Anatomy of the ureter and the urinary bladder Flashcards
1
Q
What structures form the upper urinary tract?
A
Two kidneys
Two ureters
2
Q
What structures form the lower urinary tract?
A
One urinary bladder
One urethra
3
Q
What is the ureter?
A
A muscular tube that extends from the kidney to the posterior surface of the urinary bladder
4
Q
What kind of structure is the ureter?
A
Retroperitoneal
5
Q
What structure is similar to the ureter?
A
The esophagus
6
Q
What is the length and diameter of the ureter?
A
3 to 4mm diameter
25 to 30cm in legth
7
Q
What is the function of the ureter?
A
Transport urine produced in the kidneys to be stored in the bladder
8
Q
What are the mechanisms of action of the ureter?
A
Peristaltic contractions (1 to 5mins)
Hydrostatic pressure & gravity
9
Q
Why are constrictions important?
A
Important for the location of the obstructions
10
Q
What are the locations of the the constrictions of the ureter?
A
- Where the renal pelvis joins the ureter
- Where it crosses the pelvic brim, the pelvic inlet (in front of the common iliac artery)
- Where it pierces the bladder wall
11
Q
Why does the ureter have multiple arterial supplies?
A
It is a long structure; it will not have one singular arterial supply
12
Q
What is the arterial supply of the upper end of the ureter?
A
Renal artery
13
Q
What is the arterial supply of the middle portion of the ureter?
A
Gonadal arteries
14
Q
What is the arterial supply in the pelvis?
A
Superior vesical artery
15
Q
What other structures can be part of the arterial supply of the ureter?
A
Branches of the aorta can also act as a blood supply to the ureter
16
Q
What are the gender relations of the ureter?
A
Males: vas deferens
Females: uterine artery
17
Q
What is the vas deferens?
A
Contains sperm from the testes to the prostatic ureter
18
Q
What does the uterine artery supply?
A
Supplies the ureter
19
Q
What is the location of the uterine artery?
A
Below the broad ligament and above the ureter
20
Q
Why is the location of the uterine artery important?
A
In case of surgery, it needs to located in order to be ligated
21
Q
What is the lymph drainage of the ureter like?
A
Lateral aortic nodes
Iliac nodes
22
Q
What is the innervation of the ureter like?
A
Renal plexus
Testicular/ovarian plexus
Hypogastric plexus
23
Q
What is the lumen of the ureter like?
A
Star-like lumen, in lower magnification, the structure might confused with the esophagus
24
Q
What are the histological layers of the ureter? (4)
A
- Mucosa (&lamina propria)
- Submucosa
- Muscularis
- Adventitia
25
What is the epithelium of the mucosa like?
Transitional epithelium, from the minor calyx all the way to the urethra
26
27
Which parts of the ureter have muscularis?
Upper 2/3 of the ureter
27
What are the sublayers of the muscularis of the ureter?
Inner longitudinal
Middle circular
Outer longitudinal (only in the lower 1/3)
28
What is the outermost layer of the ureter?
Adventitia; it is called that because the ureter is retroperitoneal
29
What is the difference between the muscularis of the GIT and the urinary tract?
Urinary tract: Inner longitudinal, middle circular
GIT: inner circular, outer longitudinal
30
What is the volume of the bladder normally?
500 to 700ml
31
What is the location of the bladder when empty?
In the pelvic cavity, directly behind the pubic bone (pubic symphysis)
32
What happens to the location of the bladder as it fills up?
It bulges into the abdomen
33
Why is the bladder a pelvic organ in adults but not in children?
Because in children the pelvis is still growing and evolving
34
Which layer of the ureter contains the plexus?
Submucosa
35
What is the location of the bladder like in females, and why is that?
It is lower in females than it is in males due to the absence of the prostate, --> rests directly on the urogenital diaphragm
36
What does the urogenital diaphragm separate?
The perineum and the true pelvis
37
What are the shapes of the bladder?
Empty: pyramidal
Filled: ovoid
38
What are the different surfaces of the bladder?
Superior: roof
Inferiolateral Surfaces
Anterior: apex
Posterior: base
39
What covers the roof of the bladder?
Covered by peritoneum --> infraperitoneal or extraperitoneal structure
40
Which structures are related to the base of the bladder?
