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Renal > 1.3: Anatomy of Lower Urinary Tract > Flashcards

1.3: Anatomy of Lower Urinary Tract Flashcards

1
Q

What parts of the urinary tract are found in the pelvis?

A

Distal Ureter

Bladder

Proximal Urethra

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2
Q

What parts of the urinary tract are found in the perineum?

A

Distal Urethra

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3
Q

At what level does the abdomen become the pelvis?

A

At the level of the hip bones (Iliac Crests)

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4
Q

What is the pelvis split into?

A

False Pelvis

True Pelvis

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5
Q

What is the divide between the false pelvis and the true pelvis?

A

The pelvic rim

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6
Q

Name the parts of this diagram?

A

A = Pelvic Inlet

B = False Pelvis

C = True Pelvis

D = Pelvic Floor Muscles

E = Perineum

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7
Q

What is the differentiation between the true pelvis and perineum?

A

The pelvic floor (More specifically the levator ani)

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8
Q

Describe the pelvic floor?

A

This is composed of a number of muscles

Formed by the bowl shaped ‘pelvic diaphragm’

One of the muscles is the levator ani muscle

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9
Q

What is the main muscle of the pelvic floor called? (Muscle of the pelvic diaphragm)

A

Levator Ani

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10
Q

Where does the false pelvis go from?

A

From the iliac crests to the pelvic inlet

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11
Q

Where does the true pelvis go from?

A

From the pelvic inlet to the pelvic floor

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12
Q

Which part of the pelvis is the bladder found in?

A

True Pelvic (Pelvic Cavity)

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13
Q

How does the urethra get into the perineum from the pelvic cavity?

A

Passes through the pelvic floor

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14
Q

What are the openings in the pelvic floor for?

A

For the distal parts of the alimentary, renal and reproductive tracts to pass through

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15
Q

What are the borders of the perineum?

A

From the pelvic floor to the external skin

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16
Q

Describe the depth of the perineum - deep or shallow?

A

Shallow

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17
Q

What part of the urinary tract is contained in the perineum?

A

The urethra

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18
Q

Describe where the ureters cross the common iliac arteries?

A

The ureters cross the common iliac arteries at the pelvic brim

This is often the point of bifurcation

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19
Q

Do the ureters pass anteriorly or posteriorly to the common iliac arteries when they enter the pelvis?

A

The ureters pass ANTERIORLY to the common iliac arteries when the enter the pelvis

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20
Q

Describe the direction of the ureters once they have crossed the common iliac arteries?

A

They run along the lateral walls of the true pelvis

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21
Q

What happens when the ureters reach the ischial spine?

A

The ureters turn medially once the reach the ischial spine.

They enter the posterior aspect of the bladder

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22
Q

The ureters turn medially to enter the posterior aspect of the bladder

At what landmark do they turn medially?

A

The ischial spine

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23
Q

Describe the position of the ureters in relation to the peritoneum when they are in:

  • The abdomen
  • The pelvis
A

When in the abdomen they are retroperitoneal

When in the pelvis they are sub peritoneal

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24
Q

What direction do the ureters enter the bladder? Why?

A

Ureters enter the bladder in an inferiomedial direction

Helps prevent urine reflux

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25
Q

What is the pouch between the rectum and bladder (in males) called?

A

Retrovesicle pouch

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26
Q

What is the deepest part of the peritoneal cavity in males?

A

Retrovescile pouch

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27
Q

Identify this diagram (A –> J)?

A

A = Right Ureter

B = Right Iliac Artery

C = Right Iliac Vein

D = Right Testicular Vessels

E = Vas Deferens (At deep inguinal ring)

F = Retrovesicle Pouch

G = Rectum

H = Bladder

I = IVC

J = Sigmoid Colon

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28
Q

In females, what is the pouch between the rectus and uterus called?

A

Rectouterine Pouch OR Pouch of Douglas

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29
Q

In females, what is the pouch between uterus and bladder called?

A

Vesico-uterine pouch

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30
Q

What is the deepest part of the peritoneal cavity in females?

