Topic : Gross Anatomical Features of Ureter, Urinnary Bladder and Urethera
Learning Objectives:
At the end of the lecture student will able :
To define the collecting parts of excretory system.
To describe the gross anatomical feature and relation of the Ureter, urinary bladder, and urethra.
To clinically correlates the condition associated with these structures.
Lecture outline
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URETERS AND URINARY BLADDER
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IT OCCUPIES THE KIDNEY, ABDOMEN AND PELVIS
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IT IS MUSCULAR TUBE
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THESE ARE THE EXCRETORY DUCTS BETWEEN THE KIDNEYS AND THE
URINARY BLADDER
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WITHIN THE KIDNEY
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THE RENAL PELVIS , LYING IN THE RENAL SINUS
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NARROWS AT THE URETEROPELVIC JUNCTION TO FORM THE URETER.
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A STAGHORN CALCULUS MAY LODGE AT THIS POINT
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ABDOMENAL PART
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IT IS 2.5 CM LONG
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IT HAS 3 POINTS OF NARROWEST CALIBRE
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PELVIURETRIC JUNCTION
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WHEN IT CROSSES THE PELVIC BRIM
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WHEN IT ENTERS INTO THE URINARY BLADDER
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URETERS
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SURFACE ANATOMY
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LINE ON THE ANTERIOR ABDOMENAL WALL
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TIP OF THE 9TH COSTAL CARTILAGE
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SACROILIAC JOINT
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RELATIONS
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IT IS RETROPERITORNEAL STRUCTURE
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IT PASSES DOWN ON THE PSOAS MAJOR
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IN FRONT OF GENITOFEMORAL NERVE
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IT IS CROSSED ANTERIORLY BY THE GONADAL VESSELS
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CONT,
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EACH URETER IS COVERED BY THE FIBROUS SHEATH CALLED THE
PERIURETERAL SHEATH
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RELATIONS OF THE RIGHT URETER
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THE RIGHT URETER IS RELATED TO
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UPPER PART IS BEHIND THE 3RD PART OF THE DUODENUM AND POSTERIOR
TO THE ROOT OF MESENTERY
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LOWER DOWN IT IS CROSSED ANTERIORLY BY THE RIGHT COLIC AND
ILIOCOLIC ARTERIES
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LEFT URETER
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PASSES POSTERIOR TO THE LEFT COLIC VESSELS AND POSTERIOR TO THE
SIGMIOD MESOCOLON AND LEFT GONADAL VESSELS
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EACH URETER PASSES ANTERIOR TO THE PSOAS MAJOR AND THE
COMMON ILLIAC VESSELS
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IN THE PELVIS
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EACH URETER COURSES RETROPERITONEALLY ANTERIOR TO THE
SACRUM TO REACH THE URINARY BLADDER
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IN THE MALES, IT PASSES INFERIOR TO THE VAS DEFERENS AND ITS
ASSOCIATED DEFERENTIAL ARTERY
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IN FEMALES IT PASSES INFERIOR TO THE LATERAL CERVICAL LIGAMENT
AND UTERINE VESSELS
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CONT,
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THE URETER CONVERGE TO ENTER THE BLADDER POSTERIOINFERIORLY
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THE URETER NARROWS AS IT PASSES THROUGH THE WALL OF BLADDER
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BLOOD SUPPLY
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RENAL ARTERIES
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AORTA
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ARTERIES OF THE POSTERIOR ABDOMENAL WALL
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GONADAL ARTERIES
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COMMON AND INTERNAL ILLIAC ARTERIES
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INFERIOR VESICAL ARTERIES
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INNERVATION
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LEAST SPLANCHNIC NERVES
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LUMBER SPLANCHNIC NERVES
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PELVIC SPLANCHNIC NERVES
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REFFERED PAIN
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RENAL PELVIS TO THE LUMBER REGION
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ABDOMENAL URETER TO THE INGUINAL AND THE PUBIC REGIONS, THE
ANTERIOR SCROTUM OR MONIS PUBIS
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PELVIC URETER PERINEUM AND THE POSTERIOR ASPECT OF THE THIGH
AND LEG
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URINARY BLADDER
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RETROPERITONEAL ORGAN
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LIES BEHIND THE PUBIC SYMPHYSIS AND THE SUPERIOR PUBIC RAMI
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EMPTY BLADDER IS SITUATED ENTIRELY IN THE PELVIS AS IT DESTANDED
OT ENTERS IN THE ABSOMINAL CAVITY
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CONT,
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THE EMPTY BLADDER IS THREE SIDED PYRAMID
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WITH THE SHARP APEX POINTED FORARDS TO THE TOP OF THE PUBIC
SYMPSYSIS AND A TRIANGULAR BASE FACING BACKWARDS , TOWARDS
THE VAGINA OR RECTUM
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CONT,
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IT CONSISTS OF TWO INFERIOLATERAL SURFACES RELATED TO THE
LEVATOR ANI MUSCLE ANTERIORLY
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NECK WHERE THE URETHRA OPENS
