The urinary system includes the kidneys, ureters, urinary bladder, and urethra. The kidneys filter the blood to remove wastes and produce urine. The ureters are tubes that carry urine from the kidneys to the bladder. The bladder stores urine until urination. The urethra then carries urine from the bladder to the outside of the body. Key structures of the urinary system were described in detail including locations, blood supply, and clinical relevance.

1. PRESENTED BY- DR. SUKRITI
DEPARTMENT OF SHARIR RACHANA
UNIVERSITY COLLEGE OFAYURVEDA,JODHPUR

2.  Urinary system refers to the structures that produce and
conduct urine to the point of
excretion.
 Urinary system includes :
 Pair of kidneys
 Ureters
 Urinary bladder
 Urethra

3.  Kidneys are pair of excretory organs situated on the
posterior abdominal wall, one on each side of vertebral
column.
Location :
3.
 Occupy epigastric ,
hypochondriac,lumbar ,
and umbilical region.
 Extend from upper border of
T12 to the centre of body of L
 Right kidney is slightly
lower than left.

4.  Shape- Bean shaped
 Size- each kidney is 11 cm long,6 cm broad and 3cm thick.
 Wieght- 150 g in males and 135 g in females.
 Reddish brown in colour.
External features-
 It has 2 pole
 Upper pole- broad
 Lower pole- pointed
 Two border-
 Lateral- convex
 Medial- concave
 Two surface

5.  Anterior surface- irregular
 Posterior surface- flat
 Hilum- medial border shows a depression is called hilum.
 Structures in hilum from anterior to posterior-
 The Renal vein
 The renal artery
 The renal pelvis

6. Covering or Capsules of kidney
(deep to superficial):
 Fibrous capsule- thin membrane which can easily
stripped off from organ.
 Perirenal fat- adipose tissue layer which is thickest at
borders and fill extrarenal space.
 Renal fascia - made up of two layers-
1. Posterior- fascia of Zuckerkandall
2. Anterior- fascia of Gerota.
 Pararenal fat – more abundent posterolateral aspect of
the kidney and fills paravertebral gutter to form cushion
of kidney.

7. Relation Right kidney Left kidney
Upper pole Supra renal gland Supra renal gland
Lower pole 2.5 cm above the iliac crest 2.5 cm above the iliac crest
Medial border supra renal gland and ureter supra renal gland and ureter
posterior •Diaphragm, 12th rib
•Psoas major, quadratus lumborum
and transversus abdominis muscles
•Subcostal, iliohypogastric and
ilioinguinal nerves
•Diaphragm , 11 and 12 th rib
•Psoas major, quadratus lumborum
and transversus abdominis muscles
•Subcostal, iliohypogastric and
ilioinguinal nerves
Anterior •Right Suprarenal gland
•Liver
• Second part of Duodenum
•Right colic flexure
• Left Suprarenal gland
•Spleen & Splenic vessels
•Stomach
•Pancreas
•Left colic flexure
•Jejunum

10. There are three major regions of the kidney:
1. An outer region - renal cortex
2. An inner region - medulla
3. A space – renal sinus
 Renal Cortex-
The kidneys are surrounded by a renal cortex, layer of tissue that is also covered
by renal fascia(connective tissue) and the renal capsule.
 Renal Medulla
The medulla is made up of about 10 conical masses, called the renal
pyramids, Each pyramid has a base directed towards the cortex; and an
apex (or papilla) that is directed towards the renal pelvis, and fits into a
minor calyx.

11.  Renal sinus- Space between and hilum. It contains-
1. Branches of renal artery
2. Tributeries of renal vein
3. Renal pelvis- funnel-shaped structure which is devides into 2 to
3 major calyces Each major calyx divides into a number of minor
calyces. The end of each minor calyx is shaped like a cup. A
projection of kidney tissue, called a papilla fits into the cup.
The Uriniferous Tubules
Each kidney is composed by 1 to 3 million Uriniferous Tubules.
Each uriniferous tubule consists of two parts-
1. An excretory part called the nephron,
2. A collecting tubule.

12. Nephron- functional unit of kidney. The nephron consists of -
 A renal corpuscle or Malpighian corpuscle- roundedstructure
consisting of
(a) a rounded tuft of blood capillaries called the glomerulus
(b) a cup-like, double layered covering for the glomerulus
called the glomerular capsule (or Bowman’s capsule).
 The renal tubule - divisible into several parts
(a) The proximal convoluted tubule;
(b) the loop of Henle consisting of a descending limb, a loop, and
an ascending limb;
(c) The distal convoluted tubule, which ends by joining a collecting
tubule.

13. Collecting part-
Each distal convoluted tubule delivers its filtrate to a collecting
tubule. many tubules unites to form Duct of Bellini. Which opens
into minor calyces.

