anatomy of ureter & urinary bladder

2. Ureter & Urinary bladder

3. Urinary system
• Urinary system consists of
• Kidneys
• Ureters
• Urinary bladder
• Urethra

4. Ureter
• Narrow, thick-walled, expansile
muscular tube
• Conducts urine
• From kidney to urinary bladder
• Retroperitoneal
• Length: 25 cm (10inches)
• Diameter: 3 mm
•

5. Formation
• Formation of Renal pelvis
• Is a funnel-shaped structure
• Formed by
• Union of major calyces
• Location
• Partially outside and partly inside the kidney
• Formation of ureter
• Renal pelvis continues as ureter
• At lower pole of kidney

6. Parts
• Divided into
• Abdominal part
• Pelvic part
• Each part is about the same length
• i.e., 12.5 cm (5 inches)

7. Abdominal Part - Course
• Extends
• From the renal pelvis
• To the bifurcation of the common iliac
artery

8. Abdominal part - Anterior Relations
• Left side
• Left colic vessels
• Sigmoidal vessels
• Left testicular / ovarian vessels
• Sigmoid mesocolon
• Right side
• 2nd part of duodenum
• Right colic vessels
• Iliocolic vessels
• Right testicular / ovarian vessels
• Root of mesentery

9. • Tips of transverse process of lumbar vertebrae
• Psoas major
• Genitofemoral nerve
Abdominal part – posterior relations

10. Pelvic part - course
• Runs downward in front to internal
iliac artery, reaches ischial spine
• Turns forward and medially, enters the
upper lateral angle of urinary bladder
• Near its termination, is crossed by the
vas deferens
• Passes obliquely through the wall of
bladder for about ¾ inch before
opening into the bladder cavity

11. Pelvic part - parts
• 2 parts
• First part
• From infront of beginning of external iliac
artery
• To ischial spine
• Follows greater sciatic notch
• Second part
• From ischial spine
• Passes forwards and medially
• To base of urinary bladder

12. Pelvic part of Ureter – first part
• Relations
• Posterior
• Sacroiliac joint
• Internal iliac
• Anterior trunk of internal iliac
• Lumbosacral
• Anterior
• Peritoneum
• Forms posterior boundary of ovarian
fossa
• Ovary & uterine tube

13. Pelvic part of Ureter – first part
• Laterally
• Ureter crosses in front of
• All nerves and vessels on lateral pelvic wall
• Umbilical artery
• Obturator nerve & vessels
• Inferior vesical vessels
• Vesical branch of Middle rectal vessels

14. Pelvic part of Ureter – second part
• In male
• Inferolaterally
• Levator ani
• At lateral aspect of urinary bladder
• Crossed infront by vas deferens
• Below by seminal vesicle

15. Pelvic part of Ureter – second part
• In female
• Near uterine cervix,
• Uterine artery is located above and in front of it
(in female)

16. Sites of Anatomical Constrictions
• Lumen is not uniform throughout
• Has three constrictions
• At pelviureteric junction
• At pelvic brim
• Where it crosses common iliac artery
• At uretero-vesical junction
• Where ureter enters into bladder

17. Ureteric calculus
• Lodge at one of the sites of
anatomical narrowings
• At the pelvic ureteric junction.
• Where it crosses the pelvic brim.
• In the intramural part—the narrowest
part

18. Arterial supply
• Derives its arterial supply from the
branches of all arteries related to it
• Branches from
• Renal artery
• Gonadal artery
• Abdominal artery
• Common iliac artery
• Internal iliac

19. Clinical anatomy
• Arteries supplying ureter form an
anastomosis
• During transplantation
• Surgeons should bear in their mind that
stripping off fascia around ureter
• It will hamper the blood supply of
the ureter and may cause its necrosis

20. Nerve Supply
• Sympathetic supply
• T12–L1 spinal segments
• Through renal, aortic and hypogastric
plexuses
• Parasympathetic supply
• S2–S4 spinal segments
• Through pelvic splanchnic nerves
• Sensory fibres pass through
• Both sympathetic and parasympathetic
nerves

21. Injury to ureters
• May be injured at
• One of the following four dangerous
sites
• Point where the ureter crosses the iliac
vessels
• In ovarian fossa
• Where the ureter is crossed by the uterine
artery (most dangerous site) as damage is
likely at this site during hysterectomy
• At the base of the bladder

22. Urinary bladder
• Hollow muscular organ
• Reservoir of urine

23. Urinary bladder - Location
• In anterior part of pelvic cavity
• Lies behind the body of pubis & is
separated from it by the retropubic
space

24. Urinary bladder - Capacity
• Normal capacity in adult
• 200-300 ml
• Desire to micturate
• Beyond 220 cc
• Painful
• Up to 500 cc is tolerated
• Beyond this becomes painful

25. Urinary bladder- Parts
• Empty bladder is pyramidal in shape
• Has following Parts
• Apex
• Base
• 2 lateral angles
• 3 surfaces
• Superior, posterior and 2 inferolateral
• 4 borders
• Posterior, anterior, 2 lateral borders

26. Apex
• Directed forward
• Lies behind the upper margin of
symphysis pubis
• Connected to umbilicus by
• Median umbilical ligament (remnant of
urachus)

27. Neck
• Non – movable part
• Attached by
• Lateral ligaments of bladder
• Puboprostatic ligament in male and
pubovesical ligament in female
• In males
• Rests on upper surface of prostate
• In females
• On urogenital diaphragm

28. Posterior surface / base
• Triangular in shape
• Upper part covered by peritoneum in male
• Lower part related to
• In males
• Vas deferens and seminal vesicles
• In females
• Vagina

29. Superior surface
• Covered by peritoneum
• Related to
• Coils of ileum or sigmoid colon in males
• Uterus in females

30. Inferolateral surfaces
• Anterior part
• Retropubic pad of fat & the pubic bones
• Posterior part
• Obturator internus above
• Levator ani below

31. Interior
• Rugae
• Folds formed by mucous membrane
• Except in the triangular region
• Trigone
• Triangular area over the lower part of base of bladder
• Between the openings of the two ureters and the
urethra
• Mucosa is smooth (no folds)
• Due to its firm attachment to muscular coat
• Uvula vesicae
• A slight projection posterior to urethral orifice
• Formed by middle lobe of prostate

32. Arterial supply
• Superior and inferior vesical arteries
• From anterior trunk of internal iliac
arteries
• Vaginal artery replaces inferior vesical
artery in female

33. Venous drainage
• Venous plexus around the bladder
and prostate drain into
• Inferior vesical vein
• Superior vesical vein
• Both veins drain into internal iliac vein

34. Lymphatic drainage
• Upper ureter
• To lumbar lymph nodes
• Middle ureter
• To common iliac lymph nodes
• Lower ureter
• To common , external and internal iliac
lymph nodes
• Pelvic ureter and bladder
• To internal iliac lymph nodes

35. Urinary bladder - Nerve supply
• Parasympathetic
• From nervi erigentes (S2 3 4)
• Supplies
• Motor fibers to detrusor muscle
• Inhibitory to the sphincter vesicae
• Sympathetic
• Motor fibers to sphincter vesicae
• Inhibitory to detrusor muscle
• Sensory
• Both sympathetic & parasympathetic
• Voluntary motor control of external
sphincter is by pudendal nerve
Anatomy

36. Applied anatomy
• Obstruction in urine outflow
• Hypertrophy of bladder
• Hydroureter
• Hydronephrosis
• Cystoscopy
• Examining interior of urinary bladder
• By a hollow tube with a lens
• Pyelography
• Examining ureter and renal pelvis and
calyces by radiograph