Anatomy of Genitourinary System PDF FINAL

Anatomy urinary tract

1. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
URINARY SYSTEM
PART 1. KIDNEY
SafrinaD. Ratnaningrum
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2. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
3 Functions of the Urinary System
1.Excretion:
•removal of organic
wastes from body fluids
2.Elimination:
•discharge of waste
products
3.Homeostaticregulation:
•of blood plasma volume
and solute concentration
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You will learn this
on physiology
subject

3. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Contents
1.Kidneys (ren)
•Positions
•Renal blood vessels
•Renal structures
2.Ureters
3.Urinary bladder (Vesica
urinaria/VU)
4.Urethrae
a n a h i s . f k @ u b . a c . i d 3
Organ that excrete urine
Organ that eliminate urine

4. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Kidneys
Feature like soya bean; lenght=±11 cm,
breadth=±6 cm, antero-post=±3 cm,
weight=±150 gr (♂) and ±135 gr (♀);
smooth surface (fetuslobulated); lower
pole is palpable in full inspiration (thin
individu)
Position:
• Regioabdomen posterior.
• Lateral columnavertebra
• Retroperitoneal.
• Between Vertebra T.XII –Vertebra
L.III
• Rendextrausually slightly inferior
than sinistra(why?)
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Posterior view

5. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
POSITION OF THE KIDNEYS
1.Renal projection
2.Renal relations (syntopi)
3.Renal protection
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6. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
1. Renal projection
Anterior:
•Hilum: 5cm from
midline, medial
from the tip costae
9
th
•Dex: under
transpyloricum
plane
•Sin: over
transpyloricum
plane
Posterior:
•Hilum: lower
border of processus
spinosusvertebrae
lumbalis1
st
& ±5
cm from midline.
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7. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
2. Renal relations (Renal syntopi)
•Anterior:
•Right kidney:
•Superior: gld. Suprarenal
•Anterior (3/4 surface): lobus
dexheparimpressio
•Medial: duodenum pars
descendens
•Inferolateral: flexuracolon
dex
•Inferiomedial: intestinum
tenue
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8. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
•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
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9. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
•Posterior:
•Superior: diaphragma
and lig. arcuata
medial&lateral
•Inferior:
•Medial: M. psoasmajor
•Intermedia: M. quadratus
lumborum
•Lateral: aponeurotictendon
M. transversusabdominis
•A/V/N subcostalis,
N. iliohypogastrica,
N. Ilio-inguinalis
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10. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
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M. Quadratuslumborum
N. Subcostalis
N. Iliohypogastica
N. Ilioinguinalis
M. Iliacus
M. Psoasmajor

11. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
a n a h i s . f k @ u b . a c . i d 12
Relationship of the
kidney and ureters in the
male retroperitoneum.
The picture shows all
retroperitoneumvisceral
organs in the
abdominopelviccavity.

12. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Cross section at T12, to show
intra/extraperitonealvisceral
1.Hepar
2.Ligfalciformis
3.Vena porta
4.Vena cava inferior
5.Bursa omentalis(saccusminor)
6.Rendextra
7.Aorta abdominalis
8.Gldsuprarenal sinistra
9.Ligsplenorenalwith a/v lienalis
10.Lien
11.Liggastrolienaliswith a/v gastricabrevis
12.Gaster
13.M. rectus abdominis
14.Omentumminus
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1
2
3
4
5
6
7
8
9
10
11
12
13
14

13. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
3. Renal protection
1.Capsularenalis
•Collagen fibers covers outer surface organ
2.corpus adiposumperirenalis/capsula
adiposa/perirenalfat
•Adipose tissue surround renal capsule (connected by
trabeculae, >>reninferior)
3.Fascia renalis
•fibrous outer layer anchors kidney to surrounding
structures
4.Corpus adiposumpararenalis/pararenalfat
•Adipose tissue posterior to fascia renalis
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14. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Capsula renalis
Fascia renalis
(lamina anterior &
posterior
Corpus adiposum
perirenalis
Corpus adiposum
pararenalis
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15. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Pararenalfat (corpus adiposumpararenalis):
dorsal of fasciarenalis
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Perirenalfat (corpus adiposumperirenalis):
covered by fascia renalis
Lamina posterior
fascia renalis
Lamina anterior
fascia renalis

16. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Cross section at L1 level, rensyntopiand protenction
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17. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
RENAL BLOOD VESSELS
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18. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Artery renalisdirect appx25% of the cardiac output to the kidneys.
A renalisgives branches:
•a. suprarenalisinferior
•note: a. supraneralissuperior and media from a. phrenicainferior and
aorta abdominalis
•Branches to the perinephrictissue, renal capsule, pelvis and proximal part
of the ureter
Near the hilum a. renalisdivides into divisianteriorand divisi
posteriora. segmentalis
Variation:
•A. renalisaccesoriusarise from aorta (30%) and rarely from a. colica, a.
mesentericasuperior, or a. iliacacommunis
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19. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
A. renalisa. segmentalis
•Renal vascular
segmentation (by
Graves 1956)
1.Apical
2.Superior (anterior)
3.Inferior
4.Middle (anterior)
5.Posterior
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Lateral Anterior Posterior

20. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Bloodless line of Brodel(1911)
A relatively avascular longitudinal
zone along the convex renal
border
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Lateral view

21. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
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22. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
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A. lobaris(one for each pyramid) divides
into 2-3 a. interlobarisa. arcuataa.
interlobularis
• diverge radially into the cortex
• Some perforatesurface as perforating
artery rami capsularesa. afferent
a. efferent peritubularcapillary
plexus (around PCT & DCT in the
cortical nephron)vasa recta
(arteriolaerectaein the juxtamedullary
nephron)
v. interlobularis
Vasa recta
Peritubular
capillary plexus
DCT
PCT

23. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
1.Cortex
2.Medulla
a.Pyramida
b.Columnarenalis(Bertini)
3.Papilla, apex of the medulla (ductus
Bellini)
4.Medullary rays
5.Ureter
6.Calyx minor
7.Pelvis
8.Calyx major
9.Capsularenalis
10.Hilusrenalis
11.Sinus renalis(filled by perirenalfat)
12.Lobusrenalis
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Renal structures
b
a
9
10
11
12

24. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Fig. Renal structures
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25. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
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26. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Left-right orientation (dorsal view)
Posterior:
pelvis renalis
Medial:
A.renalisbut branch of artery
entry for hilum posterior pelvis
renalis
Anterior:
V.renalisbut branch of vein exit
for hilum posterior of pelvis renalis
a n a h i s . f k @ u b . a c . i d 27

27. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Nephron
(functional subunit of the kidney)
Where urine production begin
located on cortex and
columnarenalis(±1-2jt
/ren)
Consists of:
1.corpusculusrenalis
2.tubulusrenalis
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28. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Corpusculusrenalis
(Malpighian)
Consists of:
1.capsulaglomerulus
(Bowman)
2.glomerulus(capillary
network)
3.capsular space
Diameter 150–250 µm
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29. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
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30. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Fig. Glomerullarcapillaries
(electron micrograph)
Filtration membrane
•Capillary endothelium (fenestrated
capillaries)
•Lamina basalis
•Modified of visceral epithelium
(podocyte) proc. Primer proc.
Secondary (pedicels) filtration slits
a n a h i s . f k @ u b . a c . i d 32

31. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Tubulusrenalis
Consists of:
1.Tubuluscontortus
proximal (PCT)
2.Loop of Henle
•Descending limb
•Ascending limb
3.Tubuluscontortus
distal (DCT)
Located on:
•Cortex: PCT & DCT
•Medulla: Loop of Henle
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32. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
a n a h i s . f k @ u b . a c . i d 34

33. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
JUXTA GLOMERULAR APPARATUS (JGA)
Location:
Near each renal corpuscel’svascular pole,
at the point of contact between a distal
convoluted tubule and an afferent
arteriole.
Consists of:
•Juxtaglomerular (JG cell)
•Modified smooth muscle cell in the
afferent arteriole’s wall
•Function: secrete renin
•A macula densa
•Modified from DCT
•Function: homeostasis
•Polkissencells (extraglomerularmesangeal
cells). Function: maybe phagocyt
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34. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Glomerulus, PCT, DCT, JGC
(cortex renalis, 100x)
a n a h i s . f k @ u b . a c . i d 41

35. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Mesangealcell
•Located between 2 glomerulus, where they have 1 basement membrane
(membranabasalis), the function maybe as a phagocyt
•Concentrated between capillaries at the vascular pole of the corpuscle
a n a h i s . f k @ u b . a c . i d 42

36. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
URINARY SYSTEM
PART 2. URETER, BLADDER, URETHHRAE
SafrinaD. Ratnaningrum
a n a h i s . f k @ u b . a c . i d 44

37. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
•Pars abdominal
•Posterior to the peritoneum
•Medial to anterior of m. psoas major
•Crosses anterior n. genitofemoralis
•Obliquellycrossed by a/v. testicularis
(ovarica)
•Pars pelvica
•Posterolaterallyon the lateral wall of
pelvis minor, along anterior border of
incisuraischiadicamajor until spina
ischiadicaand turns anteromediallyinto
fibrous adipose tissue above m. levator
anito reach base of vesicaurinaria.
a n a h i s . f k @ u b . a c . i d 45
Pars abdominal
Pars pelvica
Ureter

38. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Bony landmark of ureter
•Lies along the tips of proc.transversus
•Crosses in front of art.sacroiliaca
•Swings out to the spinaischiadica
•Passes medial to the VU
There are 3 areas of constriction along the ureter
1. at the pelvic-ureteric junction
2. where the ureter crosses the pelvic brim
3. where the ureter enter into the bladder
a n a h i s . f k @ u b . a c . i d 46

39. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Radiography
•Descending or excretion
pyelography(IVP)
•Ascending or retrograde
pyelography
•Normal capping of the minor
calycesclinically important
obliteratedhydronephrosis
a n a h i s . f k @ u b . a c . i d 47

40. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
NOTE:
•Male ureter:
•Crossed anterosuperiorlyfrom
lateral to medial by ductus
deferens
•Anterior to the upper pole of
vesiculaseminalis
a n a h i s . f k @ u b . a c . i d 48
Male ureter, dorsal view

41. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Blood supply of ureter
•A. renalis, aorta, a. gonadalis, a. iliaca
communis, a. vesicalis
a n a h i s . f k @ u b . a c . i d 50

42. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Blood supply of ureter
•A. renalis, aorta, a. iliacacommunis, a. vesicalis
Nerve supply of ureter
•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 majusto proximal anterior of thigh.
a n a h i s . f k @ u b . a c . i d 51
Peristaltic contraction:
•Begin at renal pelvis
•Sweep along ureter
•Force urine toward urinary bladder
•Every 30 seconds

43. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Clinical correlation
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 distalthird of the ureter, pain is noted in
the ipsilateraltesticle or labia.
a n a h i s . f k @ u b . a c . i d 52

44. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
URINARY BLADDER
Vesica urinaria (VU)
a n a h i s . f k @ u b . a c . i d 53

45. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
URINARY BLADDER (Vesicaurinaria)
Empty: tetrahedral / pyramid in shape
•Apex: anterior, connected by urachusto the
umbilicus.
•Basis/fundus(posterior surface):
•Male: related to the rectum separated by
rectovesicalpouch
•Female: related to the anterior wall of vagina &
cervix of uterus separated by vesicouterinepouch
•Superior surface: covered by peritoneum,
in female posteriorlyrelated to the cervix &
corpus uteri.
•Inferolateralsurface: separated by the
adipose retropubicpad from pubis and lig.
puboprostatic/pubovesical.
Fills: ovoid
•above umbilicus
a n a h i s . f k @ u b . a c . i d 54

46. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Posterior surface of anterior
abdominal wall
Showing the peritoneum folds at
the lower anterior abdominal wall
(under umbilicus), there are 5 folds.
False ligaments for the bladder:
1.Plicaumbilicalismediana
•Extends from umbilicus to the apex of
VU, contains the urachus/its remnant.
2.Plicaumbilicalismedialissin-
dex
•Obliterated a.umbilicalis.
3.Plicaumbilicalislateralissin-
dex
•Cover a/v epigastricainferior.
a n a h i s . f k @ u b . a c . i d 55

47. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Fig. Relations of the ureter pelvica(lower ureter), from above.
(A) the male pelvis, (B) the female pelvis.
a n a h i s . f k @ u b . a c . i d 56

48. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
The Trigoneof the Urinary Bladder
(trigonumvesicaeLieutaudi)
•Is a triangular area bounded by:
•openings of ureters(ostium
ureterisdex-sin)
•entrance to urethra (ostium
urethraeinternum)
•Acts as a funnel:
•channels urine from bladder into
urethra
•The urethral entrancelies at apex
of trigone:
•at most inferior point in urinary
bladder
a n a h i s . f k @ u b . a c . i d 59
Plicaumbilicalismediana

49. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
The Neck of the Urinary Bladder
(cervicvesicae)
•Is the region surrounding
urethral opening
•Contains a musculussphincter
urethraeinterna(sphincter
vesicae-Smooth muscleof
sphincter provide involuntary
control of urine discharge)
a n a h i s . f k @ u b . a c . i d 60
Plicaumbilicalismediana
The Layers of Bladder
•4 layer of VU: urothelium, lamina
propria, muscularispropria/smooth
muscle (M. detrusor: 3 layers), serosa.

50. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Blood supply of VU
A. vesicalissuperior & inferior
Nerve supply of VU
Plexus vesicalis:
T10-L2 sympathetic
S2-S4 parasympathetic
a n a h i s . f k @ u b . a c . i d 63

51. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
URETHRAE
►Male urethrae
►Female urethrae
a n a h i s . f k @ u b . a c . i d 64

52. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
The Urethra
•Extends from neck of urinary bladder
•To the exterior of the body
a n a h i s . f k @ u b . a c . i d 65
The Male Urethra
►Extends from neck of
urinary bladder
►To tip of penis (18–20 cm)

53. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
3 Parts of the Male Urethra
1.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
3.Spongy urethra/penile urethra(pars spongiosa):
•extends from urogenital diaphragm
•to external urethral orifice (ostiumurethrae externum)
•Epithel: stratified squamous
a n a h i s . f k @ u b . a c . i d 66

54. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Pars prostatica
Pars spongiosa
a n a h i s . f k @ u b . a c . i d 67
Pars
membranacea

55. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Anatomy of prostate gland
•Basis (pierced centrally by urethrae); apex; faciesanterior (convex); facies
posterior (concave); 2 of faciesinfero-lateral
a n a h i s . f k @ u b . a c . i d 68
•Colliculusseminalis
(verumontanum) is used to
determine the position of
prostate gland during TURP

56. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Prostatic urethrae
(cut), anterior view
a n a h i s . f k @ u b . a c . i d 69

57. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
a n a h i s . f k @ u b . a c . i d 70

58. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Zonal Anatomy (McNeal)
1.The transitional/mucosal zone (5%)
•Where BPH occurs
2.The central/submucosalzone (25%)
•Contains ductusejaculatorius
•<<<diseases (rare)
3.The peripheral zone (60-70%)
•>>>glands
•The most of zone where prostate
ca/carcinoma form
4.The anterior zone
•>>>fibromuscular
•glandular (-)
a n a h i s . f k @ u b . a c . i d 71

59. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
The Female Urethra
•Is very short (3–5 cm)
•Extends from bladder to
vestibule
•External urethral orifice
(ostiumurethraeexternum)
is near anterior wall of
vagina
•Epithel: transitional 
stratified-squamous
a n a h i s . f k @ u b . a c . i d 73

60. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
The External Urethral Sphincter
(M. sphincter urethraeexterna)
•In both sexes:
•is a circular band ofskeletal muscle
•where urethra passes through urogenitaldiaphragm
•Acts as a valve
•Is under voluntary control:
•via perinealbranch of pudendalnerve
•Has resting muscle tone
•Voluntarily relaxation permits micturition
a n a h i s . f k @ u b . a c . i d 74

61. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
a n a h i s . f k @ u b . a c . i d 75
How is urination regulated voluntarily and
involuntarily and what is the micturition reflex?

62. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
The micturition reflex
Urine fills VU about 200ml (max. 500ml)
receptor M.detrusor(smooth muscle)
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
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63. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Baby and infant
•Less of voluntary control
•<< corticospinaljunction
Incontinence is the lack of ability to control urination
voluntary.
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64. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
Aging and the urinary system
•Decline number of functional nephron
•Reduction in glomerular filtration
•Reduced sensitivity to ADH (Antidiuretic Hormone)
•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.
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65. A N A T O M Y H I S T O L O G Y D E P A R T M E N T
a n a h i s . f k @ u b . a c . i d 79