Gross Anatomy of the

Renal System
MED 7523 Renal I
Surface landmark of the kidneys:
• The kidneys project onto the back on either side of the midline and are
related to the lower ribs:
• The left kidney is a little higher than the right and reaches as high as rib XI.
• The superior pole of the right kidney reaches only as high as rib XII.
• The lower poles of the kidneys occur around the level of the
disc between the L3 and L4 vertebrae.
• The hila of the kidneys and the beginnings of the ureters are at
approximately the L1 vertebra.
• The ureters descend vertically anterior to the tips of the
transverse processes of the lower lumbar vertebrae and enter
the pelvis.
Kidney
• Bean-shaped
• Retroperitoneal in the
posterior abdominal region.
• Lie in the extraperitoneal
connective tissue
immediately lateral to the
vertebral column.
• In supine position, the kidneys extend from T12 vertebra
superiorly to L3 vertebra inferiorly,
• The right kidney lower than the left because of its relationship
with the liver.
• Similar in size and shape, the left kidney is a longer and more
slender organ than the right kidney, and nearer to the midline.
Relationships to other structures

• The anterior surface of the

right kidney is related to
numerous structures
• Some of which are separated
from the kidney by a layer of
peritoneum and some of
which are directly against the
kidney.
Right Anterior Kidney
• A small part of the superior pole is
covered by the right suprarenal gland.
• Moving inferiorly, a large part of the
rest of the upper part of the anterior
surface is against the liver and is
separated from it by a layer of
peritoneum.
• Medially, the descending part of the
duodenum is retroperitoneal and
contacts the kidney.
• The inferior pole of the kidney, on its
lateral side, is directly associated
with the right colic flexure its medial
side, is covered by a segment of the
intraperitoneal small intestine.
Left Anterior Kidney
• A small part of the superior pole, on its
medial side, is covered by the left
suprarenal gland.
• The rest of the superior pole is covered
by the intraperitoneal stomach and
spleen.
• Moving inferiorly, the retroperitoneal
pancreas covers the middle part of the
kidney.
• Lateral side, the lower half of the
kidney is covered by the left colic
flexure and the beginning of the
descending colon, and, on its medial
side, by the parts of the intraperitoneal
jejunum.
• Posteriorly, the right and left kidneys are related to similar
structures.
• Superiorly is the diaphragm and inferior to this, moving in a
medial to lateral direction, are the psoas major, quadratus
lumborum, and transversus abdominis muscles.
• The superior pole of the right kidney is anterior to rib T12, while
the same region of the left kidney is anterior to ribs T11 and T12.
• The pleural sacs and the
costodiaphragmatic recesses
extend posterior to the
kidneys. Subcostal
nerve
• Also passing posterior to the
Iliohypogastric Nerve
kidneys are the subcostal Ilio-inguinal Nerves
vessels and nerves and the
iliohypogastric and ilio-
inguinal nerves.
Renal fat and fascia
• The kidneys are enclosed in
and associated with a unique
Perinephric
arrangement of fascia and fat. Fat

• Immediately outside the renal

capsule, there is an
accumulation of
extraperitoneal fat—the
perinephric fat (perirenal fat),
which completely surrounds
the kidney.
• Enclosing the perinephric fat is a membranous condensation of
the extraperitoneal fascia (the renal fascia).
• The suprarenal glands are also enclosed in this fascial
compartment, usually separated from the kidneys by a thin
septum.
• The renal fascia must be incised in any surgical approach to this
organ.

Renal Fascia
• At the lateral margins of each kidney, the anterior and posterior
layers of the renal fascia fuse and may connect with the
transversalis fascia on the lateral abdominal wall.
• Above each suprarenal gland, the anterior and posterior layers
of the renal fascia fuse and blend with the fascia that covers the
diaphragm.

