Anatomy and Physiology

Urinary System

- comprises the kidneys, ureters, bladder, and urethra

- maintain the internal chemical environment of the body
- perform various, excretory, regulatory, and secretory functions

Kidneys

- a pair of brownish-red structures located retroperitoneally (behind and outside the peritoneal
cavity) on the posterior wall of the abdomen from the 12th thoracic vertebra to the 3rd lumbar
vertebra in the adult
- an adult kidney weighs 120 to 170 g (about 4.5 oz) and is 12 (about 4.5 inches) long, 6 cm wide,
and 2.5 cm thick
- are well protected by the ribs, muscles, Gerota's fascia, perirenal fat, and the renal capsule, which
surround each kidney

Two regions

 Renal Parenchyma
 Renal Pelvis

Renal Parenchyma

- divided into the cortex and the medulla

The cortex contains the glomeruli, proximal and distal tubules, and cortical collecting ducts and their
adjacent peritubular capillaries.
The medulla resembles conical pyramids. The pyramids are situated with the base facing the concave
surface of the kidney and the apex facing the hilum, or pelvis

Renal Pelvis

- The hilum, or pelvis, is the concave portion of the kidney through which the renal artery enters
and the renal vein exits. The renal artery (arising from the abdominal aorta) divides into smaller
and smaller vessels, eventually forming the afferent arteriole.
- The afferent arteriole branches to form the glomerulus, which is the capillary bed responsible for
glomerular filtration. Blood leaves the glomerulus through the efferent arteriole and flows back to
the inferior vena cava through a network of capillaries and veins.

Nephrons

- Each kidney contains about 1 million nephrons, the functional units of the kidney. Each kidney is
capable of providing adequate renal function if the opposite kidney is damaged or becomes non-
functional.
- The nephron consists of a glomerulus containing afferent and efferent arterioles, Bowman's
capsule, proximal tubule, loop of Henle, distal tubule, and collecting ducts.
- Collecting ducts converge into papillae, which empty into the minor calices, which drain into
three major calices that open directly into the renal pelvis.

Nephrons are structurally divided into two types

 Cortical - found in the cortex of the kidney

 Juxtamedullary - sit adjacent to the medulla
Kidneys

- The glomerular membrane normally allows filtration of fluid and small molecules yet limits
passage of larger molecules, such as blood cells and albumin. Kidney function begins to decrease
at a rate of approximately 1% each year beginning at approximately age 30.

The glomerulus is composed of three filtering layers

 Capillary endothelium
 Basement membrane
 Epithelium

Kidneys

 Urine formation
 Excretion of waste products
 Regulation of electrolytes
 Regulation of acid-base balance
 Control of water balance
 Control of blood pressure
 Renal clearance
 Regulation of red blood cell production
 Synthesis of vitamin D to active form
 Secretion of prostaglandins

Ureters

- Urine, which is formed within the nephrons, flows into the ureter, a long fibromuscular tube that
connects each kidney to the bladder
- The ureters are narrow, muscular tubes, each 24 to 30 cm long, that originate at the lower portion
of the renal pelvis and terminate in the trigone of the bladder wall.

Three narrowed areas of each ureter

 Ureteropelvic junction
 Ureteral segment
 Ureterovesical junction
Ureterovesical junction

- The angling of the ureterovesical junction is the primary means of providing antegrade, or
downward movement of urine, also referred to as efflux of urine
- This angling prevents vesicoureteral reflux, which is the retrograde, or backward, movement of
urine from the bladder, up the ureter, toward the kidney

During voiding (micturition), increased intravesical pressure keeps the ureterovesical junction closed and
keeps urine within the ureters. As soon as micturition is completed, intravesical pressure returns to its
normal low baseline value, allowing efflux of urine to resume.
Therefore, the only time that the bladder is completely empty is in the last seconds of micturition before
efflux of urine resumes.

Ureters

- The lining of the ureters is made up of transitional cell epithelium called urothelium. As in the
bladder, the urothelium prevents reabsorption of urine
 - The movement of urine from the renal pelvis through the ureters into the bladder is facilitated by
peristaltic waves (occurring about one to five times per minute) from contraction of the smooth
muscle in the ureter wall
- Functions as tubes that actively convey urine from the kidneys to the bladder

Bladder

- The urinary bladder is a muscular, hollow sac located just behind the pubic bone.
- The bladder is characterized by its central, hollow area called the vesicle, which has two inlets
(the ureters) and one outlet (the urethrovesical junction), which is surrounded by the bladder
neck.
- Adult bladder capacity is about 300 to 600 mL of urine. In infancy, the bladder is found within
the abdomen. In adolescence and through adulthood, the bladder assumes its position in the true
pelvis.

The wall of the bladder comprises four layers

 Adventitia
 Detrusor
 Lamina propria
 Urothelium
Urothelium

- Is specialized, transitional cell epithelium, containing a membrane that is impermeable to water.

- prevents the reabsorption of urine stored in the bladder

Bladder

- The bladder neck contains bundles of involuntary smooth muscle that form a portion of the
urethral sphincter known as the internal sphincter.
- The portion of the sphincteric mechanism that is under voluntary control is the external urinary
sphincter at the anterior urethra, the segment most distal from the bladder
- Functions as a muscular sac that expands as urine is produced by the kidneys to allow storage of
urine until voiding is convenient.

Urethra

- Arises from the base of the bladder: In the male, it passes through the penis; in the female, it
opens just anterior to the vagina.
- In the male, the prostate gland, which lies just below the bladder neck, surrounds the urethra
posteriorly and laterally.
- A muscular tube that drains urine from the body
- It is 3-4 cm long in females, but closer to 20 cm in males