Chapter 4 The Urinary System

The urinary system includes t

wo kidneys, two ureters, one uri
nary bladder and one urethra. I
ts main function is to excrete th
e waste products, such as urea a
nd uric acid, excess water and s
ome inorganic salts, so as to reg
ular the composition of the inte
rnal environment of the body to
keep balance.
 The kidney is an organ of pro
ducing urine. Urine is produced
by the kidneys and drains out of
each kidney, is conveyed throug
h the ureter and is stored in the
urinary bladder until it is expell
ed from the body through the ur
ethra. The female urethra is a ur
inary duct while the male urethr
a serves two functions, urinary a
nd genital.
The female urogenital organs
Section 1 The kidney

The kidneys are the most

important organs in the uri
nary system and they are a
pair of bean-shaped, reddis
h-brown organs. They are
parenchymatous organs.
 I.The Features of Kidneys

In the adult male the weight

of kidney is heavier than that
in the female. The left kidney is
slender, the right one is
broader and shorter.

Each kidney has a medial

and a lateral border and an
anterior and a posterior
surface, a superior extremity
and an inferior extremity.
 The superior extremity (upper
pole) is broader and thinner than
the inferior extremity (lower pole)
. The anterior surface is slightly c
onvex and the posterior surface co
ntacting the posterior abdominal
wall directly. It is flat. The lateral
border is convex. On medial bord
er of the kidney there is the renal
hilum , which transmits the renal
vessels, nerves and a part of pelvis
.
 The renal hilum leads into a central recess name
d the renal sinus , which is filled with the branches
of the renal artery and vein, nerves,
lymphatic vessels, minor ren
al calices, major renal calice
s, renal pelvis and adipose ti
ssue. The structures passing
through the renal hilum are
enclosed together by the con
nective tissue, to form the re
nal pedicle .
 II. The Location of Kidneys
The kidneys lie on the posterior abdominal wall
one on each side of the vertebral column. The right
kidney is lower than the left one about one vertebral
body because of the upper liver. The left twelfth rib
is behind the middle part of the posterior surface of
the left kidney and the right twelfth rib behind the
superior part of the posterior surface of the right
kidney.
 The renal hilum is at the level of the first lumba
r vertebra, 5cm lateral to the midline of the body.
The area between the twelfth rib and the lateral
border of the erector spinae is called the renal regi
on in clinic.
 The location of the kidneys is varied in
different cases. Generally in female it is
lower than in male. It is higher in adult
than in child. In new born child the
inferior extremity of kidney may be at
level of the iliac crest.
 Sometimes the number or the shape of the
kidney will be changed. Congenitally, such as
single kidney, hoofbeat kidney because the inf
erior extremity of two kidneys mixing togethe
r.
 III. The Structure of Kidney

On the coronal section, the kidney includes the

renal tissue and the conveying duct. The renal
tissue is divided into two portions: the cortex and
medulla.
The renal cortex lies immedia
tely beneath the fibrous capsule,
at the superficial layer. It is rich
in blood vessels and reddish-bro
wn in color. The renal cortex is
composed of renal glomeruli an
d renal tubules.
 The renal medulla is deep to the cortex. It
consists of a number of pale striated, conical
masses, termed the renal pyramids, which vary in
number from fifteen to twenty. The bases of
pyramids are directed toward the periphery of the
kidney, while their apices converge towards the
renal sinus. The parts
from renal cortex
dipping in between the
pyramids are named
the renal columns.
 The apices of the renal pyramid are termed the
renal papilla. Sometimes two or three apices of renal
pyramids converge in one renal papilla. There are
seven to twelve renal papillae in each kidney. The
foramina on their apices are called the papillary
foramina. The urine formed in the kidney passes
through these foramina into the minor calices, which
is a cup-shaped fashion to rece
ive from one to three papillae.
There are seven to eight mino
r renal calices in the renal sin
us.
 All minor renal calices converge into two or th
ree major renal calices in each kidney. Finally the
major renal calices join the rena1 pelvis, which is
flat funnel-shaped. The renal pelvis becomes narr
ow at the renal hilum, passes
downward to continue
with the ureter at the l
evel of the inferior extr
emity of the kidney.
 IV. The Coverings of Kidneys

