PRESENTED BY- DR.

SUKRITI
DEPARTMENT OF SHARIR RACHANA
UNIVERSITY COLLEGE OF
AYURVEDA,JODHPUR
 Urinary system refers to the structures that produce and
conduct urine to the point of
excretion.
 Urinary system includes :

 Pair of kidneys

 Ureters

 Urinary bladder
 Urethra
 Kidneys are pair of excretory organs situated on the
posterior abdominal wall, one on each side of
vertebral column.
Location :
 Occupy epigastric ,
hypochondriac,lumbar ,
and umbilical region.
 Extend from upper border

of T12 to the centre of 3.

body of L
 Right kidney is
slightly lower than left.
 Shape- Bean shaped
 Size- each kidney is 11 cm long,6 cm broad and 3cm thick.

 Wieght- 150 g in males and 135 g in females.

 Reddish brown in colour.

External features-
 It has 2 pole

 Upper pole- broad

 Lower pole- pointed

 Two border-

 Lateral- convex

 Medial- concave

 Two surface
 Anterior surface- irregular
 Posterior surface- flat

 Hilum- medial border shows a depression is called hilum.

 Structures in hilum from anterior to posterior-

 The Renal vein

 The renal artery

 The renal pelvis

Covering or Capsules of kidney
(deep to superficial):
 Fibrous capsule- thin membrane which can easily

stripped off from organ.

 Perirenal fat- adipose tissue layer which is
thickest at borders and fill extrarenal space.
 Renal fascia - made up of two layers-

1. Posterior- fascia of Zuckerkandall

2. Anterior- fascia of Gerota.

 Pararenal fat – more abundent posterolateral aspect of

the kidney and fills paravertebral gutter to form

cushion of kidney.
Relation Right kidney
Upper pole Supra renal gland
Lower pole 2.5 cm above the iliac crest
Medial border supra renal gland and ureter
posterior •Diaphragm, 12th rib
•Psoas major, quadratus lumborum
and transversus abdominis muscles
•Subcostal, iliohypogastric and
ilioinguinal nerves
Anterior •Right Suprarenal gland
•Liver
• Second part of Duodenum
•Right colic flexure
Left kidney
Supra renal gland
2.5 cm above the iliac crest
supra renal gland and ureter
•Diaphragm , 11 and 12 th rib
•Psoas major, quadratus lumborum
and transversus abdominis muscles
•Subcostal, iliohypogastric and
ilioinguinal nerves
• Left Suprarenal gland
•Spleen & Splenic vessels
•Stomach
•Pancreas
•Left colic flexure
•Jejunum
There are three major regions of the kidney:
1. An outer region - renal cortex

2. An inner region - medulla

3. A space – renal sinus

 Renal Cortex-
The kidneys are surrounded by a renal cortex, layer of tissue that is also
covered
by renal fascia(connective tissue) and the renal capsule.
 Renal Medulla
The medulla is made up of about 10 conical masses, called the renal
pyramids, Each pyramid has a base directed towards the cortex; and an
apex (or papilla) that is directed towards the renal pelvis, and fits into a
minor calyx.
 Renal sinus- Space between and hilum. It contains-
1. Branches of renal artery

2. Tributeries of renal vein

3. Renal pelvis- funnel-shaped structure which is devides into
2 to 3 major calyces Each major calyx divides into a number of
minor calyces. The end of each minor calyx is shaped like a cup.
A projection of kidney tissue, called a papilla fits into the cup.
The Uriniferous Tubules
Each kidney is composed by 1 to 3 million Uriniferous Tubules.
Each uriniferous tubule consists of two parts-
4. An excretory part called the nephron,

5. A collecting tubule.
 Nephron- functional unit of kidney. The nephron consists of -
 A renal corpuscle or Malpighian corpuscle- rounded structure
consisting of
(a) a rounded tuft of blood capillaries called the glomerulus
(b) a cup-like, double layered covering for the glomerulus
called the glomerular capsule (or Bowman’s capsule).
 The renal tubule - divisible into several parts
(c) The proximal convoluted tubule;
(d) the loop of Henle consisting of a descending limb, a loop,
and an ascending limb;
(e) The distal convoluted tubule, which ends by joining a collecting
tubule.
Collecting part-
Each distal convoluted tubule delivers its filtrate to a collecting
tubule. many tubules unites to form Duct of Bellini. Which
opens into minor calyces.
 Blood supply of kidney
–
 Blood supply of kidney
Arterial Supply
renal arteries, which arise directly from the abdominal
aorta.
Venous Drainage
The kidneys are drained of venous blood by the left and
right renal veins. They leave the renal hilum anteriorly to
the renal arteries, and empty directly into the inferior
vena cava.
Nerve supply- renal plexus.
 CLINICAL
ANATOMY
 The angle between the lower border of 12th rib and outer border of
erector spinae is known as renal angle. Tenderness in the kidney is
elicited by applying pressure over the angle with the thumb
 Kidney stones
 Renal failure-In people with renal failure, the kidneys
become unable to filter out waste products from the blood
effectively.
 Kidney hydronephrosis-This means “water on the kidney.”
 It usually occurs when an obstruction prevents urine from
leaving
the kidney, causing intense pain.
 Nephrotic syndrome-Damage to the kidney function causes protein
levels in the urine to increase. This results in a protein shortage
throughout the body, which draws water into the tissues.
 The ureters are two thick tubes which act to transport urine
from the kidney to the bladder.
 Length – 25cm
 Diameter- 3mm
Anatomical Course
The anatomical course of the ureters can therefore
be divided into abdominal and pelvic components.

