Urinary bladder & Ureters

Dr W Mushiwokufa
MBChB, MMedSci (Anatomy)
Department of Anatomy
MSU Faculty of Medicine
ANATOMY OF THE URETERS, URINARY BLADDER,
URETHRA

Dr W Mushiwokufa
URINARY SYSTEM

Dr W Mushiwokufa
URETERS
• Are 25-30 cm long, thick walled narrow
tubes
• Retroperitoneal

• Ureteropelvic junction- renal pelvis

narrows and continues as ureter

• At pelvic brim cross bifurcation of

common iliac artery or external iliac
artery

• Constricted at 3 points

• Enters the base of the bladder

• In pelvis crossed by: ductus deferens in

males, uterine artery in females

Dr W Mushiwokufa
URINARY BLADDER Position

• Hollow, muscular organ, situated posterior to the pubic symphysis

• Most anterior element in the pelvic cavity

• When empty located in pelvis, full expands into the abdomen

Dr W Mushiwokufa
URINARY BLADDER In males

• Lies anterior to the rectum

Dr W Mushiwokufa
URINARY BLADDER In females

• Lies anterior to vagina and inferior to uterus

Dr W Mushiwokufa
URINARY BLADDER Peritonem

• Drapes over pelvic organs forming pouches and ligaments

• Anteriorly the peritoneum forms folds that cover embryological

remnants- median and medial umbilical ligaments

Dr W Mushiwokufa
URINARY BLADDER Peritonem-males

• Drapes over the superior surface of bladder and superior poles of

the seminal vesicles and reflects on anterior and lateral surfaces of
the rectum-rectovesical pouch

Dr W Mushiwokufa
URINARY BLADDER Peritonem-females

•Uterus lies between the rectum and bladder

•Vesicouterine and rectouterine pouch(Pouch of Douglas) occurs
•Broad ligament -fold of peritoneum extends from the uterus to lateral
pelvic wall

Dr W Mushiwokufa
 URINARY BLADDER
• Apex-directed towards the pubic symphysis and the median

umbilical ligament attached

• Base-faces posteroinferiorly, two ureters enters the upper

corner of the base and the urethra drains from the inferior

corner. Smooth triangular area lies between the openings-

trigone

• Inferolateral surfaces-cradled between the lavator ani muscles

• Superior surface- covered by peritoneum

Dr W Mushiwokufa
URINARY BLADDER Neck of Bladder

• Surrounds the origin of urethra

• Most inferior part of bladder and
fixed
• Held in place by pubovesical
ligaments(in women:A) and
puboprostatic ligaments(in males:B)

Dr W Mushiwokufa
URINARY BLADDER Histology

• Deepest layer-mucosa: transitional epithelium and lamina propria,

surrounding the mucosa. Folds in the mucosa-rugae
• Intermediate layer-detrusor muscle(inner longitudinal, middle
circular, outer longitudinal).
• Around the opening of the urethra the circular muscles form the
internal urethral sphincter, inferior to it is the external urethral
sphincter which is made of skeletal muscle(deep perineal muscle)
• Superficial layer-adventitia, and the superior surface of the bladder-
visceral peritoneum

Dr W Mushiwokufa
Dr W Mushiwokufa
URINARY BLADDER The micturition reflex

• Micturition/urination/voiding

• Combination of voluntary and involuntary contractions

• Volume of urine>200-400ml stretch receptors send impulses to spinal cord

• coordination between the central, autonomic and somatic nervous systems

• Impulses trigger the micturition centre and cerebrum

• Parasympathetic impulses contract the detrusor muscle and relax internal urethral sphincter

• In addition the somatic neurons that innervate the skeletal muscle of external urethral

sphincter are inhibited

• Relaxation of the sphincters and contraction of the detrusor muscle causes urination

• Urinary bladder filling causes a sensation of fullness that initiates the a conscious desire to

urinate before the micturition reflex occurs

• Through learned control of the external urethral sphincter and muscles of the pelvic floor , the

cerebral cortex can initiate and delay occurrence for a limited period
Dr W Mushiwokufa
Dr W Mushiwokufa
URINARY BLADDER Vessels

• Anterior trunk of internal

iliac artery-superior
vesical artery and inferior
vesical artery(males),

vaginal artery(females)

Dr W Mushiwokufa
 Veins
• Veins follow same course as
arteries except for iliolumbar
and umbilical artery.
• Within the pelvic
cavity ,extensive
interconnected venous
plexuses are associated with
the surfaces of the viscera-
pelvic plexus of veins
• The part around the rectum
and anus are connected with
 URETHRA

• The urethra begins at base of bladder and ends in perineum

• Paths are different in males and females

Dr W Mushiwokufa
 URETHRA In females

• Is short, 4cm long

• Passes through deep perineal pouch, perineal membrane and then

vestibule lies between labia minora
• Urethal opening is anteruior to vagina’

• Paraurethral glands (Skene’s glands) open into the lower end of urethra

Dr W Mushiwokufa
 URETHRA In females

Dr W Mushiwokufa
 URETHRA In males

• Is long, 20 cm

• Begins at base of bladder, passes through prostate, deep perineal pouch,

perineal membrane, root of penis, body of penis

Dr W Mushiwokufa
 URETHRA In males

Dr W Mushiwokufa
URETHRA Parts of urethra-male

• Prostatic-surrounded by prostate
• Lumen is marked by urethral crest and
depression on either side is the prostatic
sinus
• Seminal colliculus-circular elevation,
prostatic utricle -blind end opening is found
in the centre
• Ejaculatory ducts open on either side
• The connection between the reproductive
and urinary system occurs here.

Dr W Mushiwokufa
URETHRA Parts of urethra-male

• Membranous :passes through the deep

perineal pouch. The urethra(in both
sexes) is surrounded by skeletal muscle of
the external urethral sphincter
• Spongy: Surrounded by erectile
tissue(corpus spongiosum). Enlarged to
form the bulb at the base and navicular
fossa at the end of the penis. Two
bulbourethral glands open in urethra at
deep perineal pouch

Dr W Mushiwokufa
 Nerves
Sympathetic:

-innervate blood vessels

-contract smooth muscle of internal
urethral /anal sphincter
-are important in movement of secretions
from epididymis and associated glands
into urethra to form semen in ejaculation

Parasympathetic:

Vasodilatory
Stimulate bladder contraction
Relax internal urethral/anal sphincter
Stimulate erection

Dr W Mushiwokufa
 Nerves
• Somatic

The pudendal nerve(S2-S4) innervates the skeletal muscle of the

perineum and anal sphincters and levator ani

Dr W Mushiwokufa