urinary system includes kidney, ureter, urinary bladder and urethra. kidney is retroperitoneal with 4 layers of coverings. 2 boarders, 2 surfaces and poles. hilum contains neuro vascular structures and ureter. ureter lies posteriorly. ureter is muscular tube parts are pelvis, abdominal and pelvic part

1. Urinary system

2. We should know about..?
• Kidney
• Ureter
• Urinary bladder
• Urethra

3. Topographic regions of abdomen
• 2horizontal planes
• Transpyloric plane(L1)
• Trans tubercular plane(L5)
• 2vertical planes
• Right & Left lateral planes
• Passes through midclavicular plane and
mid-inguinal point

5. Kidney
• Pair of excretory organ
• excretes products of protein metabolism
• maintains electrolyte and water balance
• Secretes
1. Renin- bp regulation
2. Erythropoietin- Rbc maturation
3. Dihydroxy Cholecalciferol- calcium metabolism

8. Kidneys
• Position-
• retroperitoneally
• Occupy epigastric,
hypochondriac, lumbar and
umbilical region
• in the posterior abdominal wall
• Vertical extend: T12 -L3
• Right- lower
• Left- longer, narrower
• Measurements- 11×6×3 cm
• Shape- bean shaped with medial
hilum

9. Coverings of kidney
• True capsule(fibrous capsule)
• Perinephric fat
• Renal Fascia(false capsule, fascia of Gerota)
• Paranephric fat

10. Presenting parts
• 2surfaces- anterior&
posterior
• 2ends/poles- upper and
lower
• 2Borders- lateral and medial
• hilum: At the center of
medial boarder

11. Renal hilum
• Concavity in the center of
medial boarder(L1)
• Structures passing from
before backwards
1. Renal vein
2. Renal artery
3. pelvis of ureter
4. branch Of renal artery and
vein
5. Lymphatics, nerves, fat

12. Anterior relations
Right kidney Left kidney
Supra renal area Supra renal area
Duodenal area Splenic area
Hepatic area Gastric area
Colic area Pancreatic area
Jejunum area Colic area
Jejunum area

14. Macroscopic structure
• Naked eye examination of a
coronal section of kidney shows
Inner medulla and outer cortex
Medulla:
• 8-18 renal pyramids; apex--> renal
papilla into renal sinus
• each Papilla perforated by 16-20
ducts of Bellini --> minor calyx-->
major calyx

15. Renal cortex
• 2 parts
• Cortical arches/cortical lobules:
forms arches over the bases of
pyramids
• Renal columns: dip in between the
pyramids
• Lobe of the kidney: each pyramid
along with overlying cortical arch

16. Renal sinus
• Space that extend into the kidney from the hilus
• Contains:
• Tributaries of renal vein
• Branches of renal artery
• The renal pelvis
• Renal pelvis
• Divides into2 to 3 major calyces

18. Structure of nephron
• Or uriniferous tubule
• Each kidney- 1-3 million
• Each tubule consists of 2 embryological parts
• Excretory part- Nephron
• Collecting part- begins as a junctional tubule from DCT
• Nephron :
• Functional unit
• Renal corpuscle/Malpighian corpuscle: Glomerulus+
Bowman’s capsule
• Renal tubule: PCT, LOH, DCT

20. Renal
corpuscle

21. Parts of renal
tubule

22. Blood supply
Arterial supply- renal artery from abdominal aorta
• venous Drainage- corresponding renal vein
Nerve supply
• Sympathetic: T10- L1( referred pain of renal colic),
vasomotor
• Parasympathetic: vagus ( function unknown)
Lymphatic drainage
• Lateral aortic LN

23. Vascular segments
• 5 segmental branches of
renal artery
• 4 from anterior division
• 1 from posterior division
• Segments:
• Apical, upper, middle and
lower in anterior aspect
• Posterior and portions of
apical and lower

26. Applied anatomy
• Renal stones- lithotrypsy( extra corporeal shock
wave therapy)
• Renal artery stenosis- systemic hyper tension,
surgical anstamosis with splenic artery

27. Ureters
• Pair of thick walled
cylindrical tubes
• convey urine from kidney
to the bladder
• length- 25cm(10inches)
• Upper half- in abdomen
• Lower half- in pelvis
• Diameter- 3mm
• Parts:
1. Pelvis of the ureter
2. Abdominal part
3. Pelvic Part

28. 1.Pelvis of ureter
• Funnel shaped dilation in the upper part
• formed by union of major calyces
• Passes through hilum and continous with
abdominal part at the level of lower end of kidney

29. 2.Abdominal part
• Passes behind the peritoneum of
posterior abdominal wall
• Lies on psoas major, tips of tr processes of
vertebrae
• Crosses the bifurcation of common iliac
artery
• Structures in front:
1. Gonadal vessels
2. Root of mesentery
3. Ileum Terminal part
4. Duodenum- 2nd and 3rd parts
5. Sigmoid Mesocolon

30. 3.Pelvic part
• Passes beneath the peritoneum
• Along lateral pelvic wall
• Along greater sciatic notch
• Opposite ischial spine turns forwards and medially
to reach the base of the bladder
• In females: in broad ligament, uterine artery
crosses ureter from lateral to medial side