A

Rectouterine pouch (pouch of douglas)

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31
Q

Identify the labels (A–>I)?

A

A = Right Ureter

B = Right Ovary

C = Right uterine tube

D = Vesico-uterine pouch

E = Recto-uterine pouch (pouch of douglas)

F = Inferior part of parietal pleura

G = Bladder

H = Uterus

I = Rectum

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32
Q

What is lateral to the ureter in females?

A

The suspensory ligament of the ovary

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33
Q

Describe the anatomical relationship of the ureter, uterine tubes and uterine artery in females?

A

The ureter is inferior to the uterine tubes and uterine artery (water under the bridge)

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34
Q

Describe the anatomical relationship of the vas deferens and the ureter in males?

A

The ureter runs inferiorly to the vas deferens

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35
Q

The arteries entering the pelvis are mainly branches from the …?

A

Internal Iliac Artery

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36
Q

Describe the blood supply to the pelvis in females?

A
  • Vesical Arteries (to bladder)
  • Middle Rectal Artery
  • Uterine Artery
  • Vaginal Artery
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37
Q

Describe the blood supply to the pelvis in males?

A
  • Vesical Arteries
  • Middle Rectal Artery
  • Prostatic Arteries
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38
Q

Which arteries are seen in the pelvis of both males and females?

A

Vesical Arteries

Middle Rectal Artery

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39
Q

Which arteries are specific to:

  • Females?
  • Males?
A

Females have the vesical arteries, middle rectal artery AND the vaginal artery and uterine artery

Males have the vesical arteries, middle rectal artery AND prostatic arteries

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40
Q

The prostatic arteries are branches of which arteries?

A

Vesical Arteries

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41
Q

What do vesical arteries supply?

A

The Bladder

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42
Q

When empty, where is the bladder contained?

A

Within the true pelvis

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43
Q

When the bladder begins to fill, where does it expand into?

A

Can expand into the false pelvis

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44
Q

Describe the relationship between the bladder and the peritoneum?

A

Only the superior border of the bladder is in contact with the peritoneum

This relationship stays constant even when the bladder is full or empty

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45
Q

Where is the prostate in relation to the bladder?

A

Below the bladder

46
Q

What is the part of the ureter that passes through the prostate called?

A

The prostatic ureter

47
Q

What is the triangle of the bladder called?

A

The Trigone

48
Q

What makes up the top corners (base) of the trigone/bladder triangle?

A

Left and right ureteric orifices

49
Q

What are the left and right ureteric orifices?

A

This is where the ureter from the kidneys opens into the bladder

50
Q

What is the point of the bladder triangle/trigone?

A

This is the internal urethral orifice

51
Q

Describe the internal urethral orifice?

A

This is where the bladder empties into the urethra

52
Q

What muscle surrounds the ureteric orifices? Function?

A

The detrusor muscle fibres encircle the ureteric orifices

When the bladder contracts to expel urine, these fibres also contract to prevent back flow of urine

53
Q

The muscle that forms the main bulk of the bladder wall is called the…?

A

Detrusor Muscle

54
Q

Describe the internal urethral sphincter muscle?

A

This is seen in males only

Formed by the detrusor muscle fibres around the internal urethral orifice

Contracts during ejaculation to prevent semen back flow

55
Q

Name the labels on this diagram? (A–>D)

A

A = Ureteric Orifices

B = Internal Urethral Orifice

C = Urethra

D = Prostate Gland

56
Q

What is the most anterior organ in the pelvis?

A

The bladder (when empty)

57
Q

Describe the anatomical relationships between the uterus and bladder in females?

A

The uterus sits superior to the bladder in an anteflexed position

They are separated by the vesico-uterine pouch

Most of the weight of the uterus is borne by the bladder

58
Q

Describe the anatomical relationships between the prostate and bladder in males?

A

In males, the prostate is inferior to the bladder

The rectum is posterior to the bladder

The rectovesical pouch is between the bladder and rectum

59
Q

What are the two types of catheterisation?