Transversalis Fascia
• Medially, the anterior layer of the renal fascia continues over the
vessels in the hilum and fuses with the connective tissue
associated with the abdominal aorta and the inferior vena cava.
• The anterior layer cross the midline to the opposite side and
blend with its companion layer.

Inferior Vena Cava

Abdominal Aorta
• The posterior layer of the renal fascia passes medially between
the kidney and the fascia covering the quadratus lumborum
muscle to fuse with the fascia covering the psoas major muscle.
• Inferiorly, the anterior and posterior layers of the renal fascia
enclose the ureters.
• In addition to perinephric fat and the renal fascia, a final layer of
paranephric fat (pararenal fat) completes the fat and fascias
associated with the kidney.
• This fat accumulates posterior and posterolateral to each kidney.
Kidney structure
• Each kidney has a smooth anterior and posterior surface
covered by a fibrous capsule

Fibrous Capsule
Internal Anatomy

• The main unit of the medulla is

the renal pyramid.
• There are 8-18 renal pyramids in
each kidney, that on the coronal
section look like triangles lined next
to each other with their bases
directed toward the cortex and apex
to the hilum.
• On the medial margin of each
kidney is the hilum of the kidney,
which is a deep vertical slit
through which renal vessels,
lymphatics, and nerves enter and
leave the substance of the kidney.
• Internally, the hilum is continuous
with the renal sinus.
• Perinephric fat continues into the
hilum and sinus and surrounds all
structures.
• Each kidney consists of an
outer renal cortex and an
inner renal medulla.
• The renal cortex is a continuous band of pale tissue that
completely surrounds the renal medulla.
• Extensions of the renal cortex (the renal columns) project into
the inner aspect of the kidney, dividing the renal medulla into
discontinuous aggregations of triangular-shaped tissue (the
renal pyramids). Renal Columns

Renal
Cortex
• The bases of the renal pyramids are directed outward, toward
the renal cortex, while the apex of each renal pyramid projects
inward, toward the renal sinus.
• The apical projection (renal papilla) contains the openings of
the papillary ducts draining the renal tubules and is surrounded
by a minor calyx.

Renal Papilla
Renal Sinus

Minor Calyx
• The minor calices receive urine from the papillary ducts and
represent the proximal parts of the tube that will eventually form
the ureter.
• In the renal sinus, several minor calices unite to form a major
calyx, and two or three major calices unite to form the renal
pelvis, which is the funnel-shaped superior end of the ureters.
Renal vasculature and lymphatics
• A single large renal artery, a lateral branch of the abdominal
aorta, supplies each kidney.
• These vessels usually arise just inferior to the origin of the
superior mesenteric artery between vertebrae L1 and L2.
• The left renal artery usually arises a little higher than the right,
and the right renal artery is longer and passes posterior to the
inferior vena cava.

Renal Artery

Renal Artery
• As each renal artery approaches the renal hilum, it divides into
anterior and posterior branches, which supply the renal
parenchyma.
• Accessory renal arteries are common.
• They originate from the lateral aspect of the abdominal aorta,
either above or below the primary renal arteries, enter the hilum
with the primary arteries or pass directly into the kidney at some
other level, and are commonly called extrahilar arteries.
Posterior branch of renal artery
• Multiple renal veins contribute to the formation of the left and
right renal veins, both of which are anterior to the renal arteries.
• Importantly, the longer left renal vein crosses the midline
anterior to the abdominal aorta and posterior to the superior
mesenteric artery and can be compressed by an aneurysm in
either of these two vessels.
• The lymphatic drainage of each kidney is to the lateral aortic
(lumbar) nodes around the origin of the renal artery.
Ureters
• The ureters are muscular tubes that transport urine from the
kidneys to the bladder.
• They are continuous superiorly with the renal pelvis, which is a
funnel-shaped structure in the renal sinus.
• The renal pelvis is formed from a condensation of two or three
major calices, which in turn are formed by the condensation of
several minor calices (see Fig. 4.153).
• The minor calices surround a renal papilla.
• The renal pelvis narrows as it passes inferiorly through the hilum
of the kidney and becomes continuous with the ureter at the
ureteropelvic junction (Fig. 4.155).
• Inferior to this junction, the ureters descend retroperitoneally on
the medial aspect of the psoas major muscle. At the pelvic brim,
the ureters cross either the end of the common iliac artery or the
beginning of the external iliac artery, enter the pelvic cavity, and
continue their journey to the bladder.
• At three points along their course the ureters are constricted
(Fig. 4.155):
• The first point is at the ureteropelvic junction.
• The second point is where the ureters cross the common
iliac vessels at the pelvic brim.
• The third point is where the ureters enter the wall of the
bladder.