14.  Blood supply of kidney–

15. Blood supply of kidney
Arterial Supply
renal arteries, which arise directly from the abdominal
aorta.
Venous Drainage
The kidneys are drained of venous blood by the left and
right renal veins. They leave the renal hilum anteriorly to
the renal arteries, and empty directly into the inferior vena
cava.
Nerve supply- renal plexus.

16. CLINICALANATOMY
 The angle between the lower border of 12th rib and outer border of
erector spinae is known as renal angle. Tenderness in the kidney is
elicited by applying pressure over the angle with the thumb
 Kidney stones
 Renal failure-In people with renal failure, the kidneys become
unable to filter out waste products from the blood effectively.
 Kidney hydronephrosis-This means “water on the kidney.”
 It usually occurs when an obstruction prevents urine from leaving
the kidney, causing intense pain.
 Nephrotic syndrome-Damage to the kidney function causes protein
levels in the urine to increase. This results in a protein shortage
throughout the body, which draws water into the tissues.

17.  The ureters are two thick tubes which act to transport urine
from the kidney to the bladder.
 Length – 25cm
 Diameter- 3mm

18. Anatomical Course
The anatomical course of the ureters can therefore be
divided into abdominal and pelvic components.
Abdominal Part
 The ureters arise from the renal pelvis – a funnel like
structure located within the hilum of the kidney. The point
at which the renal pelvis narrows to form the ureter is
known as the uretero pelvic junction.

19.  The ureters descend through the abdomen, along the
anterior surface of the psoas major.
 Here, the ureters are a retroperitoneal structure
 At the area of the sacroiliac joints, the ureters cross the
pelvic brim, thus entering the pelvic cavity.
 At this point, they also cross the bifurcation of the
common iliac arteries.

20. Pelvic Part
 within the pelvic cavity, the ureters travel down the lateral
pelvic walls. At the level of the ischial spines, they turn
anteromedially, moving in a transverse plane towards the
bladder.
 Upon reaching the bladder
wall, the ureters pierce
Its lateral aspect in an
Oblique manner.

21. Normal constrictions-
1. At the pelvi ureteric junction
2. At the brim of lesser pelvis
3. Point ofcrossing of ureter
by ductus deference or
Broad ligament of uterus
4.Oblique passage through
the bladder
5. At its opening in lateral
angle of trigone

22.  Anatomical relations of Abdominal part
Right ureter Left ureter
Anterior •3rd part of duedenum
•Right colic vessels
• ileocolic vessels
• Root of mesentry
•Terminal part of ileum
•Gonadal vessels
•perotoneum
•Peritoneum
•Gonadal artery
•Left colic vessels
•Sigmoid colon
•Sigmoid mesocolon
Posterior •Psoas major
•Genitofemoral nerve
•Psoas major
•Genitofemoral nerve
Medially •Inferior vena cava •Left gonadal vein
•Inferior mesentric vein

23.  Posteriorly-
 Internal iliac vessels
 Lumbosacral trunk
 Sacroiliac joint
 Laterally-
 Superior vesical artery
 Obturator artery and nerve
 Middle rectal artery
 Fascia covering obturator
internus

24.  Bloodsupply
Ureter is supplied by three sets of long arteries
1. The upper part -renal artery, gonadal or colic vessels
2. Middle part- aorta,gonadal, iliac vessels
3. Pelvic part- vesical, middle rectal, uterine vessels
Nerve supply-
1. Renal, aoertic and hypogastric plexus.

25.  Ureteric stone- presence of a solid stone in the urinary tract
formed from minerals within the urine. These can obstruct
urinary flow, causing renal colic (an acute and severe loin pain)
and haematuria (blood in the urine).
 Ureteric colic- this term is used for severe pain due to ureteric
stone . The pain start in the loin and rediates in groin,
scrotum,labium majus and inner thigh.
 Duplex ureter- 2 ureters drains renal pelvis on one side.
 Ureteroceles-cystic dilatation of lower end of ureter.

26.  The bladder is muscular reservoir of urine.
 Lying in the anterior part of pelvis.
 It plays two main roles:
 Temporary storage of urine
 Assists in the expulsion of urine

27. Shape of the Bladder-
 Tetrahydral -when empty
 Ovoid- when distended
Capicity –
 Capacity in an adult male 120 to 320 ml.
 Filling beyond 220 ml causes micturition,
 emptied when filled to about 250 to 300 ml.
 Filling up to 500 ml may be tolerated, but beyond this it
becomes painful.

28.  The urinary bladder is situated in the anterior part of the
lesser pelvis immediately behind the pubic symphysis and
in front of rectum in male and uterus in the female. •
 When the bladder is empty it lies entirely within the lesser
pelvis
 when it becomes distended with urine, it expands upward
and forward into the abdominal cavity.

29. EXTERNAL FEATURES ANDRELATIONS
1. Apex.
2. Base.
3. Neck.
4.Three surfaces
(superior and two
inferolateral surfaces).
5.Four borders
(anterior, posterior
and two lateral).

