ILO- ANATOMY OF URINARY TRACT...ILO:%ANATOMY%OF%URINARY%TRACT% BY:$MUHAMMADNAIM$MOHDNAWI$ Posterosuperior% angles% Receivetheuretericorificesoneachsides $ Base%(Fundus)% Male% Female%

ILO: ANATOMY OF URINARY TRACT BY: MUHAMMAD NAIM MOHD NAWI

(A) Ureters (B) Urinary Bladder (C) Urethra (D) Prostate Gland

(A) Ureters Length: 10 inches (25cm) Course: 3 Parts (2 Parts refer to Dr. Adel Bondok notes, not include Renal Pelvis) Renal Pelvis Form by -‐-‐-‐> Union of 2 -‐ 3 Major calyces Abdominal Part

Length: 5 inches Course: 1. Begins from the renal pelvis 2. Descends downwards& medially behind the peritoneum of PAW 3. Enters the pelvis anterior to the bifurcation of common iliac a. Relations: i. Posteriorly (Same for both right & left ureters) 1. Psoas major 2. Genitofemoral nerve 3. Bifurcation of common iliac artery ii. Anteriorly (Differ in Right & Left ureters)

Right Ureter Left Ureter Renal vessels Renal vessels 2nd part of duodenum Body of pancreas 3rd part of duodenum Jejunum Right gonadal artery Left gonadal artery Right colic artery Left colic artery Ileocolic artery 2 sigmoid arteries Sup. Mesentric artery Root of mesentry Sigmoid mesocolon Terminal ileum Sigmoid colon

Vas deferens (male) & Broad ligament (female)

Pelvic Part Length : 5 inches Beginning : From abdominal part at bifurcation of common iliac a. Termination : at the posterosuperior angle of urinary bladder Course : 1. On the lateral wall 2. The floor of the pelvis 3. In the wall of the bladder

Blood supply 1. Renal artery 2. Gonadal artery 3. Abdominal aorta 4. Common iliac artery 5. Internal iliac artery 6. Inferior vesicle artery (Male) 7. Uterine artery (Female)


Nerve supply i. Sympathetic fibers -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐> Lowest splanchnic nerve (T12) -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐> Splanchnic nerve (L1) ii. Parasympathetic fibers -‐-‐-‐> Pelvic splanchnic nerve (S2,3,4) Lymphatic drainage Upper part Para-‐aortic LN Middle part Common iliac LN Lower part Internal iliac LN Constrictions 1. At the lower end of the kidney : Pelviureteric junction 2. At the bifurcation of common iliac artery 3. Opposite the ischial spine 4. Inside the wall of urinary bladder (intramural part) Clinical notes X-‐ray of the ureter (we can see the ureter in front of) 1. Tip of lumbar transverse processes 2. Sacroiliac joint 3. Ischial spine

(B) Urinary Bladder Position Adult *Lower anterior part of the pelvis

*Behind & above the symphysis pubis Children *Above the pelvic inlet

*Gradually descends into the pelvis *Reaches its adult position after puberty

Shape *Empty UB ==> Pyramidal *4 angles:-‐ i. Anterior angle (Apex of the bladder) ii. Inferior angle (Neck of bladder) iii. 2 Posterosuperior angles *4 surfaces:-‐ i. Posterior surface (Base or Fundus) ii. 2 Inferolateral surfaces iii. Superior surface Relations Apex *Lies 1 inch above & behind the symphysis pubis

*Connected to the umbilicus by median umbilical ligament (represents the obliterated urachus)

Neck Male Female *It rests on the prostate *Continuous with the prostatic part of urethra *It gives attachment to the puboprostatic ligament

*It is continuous with the urethra *It gives attachment to the pubovesical ligament


Posterosuperior angles

Receive the ureteric orifices on each sides

Base (Fundus) Male Female The rectum from which it is separated by:-‐ 1. Upper part: -‐rectovesical pouch 2. Lower part: -‐seminal vesicle -‐ampulla of vas deferens

It is related to:-‐ 1. Cervix of uterus (above) 2. Anterior wall of vagina (below)

Superior surface

It is the only surface, covered wth peritoneum Male Female

Related to: 1. Pelvic colon 2. Loops of ileum

Related to: Ventral aspect of uterus

Inferolateral surfaces

*Directed downwards with no peritoneal coverings *Related to: at Anterior part Retropubic fat at Middle part Obturator internus at Posterior part Levator ani

Trigone of the Bladder Triangular area bounded by: 1. Ureteric orifices 2. Internal urethral orifice Blood supply Arterial supplies:

Male Female Superior Vesical ateries *From the umbilical artery

Inferior vesical arteries *From the Internal iliac artery

Vaginal artery *From the Internal iliac artery

Venous drainage: Vesical plexus -‐-‐-‐> drains into the Internal iliac vein


(C) Urethra Female Urethra *Short duct (4cm) *Related to -‐-‐-‐> Anterior wall of the vagina *Upper part -‐-‐-‐-‐> Surrounded by the external urethral sphincter *Opens in the vestibule Male Urethra Length: 20cm Beginning: Neck of the bladder Termination: Opens on tip of glans of penis at external urethral meatus Shape: S-‐shaped Parts: 4 parts 1. Preprostatic 2. Prostatic 3. Membranous 4. Spongy part Urethral Sphincters

Internal Urethral Sphincters External Urethral Sphincter *Between the neck of the bladder & the prostate *Surround the preprostatic part in the neck of the urinary bladder *Smooth muscle => Involuntary control of urination

*Present in deep perineal pouch *Surround the membranous part *Skeletal muscle => Voluntary control of urination


(D) Prostate Gland Position Below Neck of urinary bladder Above Deep perineal pouch Behind Lower part of symphysis pubis In front Lower 1/3 of the rectum Shape: Inverted cone External features 1. Apex: directed Downwards 2. Base: directed Upwards 3. 4 surfaces: Surfaces Relations

Anterior *Symphysis pubis *Connected to the pubis by the puboprostatic ligaments

Posterior Rectum 2 Inferolateral Levator ani Lobes: 5 Lobes 1. Anterior: Doesn't contain glands 2. Posterior 3. Middle: *Rich in glands *Liable to enlargement => Obstructing urethra 4. Right 5. Left Arterial supply 1. Inferior vesical 2. Middle rectal Venous drainage Prostatic venous plexus which lies between the 2 capsules Clinical Notes Enlargement of middle lobe -‐-‐-‐> Benign prostatic hyperplasia -‐-‐-‐> Post prostatic pouch (PPP)

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ILO- ANATOMY OF URINARY TRACT...ILO:%ANATOMY%OF%URINARY%TRACT% BY:$MUHAMMADNAIM$MOHDNAWI$ Posterosuperior% angles% Receivetheuretericorificesoneachsides $ Base%(Fundus)% Male% Female%