• Importance - kidney stones can become lodged at these

constrictions
Ureteric vasculature and lymphatics
• The ureters receive arterial branches from adjacent vessels as
they pass toward the bladder (Fig. 4.155):
•■ The renal arteries supply the upper end.
•■ The middle part may receive branches from the abdominal
aorta, the testicular or ovarian arteries, and the common iliac
arteries.
•■ In the pelvic cavity, the ureters are supplied by one or more
arteries from branches of the internal iliac arteries.
• In all cases, arteries reaching the ureters divide into ascending
and descending branches, which form longitudinal
anastomoses.
• Lymphatic drainage of the ureters follows a pattern similar to
that of the arterial supply. Lymph from:
•■ the upper part of each ureter drains to the lateral aortic
(lumbar) nodes,
•■ the middle part of each ureter drains to lymph nodes
associated with the common iliac vessels, and
•■ the inferior part of each ureter drains to lymph nodes
associated with the external and internal iliac vessels.
Ureteric innervation
• Ureteric innervation is from the renal, aortic, superior
hypogastric, and inferior hypogastric plexuses through nerves
that follow the blood vessels.
• Visceral efferent fibers come from both sympathetic and
parasympathetic sources, whereas visceral afferent fibers return
to T11 to L2 spinal cord levels.
• Ureteric pain, which is usually related to distention of the ureter,
is therefore referred to cutaneous areas supplied by T11 to L2
spinal cord levels. These areas would most likely include the
posterior and lateral abdominal wall below the ribs and above
the iliac crest, the pubic region, the scrotum in males, the labia
majora in females, and the proximal anterior aspect of the thigh.
 Gross Anatomy
of the Renal System
Objective
• To discuss the gross anatomy of the renal system.
Introduction
• The kidneys are bilateral organs placed retroperitoneally in the upper
left and right abdominal quadrants and are part of the urinary system.
• Their shape resembles a bean, where we can describe the superior
and inferior poles, as well as the major convexity pointed laterally,
and the minor concavity pointed medially.
Functions Eliminating toxic metabolites through urine, regulation
of blood homeostasis and blood pressure, production
of some hormones
Morpho-functional Positioned retroperitoneally, consists of the cortex and
characteristics medulla, empties urine into the ureter (which carries
urine to the urinary bladder)
Artery Renal artery (branch of the abdominal aorta)

Vein Renal vein (drains to the inferior vena cava)

