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Similar to ureter & urinary bladder -.pptx
ureter & urinary bladder -.pptx
- 2. Ureter & Urinarybladder
- 3. Urinary system • Urinarysystem 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 ofRenal 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 oftransverse 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 ofUreter – 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 ofUreter – 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 ofUreter – 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 ofUreter – second part • In female • Near uterine cervix, • Uterine artery is located above and in front of it (in female)
- 16. Sites of AnatomicalConstrictions • 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 • Lodgeat 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 • Derivesits 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 • Arteriessupplying 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 • Sympatheticsupply • 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 • Hollowmuscular 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 • Coveredby peritoneum • Related to • Coils of ileum or sigmoid colon in males • Uterus in females
- 30. Inferolateral surfaces • Anteriorpart • Retropubic pad of fat & the pubic bones • Posterior part • Obturator internus above • Levator ani below
- 31. Interior • Rugae • Foldsformed 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 • Superiorand inferior vesical arteries • From anterior trunk of internal iliac arteries • Vaginal artery replaces inferior vesical artery in female
- 33. Venous drainage • Venousplexus around the bladder and prostate drain into • Inferior vesical vein • Superior vesical vein • Both veins drain into internal iliac vein
- 34. Lymphatic drainage • Upperureter • 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 • Obstructionin 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