33. Constrictions of ureter
1. Pelvi-ureteric junction
2. Pelvic Brim
3. Point of piercing bladder wall
4. Point of crossing by ductus deferens or broad
ligament
5. At opening in lateral angle of trigone

34. Ureter
Arterial supply
• Branches of renal, Gonadal,
lumbar, peritoneal,
common iliac, internal iliac,
inferior vesical
• female: Uterine and vaginal
arteries
Venous drainage
Corresponds
Lymphatic drainage
• Para- aortic
• common Iliac
• Internal and external iliac
Nerve supply
Sympathetic: T10 to L1
Parasympathetic: Vagus and
pelvic splanchnic
Through renal, aortic and
hypogastric plexus

35. Histology
• 3layers
• Innermost mucous membrane
• Middle smooth muscle layer
• Outer tunica adventitia
• Epithelium: transitional
• Upper two third- muscle coat is having inner
longitudinal and outer circular fibers
• Lower one third- additional outer longitudinal layer

36. Inner longitudinal
muscle layer
Outer circular
muscle layer
Mucous
membrane
Adventitia

37. Applied anatomy
• Hysterectomy- surgical injury

38. Urinary Bladder
 Temporary reservoir of urine
 Position
Children- abdominal pelvic
Adults- pelvic --> filled --> abdominal
 Shape- tetrahedral( empty)
- ovoid (distended)
 Capacity- 120- 320ml
-physio. Max (450ml)
-anatomical max( 1 liter)
 Presenting Parts
- apex, base, superior surface, two
infero-lateral surfaces, and a neck
- 4 boarders (anterior, posterior, and two
lateral)

39. Presenting Parts
• Apex
• Base
• Surfaces
• Boarders:
• Anterior- apex to neck
• posterior- separates superior surface from base
• Lateral- seperates superior surface from inferolateral
surface
• Neck- Where urethra begins

41. Urinary Bladder
Apex
• Directed forwards
• Attached to median
umbilical ligament
Base
Or posterior inferior
surface Or fundus
non Peritoneal area-
trigone
Relations of base
• Rectum ampulla
• Seminal vesicles
• Vas deference ampulla
• Females- vagina, cervix

45. Interior of bladder
• Temporary folds-rugae
• except At trigone- a triangular area over the lower part
of the base

46. Trigonum vesicae
• Equilateral triangle on inner aspect of base
• mucosa is tense and glistening
• Submucosa absent
• Apex : down internal urethral orifice
• Uvula Vesicae-median lobe of prostate
• Base: inter ureteric ridge
• Sides: urethro- ureteric lines

48. Structure of
Bladder trigone
 Mucous membrane-
transitional
 trigonal Muscle of bell-
replaces the sub mucosa coat
 fascia Of WaldWaldeyer-
loose areolar sheet
 detrusor Muscle

49. Importance of trigone
• Most fixed and dependent part
• Rich blood and nerve supply
• Mesodermal development
• Clinical- enlargement of uvula vesicae- prostate

50. Histology of urinary bladder
1. Epithelium
2. Sub epithelial tissue
3. Muscle layer
4. adventitia

51. Urinary bladder
Arterial supply
• Superior vesical artery
• inferior Vesical artery
• Obturator artery
• inferior Gluteal artery
branch
• Uterine Artery
Venous drainage
• Vesical plexus
• on Infero lateral surface
Lymphatic drainage
• external Iliac LN
Nerve supply
• Sympathetic- T11-L2
• parasympathetic-S2,S3,S4
segments and pelvic splachnic
nerves

52. Male urethra
• Common tubular passage
for urine and semen
• Internal to external
urethral orifice
• Parts:
Pre-prostatic: 1.5cm
Prostatic: 3cm
Membranous part: 2cm
Spongy: 15cm

54. Pre-prostatic part
• Bladder neck to colliculus
seminalis (verumontanum)
• surrounded By pre-prostatic
sphincter
• prevents Reflux of semen into
bladder
• damage To sphincter: during
trans-urethral resection of
prostate

55. Prostatic part
• Upto apex of prostate
• widest & most dilatable part
• features In the posterior wall
• urethral Crest
• colliculus Seminalis- 3
orifices
• prostatic utricle
• Openning of ejaculatory
ducts in colliculus
• prostatic Sinuses

56. Membranous part
• Second Narrowest
• Curved course downwards and forwards from
prostate to upper surface of bulb of penis
• surrounded by shincter urethra

57. Spongy part
• Contained in the corpus spongiosus penis
• 15cm long
• Passes through bulb, body and glans penis
• terminates At external urethral orifice

58. Female urethra
• 4cm long, 6mm diameter
• Begins at IUOrifice
• Apprx at middle of opposite of pubic symphysis
• Embedded in anterior wall of vagina
• Ends at EUO
• Anterior to vaginal opening
• 2.5cm behind glans clitoris

59. Adrenal glands
• Small triangular
• Located on top of kidney
• Produce hormones
• Cortex and medulla

60. Pyelogram

61. Types
• Antero-grade/IVP
• Retro-grade

62. IVP

69. KUB