There are three layers of coverings surrounding

each kidney. The inner layer is termed the fibrous
capsule, which is a firm, strong fibrous capsule that
can be stripped easily from a normal kidney but can't
from a diseased one.
 The middle layer is the adipose capsule. It
continues with the adipose tissue within the r
enal sinus. The amount of fat is very variable
. Generally there is more adipose tissue along
the borders of the kidney.
 The outer layer is the renal fascia. The renal fas
cia likes a bag and inverted encloses two kidneys a
nd two suprarenal glands. So the renal fascia is div
ided into anterior and posterior layers. The superi
or border and two lateral borders are merged, the
anterior layer and the posterior layer continue, bu
t the inferior is open. The ureters pass through bet
ween the two layers inferiorly.
 The kidney and the suprarenal gland have the
fibrous capsule and the adipose capsule separately,
but they have a common renal fascia, so when the
kidney descends, the suprarenal gland don’t
descend together.
 The connective trabeculae from renal fascia cross
the adipose capsule to the fibrous capsule to fix the k
idney. Besides, the adipose capsule, the neighboring
organs, the renal vessels, peritoneum and pressure in
the abdominal cavity play the role also in maintainin
g the normal location of the kidney. If these supporti
ng structures are abnormal the kidney may descend
to an abnormally low level called nephroptosis.
 Section 2 The Ureters

The ureters are two mus

cular tubes conveying the u
rine from the renal pelvis t
o the urinary bladder to be
stored. Each ureter is 20~3
0cm in length. According to
the course each ureter may
be divided into three parts.
 The abdominal part is be
tween the renal pelvis and t
he ureter cross through the
iliac vessel anteriorly. The
ureter is continuous superi
orly with the funnel-shaped
renal pelvis and then runs
downwards and slightly me
dially in front of the psoas
major and behind the perit
oneum.
 At the superior pelvic aperture, the ureter crosse
s through the iliac artery anteriorly to continue wit
h the pelvic part.
The pelvic part is the second part of the ureter.
The ureter passes dow
nwards along the later
al wall of the lesser pel
vis, then turns mediall
y at the level of the isc
hial spine to the base o
f the urinary bladder.
 At here the ductus deferens crosses it anterior1
y to its medial side in the male. In the female, at t
he level of ischial spine, 2cm lateral to the cervix
of uterus, it is crossed anteriorly by the uterine ve
ssels. It then runs along the lateral side
and the anterior surface of
the vagina to the base of t
he urinary bladder.
 The third portion is the i
ntramural part where the
ureter passes obliquely thr
ough the wall of the urinar
y bladder for 1.5cm long. T
he opening of the ureter is
into the superolateral angl
e of the bladder. As the bla
dder is filled up, the intra
mural part serves as a valv
e to prevent the backflow o
f urine.
 The ureters are not uniform in caliber. In all c
ourse, three constricted parts are the places whe
re the renal stones stay usually. They are: ①at t
he junction of the ureter and the renal pelvis;
② at the point where ur
eter crosses the superior
aperture of the lesser pel
vis; ③the intramural pa
rt.
 Section 3 The Urinary Bladder