Innervation Renal plexus
Clinical relations Third kidney, horseshoe kidney, kidney agenesis,
kidney stones, acute kidney failure
Functions
• The kidney is a very important organ in regards to body homeostasis.
• It participates in vital processes such as regulation of blood
osmolarity and pH, regulation of blood volume and blood pressure,
production of hormones, and filtration of foreign substances.
• The main function of the kidney is to eliminate excess bodily fluid,
salts and by products of metabolism – this makes kidneys key in the
regulation of acid-base balance, blood pressure, and many other
homeostatic parameters.
 Main kidney functions
Blood pressure Regulates the amount of fluid in the body by
regulation increasing or decreasing the urine production
Hormones Calcitriol (active form of vitamin D)
production Erythropoietin (stimulates bone marrow to produce
blood cells)
Acid-base Maintain the pH of blood at 7.4 by decreasing or
balance increasing the excretion of hydrogen ions
regulation
• Total Body Water Water constitutes approximately 50% to 60% of total
body weight.In general, the amount of blood in the body is 5 liters.
• Any excessive amount of fluid will increase the pressure on the arterial wall
and cause the blood pressure to rise (hypertension).
• The kidneys also sense this increase of pressure, and in cases when this
happens, they increase the filtration rate of blood and production of urine,
which subsequently leads to the increase fluid excretion and decrease of
blood pressure.
• If less than 5 liters of blood, blood pressure is too low (hypotension).
Hypotension is a stimulus for the kidneys to increase the retention of fluid
and thus increase blood pressure.
• Besides blood volume and pressure regulation, kidneys also
participate in the production of calcitriol (the active form of vitamin
D).
• Also, in situations with notable blood losses, kidneys release a
hormone called erythropoietin, which stimulates bone marrow to
produce more blood cells.
• Cells in body constantly produce hydrogen ions.
• An increased amount of hydrogen ions can acidify the blood and
cause a state called acidosis.
• Kidneys have a special system for the excretion of hydrogen ions, and
in that way consistently maintain the pH of blood at 7.4.
• The opposite situation is possible too, if the kidneys excrete too many
hydrogen ions, the pH of blood becomes too alkaline, and leads to a
state called alkalosis.
Anatomy
• The kidneys have their anterior and posterior surfaces.
• The anterior surface faces towards the anterior abdominal wall,
whereas the posterior surface is facing the posterior abdominal wall.
• These surfaces are separated by the edges of the kidney, which are
the major convexity laterally, and minor concavity medially.
• The center of the minor concavity is marked as the hilum of the
kidney where the renal artery enters the kidney, and the renal vein
and ureter leave the kidney.
• The kidneys are positioned
retroperitoneally, meaning
that they are not wrapped
with the peritoneal layers
the way most abdominal
organs are, but rather are
placed behind it.
External Anatomy
• The kidneys are located between the transverse processes of T12-L3
vertebrae, with the left kidney typically positioned slightly more
superiorly than the right.
• This is because the liver and the stomach offset the symmetry of the
abdomen, with the liver forcing the right kidney a bit down, and the
stomach forcing the left kidney a bit up.
• The superior poles (extremities) (T12) of both kidneys are more
medially pointed towards the spine than the inferior poles
(extremities) (L3).
• The hilum of the kidney usually projects at the level of the L2
vertebra. Thus, the ureter is seen paravertebrally starting from the L2
and going downwards.
Borders of the kidneys.
• A bean-like structure like the kidney has two borders: medial and
lateral.
• The lateral border is directed towards the periphery, while the medial
border is the one directed towards the midline.
• The medial border of the kidney contains a very important landmark
called the hilum of the kidney, which is the entry and exit point for
the kidney vessels and ureter.
• The most superior vessel is the
renal vein which exits the
kidney, just under it is the renal
artery that enters in, and under
the artery is the exiting ureter.
• The anterior to posterior
orientation follows the same
pattern:
• renal vein,
• renal artery
• ureter.
• The kidney tissue is protected by three layers that entirely surround
the kidney:
• The fibrous capsule (renal capsule)
• The perinephric fat (perirenal fat capsule)
• The renal fascia which besides the kidneys also encloses the
suprarenal gland and its surrounding fat.
• Outside the fascia is the most
superficial layer – a layer of fat
tissue called the perinephric fat.
This layer sits posteriorly and
posterolaterally to each kidney
and separates it from the
muscles of the abdominal wall.
Relations
 Right kidney relations
Right suprarenal gland Superior pole
Peritoneum Superior one-half of anterior surface
Descending duodenum Center of the anterior surface