A
  • Urethral
  • Suprapubic (if urethra is blocked)
60
Q

Name the labels A –> L

A

A = Bladder (Empty)

B = Internal Urethral Orifice

C = Urethra

D = Level of the levator ani (pelvic floor)

E = External Urethral Sphincter (Voluntary)

F = External Urethral Orifice

G = Vaginal Orifice

H = Anus

I = Perineum

J = Pelvis

K = Rectum

L = Uterus

61
Q

Which is longer, the male or female urethra?

A

Male

62
Q

Label the diagram (A –> K)

A

A = Ureter

B = Pelvis

C = Levator Ani/Pelvic Floor

D = Perineum

E = Spongy Urethra (Within corpus spongiosum)

F = External Urethral Orifice

G = External Urethral Sphincter (Voluntary)

H = The prostatic urethra

I = Prostate Gland

J = Internal Urethral Sphincter (Involuntary)

K = Internal Urethral Orifice

63
Q

What is the black arrow pointing at?

A

Corpus Spongiosum

64
Q

Describe the route sperm follows in the male reproductive system?

A

Produced in testes

Stored in epididymis

Travels in the vas deferens

Through spermatic cord

Spermatic cord passes through superficial ring, inguinal canal then deep ring

Vas deferent then enters abdomen

Passes posterior to bladder

Joins with seminal duct to become ejaculatory duct

Becomes prostatic urethra

Becomes spongy urethra

Exits through external urethral orifice

65
Q

Where is sperm produced?

A

Testicles

66
Q

Where is sperm stored?

A

Epididymis

67
Q

What happens to sperm in the epididymis?

A

Goes into the vas deferens

Vas deferens passes through spermatic cord

Passes through the superficial ring then inguinal canal then exits through the deep ring

68
Q

What happens to sperm once it has left the deep ring of the inguinal canal?

A

Enters the abdomen

Passes posteriorly behind the bladder

69
Q

What happens to the vas deferens/sperm after it has passed posteriorly to the bladder?

A

Joints with seminal duct (gets semen)

Becomes ejaculatory duct

70
Q

What happens to the ejaculatory duct after it has formed?

A

Passes into prostate

Joints with prostatic urethra

71
Q

What happens to the prostatic urethra (which contains sperm and semen) after it exits the prostate?

A

Become the spongy urethra

Exits through the external urethral orifice (ejaculation)

72
Q

What is the embryological origin of the testicles?

A

Posterior abdominal wall

73
Q

Describe movement of the testicles from original position to final position?

A

Testes descend from the posterior abdominal wall into the scrotum through the inguinal canal

Should be descended by birth

74
Q

The spermatic cord goes through the inguinal canal and contains a number of important structures. Name them:

A
  • Testicular arteries
  • Testicular veins
  • Vas Deferens
  • Lymphatic Drainage
  • Nerves
75
Q

The testes sit inside a sac. What is this sac called?

A

Tunica Vaginalis

76
Q

What are the two layers of the tunica vaginalis?

A

The parietal layer (fibrous outer part)

The visceral layer (covers the testicle)

77
Q

What is between the parietal and visceral layers of the tunica vaginalis?

A

A small amount of serous fluid

78
Q

What is excess fluid between the parietal and visceral layers of the tunica vaginalis called?

A

Hydrocele

79
Q

What is a hydrocele?

A

Excess fluid accumulation between the two layers of testicles - the visceral and parietal layers of tunica vaginalis

80
Q

What is the appendix testis?

A

An embryological origin - has no function

81
Q

What can happen to the appendix testis?

A

Can twist (torsion) and cause pain

82
Q

What does this photo show?

A

A hydrocele

83
Q

The testes and the epididymis are connected to the …. superiorly

Fill in the blank?

A

The testis and the epididymis are connected to the spermatic cord superiorly

84
Q

Is the testicle very mobile or very immobile? Complications of this?

A

The testicles are very mobile

This can lead to testicular torsion –> Causes pain and can lead to necrosis

85
Q

What is contained within the spermatic cord?

A
  • Testicular artery
  • Vas Deferens
  • Pampiniform Plexus
86
Q

What is the pampiniform plexus?