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SUPERIOR SURFACE WHERE THE LOOPS OF GIT ARE RELATED
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APEX
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THE APEX HAS REMAINS OF THE URACHUS ATTACHED TO IT
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URECHUS FORMS THE MEDIAN UMBLICAL LIGAMENT
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IT IS COVERED BY THE FOLD OF PERITOMIUM CALLED THE MEDIAN
UMBLICAL FOLD
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IT RUNS UPWARDS IN THE MIDLINE OF THE ANTERIOR ABDOMENAL WALL
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BASE OR POSTERIOR SURFACE
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LIES BELOW THE RECTOVESICAL POUCH
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ONLY THE UPPER MOST POSRION IS COVERED BY THE PERITONIUM
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IT IS RELATED TO THE DUCTUS DEFERENS AND THE SEMINAL VESICALES
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IN THE FEMALES THE BASE HAS A FIRM CONNECTIVE TISSUE UNION WITH
THE ANTERIOR VEGINAL WALL AND THE UPPER PART OF THE UTERINE
CERVIX WITH NO PERIRONIUM INTERVENING
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URINARY BLADDER
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INFERIOLATERAL SURFACE
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EACH SURFACE SLOPES DOWNWARDS AND MEDIALLY TO MEETS IT
FELLOW
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WHERE THE SURFACES MEET THERE IS A RETROPUBIC SPACE
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THIS SPACE CONTAINS LOOSE CONNECTIVE TISSUE AND THE
PUBOVESICAL LIGAMENTS THAT EXTAND FROM THE NECK OF THE
BLADDER TO THE INFERIOR ASPECT OF THE PUBIC BONES
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URINARY BLADDER
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NECK OF BLADDER
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THE LOWEST PART OF THE BLADDER IS NECK
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HERE THE BASE AND THE INFEROLATERAL SURFACES MEET
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IT IS PERICED BY THE URETHERA AT THE INTERNAL URWTHERAL ORIFICE
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IN THE MALES IT LIES AGAINEST THE UPPER SURFACE OR THE BASE OF
THE PROSTATE
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IN THE FEMALES IT IS ABOVE THE URETHERA IN THE CONNECTIVE TISSUE
OF THE ANTERIOR VAGINAL WALL
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SUPERIOR SURFACE
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IT IS COVERED BY PERITONIUM
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AT THE POSTERIOR MARGIN OF THIS SURFACE THE PERITONIUM IS
CONTINUE ON THE BASE AND FROM HERE IT IS CONTINUE WITH THE
RECTOVESICAL POUCH IN MALES
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IN FEMALES IT IS CONTINUE ON THE UNDERSURFACE OF THE UTEROUS
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INTERIOR OF THE BLADDER
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IT DEPANDS ON THE STATE OF DISTENSION OF THE ORGAN
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THE INTERIOR IS THROWN INTO FOLDS WHEN BLADDER IS EMPTY THIS
APPLIES LITTLE ONN THRIGONE
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TRIGONE
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DEVLOPS FROM THE MESONEPHRIC DUCTS
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IT IS MESODERMAL IN ORIGIN
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LIES AT THE BASE OF THE BLADDER
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BETWEEN THE TWO ORIFICES OF THE URETERS ABOVE AND LATERALLY
AND THE ORIFICE OF THE URETHERA IN THE CENTRE AND BELOW
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IN THE EMPTY BLADDER THESE OPENING ARE 2.5 CM APART BUT WHEB
DESTENDED AND IN PREGENCY THESE ARE 5 CM APART
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CONT,
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BEING FIXED ON TOP OF THE PROSTATE BY THE URETHERA , TRIGONE IS
THE LEAST MOBILE PART OF BLADDER. IN THE FEMALE IT IS STABLIZED
BY THE CONNECTIVE TISSUE ATTACHED WITH VAGINA
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THE URETERIC ORIFICES ARE CONNECTED BY THE INERURETERIC BAR
WHICH IS PRODUCED BY THE SMOOTH MUSCLE OF THE TWO URETERS
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THE URETERIC OPENINGS ARE OBLIQUE IMPORTANT FACTOR IN
PREVENTING REFLUX
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CONT,
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IN THE MALE THE TRIGONE LIES ON THE MEDIAN PART OF THE CENTRAL
ZONE OF THE PROSTATE, WHICH AFTER THE MIDDLE AGE PROJECT ABOVE
THE INTERNAL URETHERAL ORIFICE AS A ROUNDED ELEVATION , THE
UVULA OF THE BLADDER
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BLOOD SUPPLY
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SUPERIOR VESICAL ARTERY FROM THE PATENT PORTION OF THE
UMBLICAL ARTERY
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INFERIOR UMBLICAL ARTERY FROM THE INTERNAL ILLIAC ARTEY
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SOME CONTRIBUTION FROM THE OBTURATOR, INFERIOR GLUTEAL
UTERINE AND VAGINAL ARTEIRES
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BLOOD SUPPLY
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VEINS FORM THE PLEXUS THAT CONVERGE ON THE VESICOPROSTATIC
PLESUS IN THE GROOVE BETWEEN THE BLADDER AND THE PROSTATE
WHICH DRAINS INTO THE INTERNAL ILLIAC VEINS
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CONT,
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IN THE FEMALES SIMILAR PLEXUS COMMUNICAT WITH THE VEINS IN THE
BASE OF THE BROAD LIGAMENT
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NERVE SUPPLY
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PARASYMPATHATIC VIA PELVIC SPLANCHNIC NERVES
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SYMPATHATIC FROM THE L1 AND L2 SEGMENTS OF THE CORD VIA THE
SUPERIOR AND INFERIOR HYPOGASTRIC PLEXUSES
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LYMPHATIC DRAINAGE
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THE LYMPH DRAINS MAINLY INTO THE EXTERNAL ILIAC NODES
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SOME LYMPH DRAINS INTO THE INTERNAL ILIAC NODES INCLUDING THE
NODES INTO THE OBTURATOR FOSSA