Right colic flexure Lateral part of inferior pole

Jejunum Medial part of inferior pole
• The highest portion of the superior pole is covered with the right
suprarenal gland.
• The superior one-half of the anterior surface is in contact with the
layer of peritoneum that separates it from the liver.
• This potential space that separates the liver from the right kidney is
called the hepatorenal pouch of Morison.
• Under normal conditions, this pouch is empty, but certain
pathological conditions, such as ascites or hemoperitoneum, can
cause fluid to collect within the pouch.
• This can be visualized with ultrasound or CT.
• At the center of the anterior surface, a horizontal stripe that extends
from the medial concavity toward the center of the lateral convexity –
that is the area of the kidney that is directly touched by the
retroperitoneal posterior wall of the descending duodenum
• The lateral part of the inferior pole is directly contacted with the right
colic flexure (also known as the hepatic flexure) which is also
retroperitoneal at this part
• The rest of the inferior pole is associated with the peritoneum of the
small intestine, more precisely the jejunum
Key facts about the left kidney relations
Left suprarenal Upper one half of superior pole
gland
Stomach Medial part of the lower half of superior pole
Spleen Lateral part of the lower half of superior pole
Pancreas Center of the anterior surface
Splenic flexure of Lateral part of inferior half of anterior surface
descending colon
Jejunum Medial part of inferior half of anterior surface
The anterior surface of the left kidney, has the
following anatomical relations:
• Highest part of the superior pole of the left is also covered with the left
suprarenal gland
• The inferior portion of the superior pole contacts with the peritoneum of
the stomach (medially) and spleen (laterally)
• Just inferior to the stomach and spleen impression, is where the left kidney
directly contacts the pancreas
• The lateral part of the inferior half of the anterior surface is directly
associated with the left colic flexure (also known as the splenic flexure)
and descending colon
• The medial part of the inferior half and the inferior pole are contacted by
the peritoneum of the jejunum
Key facts about posterior surface relations
Diaphragm Superior half
Psoas major muscle Medial third of lower half
Quadratus lumborum Middle third of lower half
muscle
Transversus abdominis Lateral third of lower half
muscle
• The superior half is covered by the diaphragm, which is why the
kidneys move up and down during respiration
• The inferior half is easy to remember by dividing it into three vertical
stripes, where the medial stripe represents the impression of
the psoas major muscle, the central stripe the quadratus lumborum,
and the lateral stripe the transversus abdominismuscle
Internal Anatomy
• The main unit of the medulla is
the renal pyramid.
• There are 8-18 renal pyramids in
each kidney, that on the coronal
section look like triangles lined
next to each other with their
bases directed toward the cortex
and apex to the hilum.
Medulla Cortex
• The apex of the pyramid projects medially toward the renal sinus.
• This apical projection is called the renal papilla and it opens to
the minor calyx.
• The minor calyces unite to form a major calyx.
• Usually, there are two to three major calyces in the kidney (superior,
middle, and inferior), which again unite to form the renal pelvis from
which the ureter emerges and leaves the kidney through the hilum.
• The pyramids are separated by extensions of the cortex called
the renal columns.
Renal Papilla
Renal Pelvis
Renal Column
• Each minor calyx is a funnel shaped structures that surrounds a renal
papilla and collects urine from it through the area cribrosa (sieve-like
apparatus).
• Several minor calyces converge to form one major calyx. The major
calyx then facilitates the passage of urine to the renal pelvis (the
beginning of the ureters).
• The renal pelvis is an empty cavity that exits the medial border of the