Abdominal Part
 The ureters arise from the renal pelvis – a funnel like
structure located within the hilum of the kidney. The point
at which the renal pelvis narrows to form the ureter is
known as the uretero pelvic junction.
 The ureters descend through the abdomen, along the
anterior surface of the psoas major.
 Here, the ureters are a retroperitoneal structure
 At the area of the sacroiliac joints, the ureters cross the
pelvic brim, thus entering the pelvic cavity.
 At this point, they also cross the bifurcation
of the common iliac arteries.
Pelvic Part
 within the pelvic cavity, the ureters travel down the lateral
pelvic walls. At the level of the ischial spines, they turn
anteromedially, moving in a transverse plane towards the
bladder.
 Upon reaching the
bladder wall, the ureters
pierce
Its lateral aspect in an
Oblique manner.
Normal constrictions-
1. At the pelvi ureteric junction

2. At the brim of lesser pelvis

3. Point ofcrossing of ureter

by ductus deference or
Broad ligament of uterus
4. Oblique passage
through the bladder
5. At its opening in lateral
angle of trigone
 Anatomical relations of Abdominal part
Right ureter Left ureter
Anterior •3rd part of duedenum •Peritoneum
•Right colic vessels •Gonadal artery
• ileocolic vessels •Left colic vessels
• Root of mesentry •Sigmoid colon
•Terminal part of ileum •Sigmoid mesocolon
•Gonadal vessels
Posterior perotoneum
•Psoas major •Psoas major
•Genitofemoral nerve •Genitofemoral nerve

Medially •Inferior vena cava •Left gonadal vein

•Inferior mesentric vein
 Posteriorly-  Laterally-
 Internal iliac vessels  Superior vesical artery

 Lumbosacral trunk  Obturator artery and nerve

 Middle rectal artery
 Sacroiliac joint
 Fascia covering obturator

internus
 Blood
supply
Ureter is supplied by three sets of long arteries
1. The upper part -renal artery, gonadal or colic vessels
2. Middle part- aorta,gonadal, iliac vessels
3. Pelvic part- vesical, middle rectal, uterine vessels

Nerve supply-
1. Renal, aoertic and hypogastric
plexus.
 Ureteric stone- presence of a solid stone in the urinary tract
formed from minerals within the urine. These can obstruct
urinary flow, causing renal colic (an acute and severe loin pain)
and haematuria (blood in the urine).
 Ureteric colic- this term is used for severe pain due to ureteric
stone . The pain start in the loin and rediates in groin,
scrotum,labium majus and inner thigh.
 Duplex ureter- 2 ureters drains renal pelvis on one side.
 Ureteroceles-cystic dilatation of lower end of ureter.
 The bladder is muscular reservoir of urine.
 Lying in the anterior part of pelvis.

 It plays two main roles:

 Temporary storage of urine

 Assists in the expulsion of urine

Shape of the Bladder-
 Tetrahydral -when empty
 Ovoid- when distended

Capicity –
 Capacity in an adult male 120 to 320 ml.
 Filling beyond 220 ml causes micturition,

 emptied when filled to about 250 to 300 ml.


Filling up to 500 ml may be tolerated, but beyond
this it becomes painful.
 The urinary bladder is situated in the anterior part of the
lesser pelvis immediately behind the pubic symphysis
and in front of rectum in male and uterus in the female. •
 When the bladder is empty it lies entirely within the
lesser pelvis
 when it becomes distended with urine, it expands
upward and forward into the abdominal cavity.
 EXTERNAL FEATURES AND RELATIONS
1. Apex.
2. Base.
3. Neck.
4.Three surfaces
(superior and two
inferolateral surfaces).
5.Four borders
(anterior, posterior
and two lateral).
 APEX
It provides attachment to the median umbilical ligament
and lies posterior to the upper margin of the pubic
symphysis.
 BASE - In the male:

1.Upper part is separated from rectum by the rectovesical

pouch containing coils of the small intestine.
2.Lower part is separated from rectum by the terminal parts
of vasa deferentia and seminal vesicles.
 Neck

It is the lowest and most fixed part of the bladder.