A

This is a network of veins found in the spermatic cord that drains the testes and epididymis

87
Q

Label this diagram (A–>D)?

A

A = Vas Deferens

B = Testicular Artery

C = Pampiniform (Venous) Plexus

D = Spermatic Cord

88
Q

Describe the blood supply and drainage of the testes?

A

Left and right testicular arteries

Left and right testicular veins

89
Q

Where do the testicular arteries arise from? How do they pass to the testicles?

A

Arise from abdominal aorta

Pass to the testicles in the spermatic cord

90
Q

Describe the drainage of the testes? Where do these veins drain?

A

Left testicular vein drains into left renal vein

Right testicular vein drains into IVC

91
Q

What passes in/out of the deep inguinal ring?

A

Testicular Arteries

Testicular Veins (Pampiniform Plexus)

Vas Deferens

Lymphatics

Nerves

92
Q

Where specifically in the testicles is the sperm produced?

A

Seminiferous tubules

93
Q

Which part of the testicles is the epididymis found at?

A

Superior pole

94
Q

Describe what happens to sperm produced by the seminiferous tubules?

A

Passes to the epididymis for storage

95
Q

Describe the route of sperm from testicles to ejaculation?

A
  • Carried in vas deferent which passes through spermatic cord - Travels through superficial ring, inguinal canal then deep ring - Passes posterior to the bladder
  • Joins with seminal duct to form ejaculatory duct
  • Ejaculatory duct drains into prostatic urethra
  • Drains into spongy urethra
  • Ejaculation via external urethral orifice
96
Q

Describe the size of the prostate?

A

Walnut Sized

97
Q

Describe the zones of the prostate?

A

Peripheral zones (palpated on digital rectal exam)

Central zones (between bladder and prostatic urethra)

98
Q

Label this diagram (A–>D)?

A

A = Peripheral Zones

B = Prostatic Urethra

C = Peripheral Zone

D = Central Zone

99
Q

Which zone do prostate cancers most commonly occur in?

A

Peripheral Zone

100
Q

Label this diagram (A–> H)

A

A = Root

B = Body

C = Glans

D = External Urethral Orifice

E = Corpus Spongiosum

F = Skin

G = Superficial and Deep Fascia

H = Corpus Cavernosum

101
Q

Label this diagram (A–>E)?

What lies deep to B?

A

A = Glans

B = Penile Raphe

C = Scrotal Raphe

D = Scrotum

E = Anus

The spongy urethra within the corpus spongiosum lies deep to B, the penile raphe

102
Q

What is another name for the foreskin?

A

Prepuce

103
Q

Describe retraction of the prepuce?

A

Prepuce (foreskin) can constrict the neck of the penis causing swelling and pain Treatment is circumcision (KGB)

104
Q

Describe the blood supply to the penis?

A

Via the:

  • Deep arteries of the penis
  • Branches of the internal pudendal artery (from the internal iliac)

Supply comes from internal iliac only

105
Q

Describe the blood supply to the scrotum?

A

Via the:

  • Internal Pudendal Artery (from internal iliac)
  • Branches from the external iliac

Supply comes from internal iliac and external iliac

106
Q

Match these options to the correct answer.

A = Supply from internal iliac only

B = Supply from both internal iliac and external iliac

Choose from penis and scrotum.

A

Penis = A (Supply from internal iliac only)

Scrotum = B (Supply from internal and external iliac)

107
Q

Where does lymph from the scrotum and most of the penis drain to?

A

Superficial Inguinal Lymph Nodes

108
Q

Where does lymph from the testes drain to?

A

Lumbar Nodes around abdominal aorta

109
Q

Why do the testes have lymph drainage to the lumbar nodes around the abdominal aorta?

A

Due to embryological origins of the testes being in the posterior abdominal wall

110
Q

Where does the glans of the penis lymph drainage go to?

A

Deep inguinal nodes

111
Q

Summarise lymph drainage:

  • Penis
  • Glans
  • Scrotum
A

Penis = Superficial Inguinal Nodes

Glans = Deep Inguinal Nodes

Scrotum = Lumbar Nodes

Renal (34 decks)

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