kidney posterior to the renal neurovascular structures.
• The pyramids contain the functional units of the kidney,
the nephrons, which filter blood in order to produce urine which then
is transported through a system of the structures called calyces which
then transport the urine to the ureter.
• The pyramids represent the functional tissue that creates urine,
whereas the calyces are the beginning of the ureter and transport the
urine to it.
Nephron
• The nephron is the functional
representative of the kidney.
• Each nephron contains a renal
corpuscle, which is the initial
component that filters the
blood, and a renal tubule that
processes and carries the
filtered fluid to the system of
calyces.
• The renal corpuscle has two
components: the glomerular
(Bowman’s) capsule in which sits
the glomerulus.
• The glomerulus is a web of
arterioles and capillaries, with a
special filter which filters the blood
that runs through the capillaries,
the glomerular membrane.
• The vessel which brings blood into
the glomerulus is the afferent
arteriole, whereas the vessel that
carries the rest of the blood out
that hasn’t been filtered out of the
glomerulus is called the efferent
arteriole.
Afferent glomerular arteriole Efferent glomerular arteriole
Capillary Network
• As the afferent arterioles enter the glomerulus, they form an intricate
network of communicating capillaries.
• The capillaries are lined by a unique fenestrated epithelium (each
space being around 70 – 100 nm wide).
• The fenestration allows selective passage of smaller particles into the
renal tubules and keeps larger blood cells in the vessels.
• The glomerular membrane is designed in a way in which it is not
permeable for big and important molecules in blood, such as plasma
proteins, but it is permeable to the smaller substances such as
sodium, potassium, amino acids and many others.
• It is also permeable for the products of the metabolism, such are
creatinine and drug metabolites.
Kidney is essential for the circulatory
hemostasis
• Filtered fluid that goes to the renal tubule have necessary and unnecessary
substances.
• The tubules are designed in a way that they reabsorb the necessary
substances, (sodium, potassium, and amino acids) and carries them back
to the blood; whereas they do not absorb but rather secrete unnecessary
substances such as creatinine and drug metabolites for excretion from the
body.
• Consistency of blood is preserved and no important substances are lost.
• Products of cellular metabolism and drug metabolites are eliminated from
the blood which prevents their depositing in the body and potential
toxicity. This is why the.
Vasculature and Lymphatic
Drainage
Arteries
• Each kidney is supplied by a single renal artery, which is a direct lateral
branch of the abdominal aorta.
• Both renal arteries, left and right, arise just below the superior mesenteric
artery, with the left renal artery positioned slightly superiorly to the right
one.
• The left artery has a short way to the left kidney, whereas the right has to
go behind the inferior vena cava in order to reach the right kidney.
• In addition to the renal artery, accessory renal arteries are present too.
• They are branches of the abdominal aorta and all together are called the
extrahilar renal arteries.
• The abdominal aorta gives off
many branches, including
the renal arteries.
• The renal arteries branch off
perpendicular to the abdominal
aorta, travelling posterior to the
renal veins, nerves and
the pancreas.
• The renal artery enters the kidney
at the hilum, where it divides into
anterior and posterior branches.
• The posterior division goes on to
supply the posterior region of the
kidney, while the anterior branch
divides further to
produce apical, anterior
superior, anterior
inferior and inferior segmental
arteries; each supplying their
respective segments.
• At the level of the minor calyces,
the branches of the anterior
renal arteries further divides
into interlobar arteries that
course around the borders of
the medullary pyramids.
• At the base of the pyramids,
these arteries are referred to