The urinary bladder

is a hollow, muscular
organ storing the
urine. It varies in size,
shape, position and
relations according to
the amount of urine
that it contains.
 In the adult the volume of the urinary bladde
r averages 300~500ml, with the largest volume o
f 800ml. But in the babies the volume is 1/10 of t
he adult’s volume. In old age the volume is larg
er than in the adult, because the tension of the
muscles of the urinary bladder is reduced. In fe
male its volume is less than in the male.
 The empty urinary bladder likes a triangular p
yramid. It may be divided into four portions: apex
, body, fundus and neck. The apex of bladder is di
rected ventrally toward the posterior surface of th
e upper part of the pubic symphysis. The

fundus of bladder
is triangular and
directed posterior
ly and inferiorly.
 The body of bladder is between the apex a
nd fundus. The lowest and also the most fixe
d part is the neck of bladder. It is pierced th
rough the internal urethral orifice. In the m
ale the neck rests upon the prostate gland.
 When the bladder is empty, there are many fold
s on the mucosa of its internal surface, but on the f
undus of bladder there is a smooth triangular area
are called the trigone of bladder . The
anteroinferior angle of
the trigone is formed by
the internal urethral or
ifice, the two posterolat
eral angles are formed
by the ureteric orifices.
 A transverse ridge between the two ureteric ori
fices is called the interureteric ridge being the lan
dmark to find the ureteric orifices when the urina
ry bladder is examined with cystoscope in
the living body. When
the bladder is filled up
with urine, it is oval in
shape, the boundaries
between the surfaces
are not clear, and the
mucosal folds become
disappeared.
 In the adult, the empty urinary bladder is
entirely within the lesser pelvis, but as it becomes
distended it expands upwards and forwards into
the abdominal cavity.
 When the bladder is empty, only the superior s
urface and upper portion of the inferolateral surf
aces are covered by peritoneum, which is reflecte
d from the lateral wall of the pelvis and from the
anterior abdominal wall just above the level of th
e pubic symphysis.
 As the bladder fills, the superior surface of the
bladder enlarges and bulges upward into the
abdominal cavity, the peritoneal covering is
peeled off away from the lower part of the
anterior abdominal wall, and the reflection of the
peritoneum becomes higher.
 So the bladder comes into and directly conta
cts with the anterior abdominal wall. Therefore
the puncture of bladder can be performed just
above the pubic symphysis without injurying th
e peritoneum to prevent the infection.
 In the male, the neck of bladder is firmly attached
to the prostate gland. The fundus of bladder is anteri
or to the seminal vesicles, ampullae ductus deferente
s and rectum. The peritoneum covering on the super
ior surface of the bladder reflects to the
rectum to form the re
ctovesical pouch bein
g the lowest portion o
f the peritoneal cavity
when standing.
 In the female, the neck of bladder is firmly attac
hed to the urogenital diaphragm. The peritoneum
continues to the uterus and the superior surface of
the bladder to form the vesicouterine pouch.
 Section 4 The Urethra

The urethra extends from the urinary bladder

to the exterior. It is very different in males and
females.
The male urethra serves a common tube for
urinary and genital systems. It will be described in
the genital system.
 The female urethra is a membranous canal, it is s
hort only about 5cm long and 6mm in diameter, ext
ending from the bladder to external urethral orifice.
It perforates the pelvic floor and urogenital diaphag
m. Its external orifice is situated just anterior to the
vaginal orifice and about 2.5cm posteroinferior to th
e glans of clitoris.
 Where the urethra passes through the urog
enital diaphragm, the striated muscle of uroge
nital diaphragm forms the urethrovaginal sph
incter preventing the urine freely and contrac
ting the vagina. Because the female urethra is
relatively wide, short and straight, so the reve
rsed infection of the urinary tract in female is
often occur.
Summarize:

The urine is produced by the renal tissue, then

through the minor renal calices major renal cal

ices the renal pelvis the ureters

the urinary bladder the urethra out of the

body
 Review
1.Concept:
the renal hilum, the renal sinus, the renal pedicle,
the renal region, the trigone of bladder
2. What is the composition of the urinary system?
3.What are the names and order of three coverings of k
idneys?
4.What are three constriction parts in the ureter?
5.What are the neighboring structures of the neck of th
e urinary bladder in male and female?
6.Please write down the conveying course of the urine
when it produced by the renal tissue.