Seminal vesicles
Vas deferens
Ampulla of vas deferens
41
What are the relations of the roof of the bladder in males?
Coils of ileum
Sigmoid colon
42
What are the relations of the roof of the bladder in females?
Body of uterus
Utero-visceral pouch
43
What are the structures related to the inferolateral surfaces? (3)
1. Retropubic pad of fat (behind the pubic bone)
2. Obturator internus muscle (covers the obturator foramen)
3. Levator ani muscle
44
What is the relation between the obturator internus muscle and the levator ani muscle?
The obturator internus muscle gives rise to the levator ani muscle
45
What are the pouches found in women and what are their importnace ?
The ureterovesical pouch and rectouterine pouch (pouch of Douglas) fill up with blood and fluid and usually require draining
46
How many ligaments does the apex have?
3; median umbilical ligament and medial umbilical ligaments
47
What is the urachus?
The communication between the yolk sac and urinary bladder --> it is an embryological structure which gets obliterated and becomes the median umbilical ligament
48
What gives rise to the medial umbilical ligaments?
Obliterated umbilical arteries
49
What gives rise to the lateral umbilical ligaments?
The inferior epigastric artery and veins
50
What is the shape of the base of the bladder like?
Triangular; formed by the ureters (superiorly) and the origin of the urethra (inferiorly)
51
What are the relations of the base of the bladder?
The vasa deferens (male)
Seminal vesicles (male)
Vagina (female)
Rectum
52
What are the internal structures of the urinary bladder?
Rugae
Trigone
53
What is the trigone of the bladder like?
Always smooth because it is derived from the embryological structure; mesonephric duct
54
What happens if the median lube of the prostatic gland enlarges?
Enlargement and elevation of sphincter/uvula vesicae, which causes accumulation of urine in the pouch of stagnant urine
55
Where is the trigone of the bladder found?
The base of the bladder
56
What is the arterial blood supply of the urinary bladder? What are they branches of?
Superior vesical artery
Inferior vesical artery
--> Both branches of internal iliac artery
57
What is the venous drainage of the urinary bladder?
Prostatic plexus
58
What are the histological layers of the urinary bladder?
Mucosa (& lamina propria)
Muscularis
Adventitia/serosa
59
What are the sublayers of the muscularis layer of the urinary bladder?
Inner longitudinal
Middle circular
Outer longitudinal
The detrusor muscle is usually found there; very thick muscle
60
What are the points of innervation of the urinary bladder?
Autonomic innervation
Voluntary control --> requires sensation
61
What is the pathway that the nerves of the urinary bladder follow? (Parasympathetic)
Afferent nerves --> stretch receptors --> visceral sensory --> pelvic splanchnic nerves --> S2, 3, 4
62
What is the effect of the parasympathetic innervation on the urinary bladder?
Activate pelvic splanchnic nerves --> stimulate detrusor muscle and inhibit internal urethral sphincter (relaxes it) --> urination
63
Is the internal urethral sphincter voluntary or involuntary?
Involuntary --> innervated by pelvic splanchnic nerves
64
Where do the somatic control fibres arise from?
S2, 3 and 4
65
Which nerve acts on the external urethral sphincter?
The pudendal nerve
66
What is the sympathetic innervation of the urinary bladder like?
L1 and L2
67
What is the sympathetic innervation of the urinary bladder like?
Efferent neurons —> sympathetic nervous system —> inferior hypogastric plexuses
68
Where do the inferior hypogatsric plexuses act?
It inhibits the detrusor muscle and stimulates the internal urethral sphincter —> prevents urination
69
What are the effects of the different innervations on micturition?
Sympathetic —> inhibits
Parasympathetic —> stimulates
Somatic motor —> inhibits
70
What is the effect of different innervation on retention?
Sympathetic —> stimulates
Parasymapthetic —> inhibits
Somatic motor —> stimulates
71
What is the shape of the prostate?
Walnut shape
72
What is the shape of the prostate?
Walnut shape
73
What are the surfaces of the prostate?
Base; bladder neck
Apex; urogenital diaphgarm
74
What are the relations of the prostate?