It is situated where the inferolateral and the
posterior surfaces of the bladder meet. It is pierced
by ureters
Mucosa of the bladder
shows irregular folds
except in a small triangular
area over the base •
This area is called

trigone of the bladder.

Here, the mucosa is
smooth. •
Internal urethral orifice

opens
in the apex of this
trigone.
ARTERIAL SUPPLY •
 superior and inferior vesical arteries which are the
branches of anterior division of internal iliac arteries. •
 Obturator and inferior gluteal arteries. • Uterine
and vaginal arteries in the female.
VENOUS DRAINAGE •
 The veins of the bladder do not follow the arteries.
They form a complicated plexus on the inferolateral
surfaces near the prostate called vesical venous
plexus.
 Parasympathetic efferent fibers S2,S3, S4 are motor to the
detrusor muscle and inhibitory to the sphincter vesicae.
 If these are destroyed, normal micturition is not possible.

 Sympathetic efferent fibers (T11 to L2)

 The pudendal nerve (S2, S3, S4) -supplies the

sphincter urethra.
 Urine Retention
 It is the inability to empty the bladder. Urinary retention
can be acute or chronic. Acute urinary retention is a
medical emergency
 Causes of urinary retention include an obstruction in the
urinary tract such as an enlarged prostate or bladder
stones, infections that cause swelling or irritation, nerve
problems that interfere with signals between the brain and
the bladder, medications,constipation, urethral stricture, or
a weak bladder muscle.
 A tubular structure emerging from the neck of bladder
and opens to the exterior
 It is outlet of bladder &

eliminates urine to outside •

 Present in both male &

 female but
there are some
differences b/w the. two
 Male Urethra
 PARTS OF URETHRA
1] Posterior urethra
-near to bladder
i) 4cm in length
ii) Lies in the pelvis
iii) It has 3 parts
1.pre-prostatic part
2.prostatic part
3.membranous part
pre-prostatic part
 1-1.5 cm in length
 Extends vertically from bladder neck to prostate
 Surrounded by proximal urethral sphincter made up
of smooth muscle bundle
prostatic part
 3-4 cm in length
 It passes through the substance of prostate

Membranous part
 shortest part -1.5 cm long
 Passes through perineal membrane
 surrounded by external urethral sphincter made up of
urethral smooth muscle
 Anterior
urethra
It extends from membranous urethra to external
urethral orifice .
1) bulbar urethra –
 lies in the bulbospongiosus (of penis)

 widest part of urethra

 Bulbourethral glands open in it

2)Penile urethra
 lies in corpus spongiosum

 its terminal part is dilated in glans penis k/a navicular

fossa
 numerous urethral glands open in it
SPHINCTERS OF URETHRA –TWO
1 internal urethral sphincter—
involuntary surrounds internal urethral orifice
& preprostatic urethra
2 external urethral sphincter–
voluntary surrounds membranous
urethra
 ARTERIAL SUPPLY
1. Urethral artery -just below the perineal
membrane it runs through the corpus spongiosum, to
reach the glans penis. arises from the internal
pudendal artery •
2. dorsal penile artery – via its circumflex branches
on each side.
Venous drainage
The anterior urethra drains into –dorsal veins of the
penis internal pudendal veins which drain to the
prostatic plexus--internal iliac veins
The posterior urethra drains into –prostatic venous plexus
– vesical venous plexus --internal iliac veins.
 Female urethra

 it is about 4.0 cm
long and 6mm diameter.
 It extends from the neck of bladder

to the external urethral meatus.

 the external orifice is
situated in front of the
vaginal opening
 It is homologous with upper
part of prostatic urethra of
males.
 Location: The female urethra is embedded in anterior
wall of vagina. Thus in cases of difficult child-birth, it
is more likely to be lacerated
 Lumen of Urethra on cross section
 At the internal orifice- crescentic with the convexity
directed in front.
 At the middle- transverse slit.
 At the external orifice- sagittal slit.
 Arterial supply
Superior vesical and veginal arteries
Venous drainage
Venous plexus around urethra– vesical venous plexus–
internal pudendal vein—internal iliac veins.

Clinical antomy of urethra

1. Urithritis- infection and inflammation of
urethra
2. Rupture of urethra
3. Hypospadias- urethra open on ventral of penis
4. Epispadias – urethra open on dorsal of penis