as arcuate arteries.
• The arteries enter the nephrons
(functional units of the kidneys)
as the interlobular arteries,
where afferent arterioles bring
blood to the glomerulus to be
filtered. It should be noted that
these arteries neither
anastomose nor have
accompanying veins.
Veins and Lymphatics
• Each kidney has a single renal
vein which conducts the blood out
of the kidney and is positioned
anterior to the artery.
• The renal veins empty to the
inferior vena cava, so the right vein
must be longer because the inferior
vena cava is closer to the left
kidney.
• The left renal vein passes anteriorly
to the aorta just below the trunk of
the superior mesenteric artery,
which is risky because it can be
compressed by one of those two.
Venous Drainage
• As the capillaries leave the
nephron, they condense to
form interlobular veins.
• Similar to the branches of the
renal arteries, the interlobular
veins become arcuate veins at
the base of the medullary
pyramids, then interlobar veins.
• About five or six interlobar veins
join together to form each renal
vein.
Lymphatic Drainage
• Concerning lymphatic drainage,
each kidney drains into the
lateral aortic (lumbar)
lymph nodes, which are placed
around the origin of the renal
artery.
• Superficial lymphatic vessels form a plexus under the renal capsule
(thin layer covering the kidneys) known as the subcapsular lymphatic
plexus. They, along with medullary lymph vessels, communicate with
cortical lymph vessels that travel alongside interlobular, arcuate and
interlobar arteries. The renal lymphatics then drain directly to the
lumbar lymph trunks (which then drain to the thoracic duct and
cisterna chyli) and to para-aortic nodes, including precaval, lumbar
and postcaval nodes.
• Note that the left renal vein receives blood from the left suprarenal
and left testicular veins.
• The left testicular vein must ascend higher and it drains to the left
renal vein at a right angle, unlike the right testicular vein which joins
the inferior vena cava directly.
• This can cause varicocele of the left testicle because gravity works
against the column of the blood in the left testicular vein.
• Left renal vein passes between the superior mesenteric artery and
the abdominal aorta, an enlargement of the superior mesenteric
artery can compress the left renal vein and cause an obstruction of
drainage from all three structures that use the left renal vein for
drainage (left suprarenal gland, left kidney, and left testicle).
• This significantly affects the testicle, since an obstruction of drainage
causes an obstruction of fresh arterial blood inflow, which can result
in the infarction of testicular tissue.
• This specific condition is called the nutcracker phenomenon.
Innervation
• The kidneys are innervated by the renal plexus.
• This plexus provides input from:
• The sympathetic nervous system from the lower
thoracic splanchnic nerves for the regulation of the vascular tone,
and from
• The parasympathetic nervous system as well, through the vagus
nerve.
• The sensory nerves from the kidney travel to the spinal cord at the
levels T10-T11, which is why the pain in the flank region always rises
suspicions that something is wrong with the corresponding kidney.
Ureters
• After blood has been filtered in the kidneys, the filtrate undergoes a
series of reabsorptions and exudation throughout the length of the
convoluted tubules.
• The resulting liquid then passes to the collecting tubules, after which
it enters the collecting duct.
• From the collecting ducts, the urine passes from the calyces to the
renal pelvis, which marks the beginning of the ureters.
• These are bilateral muscular,
tubular structures, each
responsible for taking urine from
one kidney to the urinary bladder
for storage, prior to excretion.
• The arterial supply to the ureters
comes directly and indirectly from
the abdominal aorta. There are no
ganglia on the ureters; however, it
receives both sympathetic and
parasympathetic innervation.
 Ureters
Histology Transitional epithelium with longitudinal and circular muscle layers

