URETERS

URINARY BLADDER
URETHRA
 OBJECTIVES
At the end of the lecture, students should be able
to:
 Describe the course of ureter & identify the sites of
ureteric constriction
 Describe the important relations & identify certain
areas (trigone, uvula vesicae) in the base of
urinary bladder.
 List the blood supply, lymphatic drainage & nerve
supply of urinary bladder
 Differentiate between male & female urethra
regarding length, structure, course & function.
 Ureter
 A 25 – 30 cm long
muscular tube transporting
urine from kidney to urinary
bladder.
 Begins as a continuation of
renal pelvis.

 COURSE IN ABDOMEN:
 It descends anterior to psoas major muscle (opposite the
tips of lumbar transverse processes).
 It crosses the end (bifurcation) of common iliac artery to
enter the pelvis.
 COURSE IN PELVIS &
TERMINATION:
 Runs downward in front to internal
iliac artery, reaches ischial spine
 Turns forward and medially ,
enters the upper lateral angle of
urinary bladder
 Near its termination, is crossed by
the vas deferens
 Passes obliquely through the wall
of bladder for about ¾ inch before
opening into the bladder cavity.

Bladder muscle contraction

mechanically closes off ureteral
orifice which prevents a reverse flow
of urine toward the kidney
 Ureteric Constrictions
 The ureter has
constrictions at three
points (sites of
obstruction and stone
impaction) 1
1. At the ureteropelvic
junction
2. At the crossing of
external/common 2
iliac artery
3. At site of entrance to 3
bladder
 Arterial Supply

 Ureter is supplied by
multiple arteries
throughout its course 1
 From above downward, 2
these are::
1. Renal artery 3

2. Gonadal artery
4
3. Common iliac artery
4. Internal iliac artery
 Urinary Bladder
 Located immediately behind
the pubic symphysis
 Shape and relations vary
according to the amount of
urine it contains
 An empty bladder:
 In adults, is entirely a

pelvic organ; as it fills,

rises up into the
hypogastric region.
 In young children, it

projects above the pelvic

inlet
 An empty bladder is
pyramidal in shape
having:
 An apex

 A base (posterior

surface)
 A superior surface

 Two infrolateral

surfaces
 A neck
 Apex
 Directed forward
 Lies behind the upper
margin of the
symphysis pubis
 Is connected to
umbilicus by the
median umbilical
ligament (remnant of
urachus)
 Base or Posterior
surface
 Triangular in shape
 Upper part covered by
peritoneum
 Lower part related to:
 In males: vas
deferentia and
seminal vesicles
 In females: vagina
 Superior surface
 Completely covered by peritoneum.
 Related to the coils of ileum or sigmoid colon in males and
to uterus in females

Male pelvis Female pelvis

Infrolateral surfaces:
 Related in front to the
retropubic pad of fat &
the pubic bones
 Posteriorly lie in contact
with the obturator
internus above and
levator ani below

Retropubic fat
 Accomodates distention of bladder
 Continuous with anterior abdominal wall.
 Rupture of bladder results in escape of urine to
anterior abdominal wall
Neck:
 Lies inferiorly, and is the
most fixed part of the
bladder
 Is related to lower border
of symphysis pubis
 In male, rests on the
upper surface of
prostate. Here, the
smooth muscle fibers of
the bladder are
continuous with those of
the prostate
 The circular muscle
fibers thickened to form
the sphincter vesicae
 Interior of the Urinary Bladder
 Mucous membrane thrown
into folds except in the
triangular region in the
base of bladder, between
the openings of the two
ureters and the urethra.
This region is called the
‘trigone’. Here The
mucous membrane is
always smooth even when
the bladder is empty
 Uvula vesicae,
vesicae a small
elevation located just
behind the urethral orifice,
It is produced by the
median lobe of prostate.
 Blood & Nerve Supply
 Arterial supply: from internal iliac artery
 Venous drainage: into internal iliac vein
 Lymphatics: into internal iliac lymph nodes
 The nerves form the vesical nerve
plexus that contains:
 Sympathetic fibers derived mainly

from L1,2
 Parasympathetic fibers derived from

pelvic splanchnic nerves S2,3,4

 Sensory fibers from the bladder are

visceral and transmit pain sensation

resulting from overdistention
 The normal capacity
of bladder is about
300-500ml.
 As bladder fills, the
superior surface
bulges upward into
abdominal cavity.
 The peritoneal lining
is peeled off the
lower part of
anterior abdominal
wall and the bladder
comes into direct
contact with the
anterior abdominal
wall
 Male Urethra
 About 8 inches (20cm)
long
 Extends from the neck
of bladder to the
external urinary meatus
on the tip of the glans
penis
 Divided into three parts:
 Prostatic

 Membranous

 Penile
 Prostatic urethra
 Length=3 cm
 Widest & most dilatable
 Extends from neck of
bladder inside prostate
gland
 Structures openings into
prostatic urethra:
 Ejaculatory ducts
 Ducts of prostate gland
 Penile (spongy) urethra
Membranous urethra
 Length=16 cm
 narrowest part of whole urethra
 Length=1 cm
 Extends inside penis & opens
 Surrounded by external
externally through external
urethral sphincter
urethral orifice
 Female Urethra
 Extends from neck
of urinary bladder
to open externally
through the
external urethral
orifice (anterior to
the vaginal
opening)
 Has only urinary
function
FLY
HIGH