Anatomy

Question 1

Kidneys in nutshell

Answer 1

Location: retroperitoneal, located postero-laterally in front of the posterior abdominal wall
Extent: T12 to L3, moves with respiration, hilum at L1, right kidney at lower level
Structures passing through the hilum: renal vein, renal artery and pelvis of ureter
Coronal section: cortex, medulla, minor calyces, major calyces, renal pelvis
Blood supply : renal vessels
Nerve supply: vasomotor by sympathetic
Lymphatic drainage: lumbar/para-aortic LN

Question 2

Physiologic constrictions

Answer 2

Three, but nowadays only two narrowing are considered:
- just where it comes out of perirenal fat
-ureterovesical junction

-ureteropelvic junction
- crossing of iliac artery (midureter)
- ureterovesical junction

Question 3

Ureter

Answer 3

Retroperitoneal in abdomen and Extraperitoneal in pelvis
Run in front of psoas major (along the transverse processes of lumbar vertebrae)
Cross pelvic brim at the bifurcation of common iliac artery
Turn medially at the level of ischial spine
Oblique course in the wall of bladder up to the ureteric orifices
Relationship with uterine artery in females
3 constrictions: pelvi-ureteric junction, at pelvic brim, at uretero-vesical junction common sites for stones
Peristalsis initiated by pacemaker cells in renal pelvis. Parasympathetics stimulate peristalsis (vagus and S2,3,4)
Ureteric colic: loin to groin. Stretch receptors in collecting system and ureter, pain stimuli pass along sympathetics

Question 4

Bladder

Answer 4

In adults- empty bladder is pelvic, when full enters greater pelvis, 400-500ml capacity
Extraperitoneal, only superior surface covered by parietal peritoneum
Uterovesical pouch in females, rectovesical pouch in males
Behind the symphysis pubis separated by retropubic space of Retzius
Trigone
Smooth muscle lining the wall is detrusor
Blood supply: vesicle arteries from anterior division of internal iliac, obturator artery, uterine artery in females. Vesicle venous plexus drains into internal iliac vein
Nerve supply: sympathetic T11-L2 nerves of filling, parasympathetic S2,3,4- nerves of emptying
Lymphatic drainage: internal iliac nodes

Question 5

Differences between male and female urethra

Answer 5

Male: 20cm long, prostatic, membranous and spongy, 2 bends, catheterisation difficult, IUS: prominent surrounding internal urethral meatus, prevents seminal reflux, smooth muscle, under autonomic control. EUS: surrounds membranous urethra, striated, voluntary, supplied by pudendal nerve. Narrowest at external urethral meatus , more prone to injuries

Female: 4cm long, straight, catheterisation easy, more prone to infections, IUS: no anatomical thickening, autonomic supply, EUS: prominent striated, voluntary supplied by pudendal nerve