►

Crista inter-ureterica
entrance to urethra (ostium urethrae internum)
Consist of smooth muscle
►
►
►
►
M. trigonum superficialis and profundus
Acts as a funnel:
 channels urine from bladder into urethra

Lies at apex of trigone:
◦ at most inferior point in urinary bladder


Is the region
surrounding
urethral opening
Contains a musculus
sphincter urethrae
interna (sphincter
vesicae- Smooth
muscle of sphincter
provide involuntary
control of urine
discharge)
Blood supply of VU
A. vesicalis superior & inferior
Nerve supply of VU
Plexus vesicalis:
T10-L2  sympathetic
S2-S4  parasympathetic
►Male
urethrae
►Female urethrae


Extends from neck of urinary bladder
To the exterior of the body
The Male Urethra
► Extends
from neck of urinary bladder
► To tip of penis (18–20 cm)
3 Parts of the Male Urethra
Prostatic urethra (pars prostatica):
 passes through center of prostate gland
 Epithel: transitional
2.
Membranous urethra (pars membranacea):
 short segment that penetrates the
 urogenital diaphragm
 Epithel: pseudo-stratified columnar / stratified
columnar
1.
3.
Spongy urethra/penile urethra (pars spongiosa):
◦
extends from urogenital diaphragm
◦
to external urethral orifice (ostium urethrae
externum)
◦
Epithel: stratified squamous
Pars membranacea
Pars spongiosa
Pars prostatica


Basis (pierced centrally by urethrae); apex; facies
anterior (convex); facies posterior (concave); 2 of
facies infero-lateral
Colliculus
seminalis
(verumontanum)
is used to
determine the
position of
prostate gland
during TURP
1.
2.
3.
4.
The transitional/mucosal zone
(5%)
◦ Where BPH occurs
The central/submucosal zone
(25%)
◦ Contains ductus ejaculatorius
◦ <<<diseases (rare)
The peripheral zone (60-70%)
◦ >>>glands
◦ The most of zone where
prostate ca/carcinoma form
The anterior zone
◦ >>>fibromuscular
◦ glandular (-)




Is very short (3–5 cm)
Extends from bladder to vestibule
External urethral orifice (ostium urethrae
externum) is near anterior wall of vagina
Epithel: transitional  stratified-squamous

In both sexes:
◦ is a circular band of skeletal muscle
◦ where urethra passes through urogenital diaphragm


Acts as a valve
Is under voluntary control:
◦ via perineal branch of pudendal nerve


Has resting muscle tone
Voluntarily relaxation permits micturition

Urine fills VU about 200ml
(max. 500ml)  receptor
M.detrusor stretch  impuls
to sacral spinal cord.






Parasympathetic >>
Stimulates contraction VU
Stimulates interneuron to
cerebral cortex
Voluntary urination by
relaxation M.s.u.ext 
relaxation M.s.u.int via
ANS
The rest urine in VU
<10ml
About 1-1,5 L/day


Less of voluntary control
<< corticospinal junction
 Incontinence is the lack of ability to
control urination voluntary.



Decline number of functional nephron
Reduction in glomerular filtration
Reduced sensitivity to ADH
◦ Less reabsorption of water and sodium ions;
frequent urination

Problem with micturition reflex
◦ << sphincter muscles tone  incontinence
◦ Ability to control micturition is often lost after
stroke, Alzheimer, CNS problem.
◦ BPH  urinary retention in male.
Belajar yang
rajin yaa…
Miaw
…