Relations Right ureter: psoas major, genitofemoral nerve, duodenum,

branches of the superior mesenteric vessels, bladder
Left ureter: psoas major, genitofemoral nerve, branches of the
inferior mesenteric vessels, bladder

Blood Supply Ureteric branch of the renal artery, ovary/testicular artery, ureteric
branch of the abdominal aorta, ureteric branches of the superior and
inferior vesicular arteries

Innervation Renal plexus and ganglia, ureteric branches from the intermesenteric
plexus, pelvic splanchnic nerves, inferior hypogastric plexus

Lymphatic Common, precaval, and lumbar lymph nodes

Drainage
Gross and Histological Perspective
• The ureters are collapsible S-shaped channels, each about 25 cm in
length.
• They are widest at the renal pelvis and narrow progressively as they
enter the urinary bladder in the concavity of the true pelvis.
• The lumen of each ureter is lined by a mucosal layer of transitional
epithelium, which accommodates the increase in pressure that
accompanies increases in the volume of urine leaving the kidney;
thereby aiding to minimize the risk of rupturing the ureters.
• These conduits have several in-folding caused by multiple layers of
smooth muscle throughout the ureteral wall.
Course
• The ureters leave the kidneys posterior to the renal vessels.
• Both ureters pass inferiorly over the abdominal surface of the psoas
major, with the genitofemoral nerve behind it and the vessels of the
gonads in front.
• As the right ureter travels towards the bladder, it travels posterior to
the duodenum and further down it is crossed by branches of
the superior mesenteric vessels.
• The left ureter, however, travels laterally to the inferior mesenteric
vessels and is subsequently crossed by its branches.
• Eventually, the vessels leave the psoas major as the common iliac
arteries bifurcate to enter the true pelvis.
• The ureter pierces through the wall of the urinary bladder from lateral
to medial and posterior to anterior.
• So, this entrance is oblique. It forms the orifice of the ureter in the
urinary bladder at the ureterovesicular junction.
Blood Supply
• The ureters have an expansive anastomosing network of arterial
supply and venous drainage along their length.
• The proximal end receives arterial supply from the ureteric branch of
the renal artery.
• Contributions from the ovarian artery(testicular artery in males) as
well as a direct ureteric branch from the abdominal aorta supply the
middle segment.
• The distal portion receives its arterial supply from ureteric branches
from both the superior and inferior vesical arteries.
• They are drained by accompanying veins.
Urinary Bladder
• The urinary bladder is an organ that serves to collect urine to be
voided through urination after the urine is filtered through
the kidneys (where the necessary ions are reabsorbed if
physiologically needed through feedback mechanisms found
throughout the body and in the nephrons of the kidneys, such as the
macula densa).
 Anatomy
the bladder is a hollow,
muscular, and pear-
shaped distensible
elastic organ that sits on
the pelvic floor.
It receives urine via the
ureters, which are thick
tubes running from each
kidney down to the
superior part of the
bladder.
• Generally, the bladder is a hollow, muscular, and pear-shaped
distensible elastic organ that sits on the pelvic floor.
• It receives urine via the ureters, which are thick tubes running from
each kidney down to the superior part of the bladder.
• Urine is collected in the body of the bladder, and finally it is voided
through the urethra.
• The fundus is the base of the bladder, which is formed by the
posterior wall and contains the trigone of the bladder, and is
lymphatically drained by the external iliac lymph nodes.
• The trigone is the structure that contains the outlet (urethra) of the
bladder.
• While the general volume of the human bladder will vary from person
to person, the range of urine that can be held in the bladder is
roughly 400 mL (~13.5 oz) to 1000 mL (~34 oz), with the average
capacity being 400 to 600 mL.
Function
• The muscles in the bladder that allow for conscious control of when
you are or are not in a suitable situation to urinate are especially
meaningful in civilized societies.
• There are 2 important pathways involving your bladder:
1) the sensation that lets you know your urinary bladder is full and
needs to be voided, and
2) the motor control of your bladder to allow you to urinate at will.
• First, as the bladder walls are
stretched when it is full or
getting closer to maximum
capacity, there are signals that
are transmitted through the
parasympathetic nervous system
to contract the detrusor muscle.
• The detrusor muscle is a layer of the bladder wall made of smooth
muscle fibers that are arranged in spiral, longitudinal, and circular
bundles.
• This signal will encourage the bladder to expel urine through the
urethra.
• Sensations from the bladder are transmitted to the central nervous
system (CNS) via general visceral afferent fibers (GVA).
• Whereas GVA fibers on the superior surface of the bladder follow the
course of the sympathetic effect nerves back to the CNS, GVA fibers
on the inferior portion follow along with the parasympathetic efferent
fibers.
• To control the act of urination voluntarily, motor control is achieved
through innervation by both sympathetic fibers, most of which arise
from the hypogastric plexuses and nerves, and parasympathetic
fibers, which come from the pelvic splanchnic nerves and the inferior
hypogastric plexus.
• Finally, there are two important sphincters the urine must pass
through in order to leave the body: both the autonomically controlled
internal sphincter and the voluntarily controlled external sphincter
must be opened.