30.  APEX
It provides attachment to the median umbilical ligament and
lies posterior to the upper margin of the pubic symphysis.
 BASE - In the male:
1.Upper part is separated from rectum by the rectovesical
pouch containing coils of the small intestine.
2.Lower part is separated from rectum by the terminal parts
of vasa deferentia and seminal vesicles.
 Neck
It is the lowest and most fixed part of the bladder.
It is situated where the inferolateral and the posterior
surfaces of the bladder meet. It is pierced by ureters

33. Mucosa of the bladder
shows irregular folds
except in a small triangular
area over the base •
This area is called
trigone of the bladder.
Here, the mucosa is smooth. •
Internal urethral orifice
opens
in the apex of this trigone.

34. ARTERIAL SUPPLY•
 superior and inferior vesical arteries which are the
branches of anterior division of internal iliac arteries. •
 Obturator and inferior gluteal arteries. • Uterine and
vaginal arteries in the female.
VENOUS DRAINAGE •
 The veins of the bladder do not follow the arteries.
They form a complicated plexus on the inferolateral
surfaces near the prostate called vesical venous plexus.

35.  Parasympathetic efferent fibers S2,S3, S4 are motor to the
detrusor muscle and inhibitory to the sphincter vesicae.
 If these are destroyed, normal micturition is not possible.
 Sympathetic efferent fibers (T11 to L2)
 The pudendal nerve (S2, S3, S4) -supplies the sphincter
urethra.

36.  Urine Retention
 It is the inability to empty the bladder. Urinary retention
can be acute or chronic. Acute urinary retention is a
medical emergency
 Causes of urinary retention include an obstruction in the
urinary tract such as an enlarged prostate or bladder stones,
infections that cause swelling or irritation, nerve problems
that interfere with signals between the brain and the
bladder, medications,constipation, urethral stricture, or a
weak bladder muscle.

37. •
 A tubular structure emerging from the neck of bladder
and opens to the exterior
 It is outlet of bladder &
eliminates urine to outside
 Present in both male &
 female but there are some
differences b/w the. two

38. Male Urethra
 PARTS OF URETHRA
1] Posterior urethra
-near to bladder
i) 4cm in length
ii) Lies in the pelvis
iii) It has 3 parts
1.pre-prostatic part
2.prostatic part
3.membranous part

39. pre-prostatic part
 1-1.5 cm in length
 Extends vertically from bladder neck to prostate
 Surrounded by proximal urethral sphincter made up of
smooth muscle bundle
prostatic part
 3-4 cm in length
 It passes through the substance of prostate
Membranous part
 shortest part -1.5 cm long
 Passes through perineal membrane
 surrounded by external urethral sphincter made up of
urethral smooth muscle

40.  Anteriorurethra
It extends from membranous urethra to external urethral
orifice .
1) bulbar urethra –
 lies in the bulbospongiosus (of penis)
 widest part of urethra
 Bulbourethral glands open in it
2)Penile urethra
 lies in corpus spongiosum
 its terminal part is dilated in glans penis k/a navicular fossa
 numerous urethral glands open in it

41. SPHINCTERS OF URETHRA –TWO
1 internal urethral sphincter—
involuntary surrounds internal urethral orifice &
preprostatic urethra
2 external urethral sphincter–
voluntary surrounds membranous urethra

42.  ARTERIALSUPPLY
1. Urethral artery -just below the perineal membrane it
runs through the corpus spongiosum, to reach the glans
penis. arises from the internal pudendal artery •
2. dorsal penile artery – via its circumflex branches on
each side.
Venous drainage
The anterior urethra drains into –dorsal veins of the penis
internal pudendal veins which drain to the prostatic
plexus--internal iliac veins
The posterior urethra drains into –prostatic venous plexus
– vesical venous plexus --internal iliac veins.

43. Female urethra
 it is about 4.0 cm long and 6mm
diameter.
 It extends from the neck of bladder
to the external urethral meatus.
 the external orifice is situated
in front of the vaginal opening
 It is homologous with upper part
of prostatic urethra of males.

44.  Location: The female urethra is embedded in anterior
wall of vagina. Thus in cases of difficult child-birth, it is
more likely to be lacerated
 Lumen of Urethra on cross section
 At the internal orifice- crescentic with the convexity
directed in front.
 At the middle- transverse slit.
 At the external orifice- sagittal slit.

45. Arterial supply
Superior vesical and veginal arteries
Venous drainage
Venous plexus around urethra– vesical venous plexus–
internal pudendal vein—internal iliac veins.
Clinical antomy of urethra
1. Urithritis- infection and inflammation of urethra
2. Rupture of urethra
3. Hypospadias- urethra open on ventral of penis
4. Epispadias – urethra open on dorsal of penis