Anterior; fat in retropubic space —> pubic symphisis
Posterior; retro visceral septum —> rectal ampulla
75
What are the coverings of the prostate?
Inside: fibrous capsule
Outside: fascial sheath
76
What is between the two coverings of the prostate?
Prostatic venous plexus, the urinary bladder drains in it
77
What forms the prostatic venous plexus?
Vesicular venous plexus
Internal vertebral venous plexus
78
What is the importance of the prostatic venous plexus being in communication with the internal vertebral plexus?
CA metastasis; in cases of cancer it can lead to metastasis of axial skeleton
79
What is arterial supply of the prostate?
Inferior vesicular artery
Middle rectal artery
80
What are the lobes of the prostate?
Anterior
Median
Posterior
2 Lateral
81
What is the location of the anterior lobe of the prostate?
In front of the urethra
82
What is the location of the median lobe of the prostate?
Between urethra & ejaculatory ducts
83
What is the location of the posterior lobe of the prostate?
Behind urethra and below ejaculatory ducts
84
What are the positions of the 2lateral lobes of the prostate?
On either side of the urethra
85
What is the anterior lobe of the prostate like?
Devoid of glands —> fibromuscular
86
What is the median lobe of the prostate like?
Bladder trigone —> stagnant urine (in the case of the median lobe enlargement)
Rich in glands
87
What makes up the posterior and the 2 lateral lobes of the prostate?
Glandular tissue
88
What are the different zones of the prostate?
Muscular zone (isthmus)
Central zone
Peripheral zones
89
Which lobe associates with the muscular zone?
Anterior
90
Which zone is associated with the median lobes?
Central zone
91
What lobes are associated with the peripheral zones?
Posterior and 2 lateral ones
92
What are histological layers of the prostate?
Branched tubuloalveolar glands
Dense fibromuscular stroma
93
What kind of glands are found in the lumen of the prostate? What do they secrete?
Branched tubuloalveolar glands, which secretes corpora amylacea
94
When is there a physiological increase of secretion of corpora amylacea? Why?
Increased secretion with age, because of the physiologic prostatic hyperplasia that occurs with age
95
What are the different zones of the branched tubuloalveolar glands?
Transitional zone
Central zone
Peripheral zone
96
What percentage does each each zone of the branched tubuloalveolar glands make up?
Transitional zone; 5%
Central zone; 25%
Peripheral zone; 70%
97
What are the gland types in the transitional zone of the prostate?
Mucosal glands
98
What are the gland types in the central zone of the prostate?
Submucosal glands
99
What are the gland types of the peripheral zone of the prostate?
Main glands
100
Which type of glands of the prostate are associated with inflammation and cancer?
Main glands
101
What is the lining of the urethra like in females?
Close to the bladder;transitional epithelium
The rest of the urethra; stratified squamous nonkeratinised epithelium
102
What are the layers of the female urethra?
Lining
Mucous secreting glands
Muscularis
103
What are the layers of the muscularis of the female urethra?
Inner longitudinal
Outer circular
104
What are the different parts of the male urethra?
1. Preprostatic part of the urethra (intramural part)
2. Prostatic part of urethra
3. Membranous part of the urethra (part of the urogenital diaphragm)
4. Spongy part of the urethra
105
What is the length of the prostatic urethra?
3 to 4cm
106
What is the length of the intermediate part of the urethra?
1 to 2cm
107
What is the length of the spongy urethra?
15cm
108
What is the epithelium that lines the prostatic urethra?
Transitional epithelium
109
What structures does the prostatic urethra receive?
Prostatic ducts
Two ejaculatory ducts
110
What is the urethral crest?
Elevation in posterior surfaces of prostatic urethra
111
What is the prostatic utricle?
Remnant of the uterus and vagina
112
What is the epithelium of the intermediate urethra like?
Stratified columnar epithelium
113
What structures does the intermediate urethra pass through?
Perineal muscles
114
What structures does the intermediate urethra pass through?
Perineal muscles
115
Where is the spongy urethra located?
Corpus spongiosum
116
What kind of epithelium lines the spongy urethra?
Stratified columnar epithelium and stratified squamous epithelium
117
Which part of the spongy urethra is lined by stratified squamous epithelium?
Navicular fossa
