Anatomy of Urological Surgery

Question 1

List the urological structures of the body.

Answer 1

1 - Kidneys.

2 - Adrenal glands.

3 - Bladder.

4 - Prostate.

5 - Pelvis.

6 - Penis.

7 - Testis.

8 - Abdominal walls (anterior and posterior).

Question 2

Which layer of connective tissue encases the kidneys?

Answer 2

Gerota’s fascia.

Question 3

List the structures that traverse the diaphragm.

Answer 3

1 - Aorta.

2 - Inferior vena cava.

3 - Azygos veins.

4 - Thoracic duct.

5 - Phrenic nerve.

Question 4

What are the crura of the diaphragm?

Where are their attachments?

Answer 4

• The tendinous leg-like projections of the diaphragm that bind the diaphragm to the spine.
• The right crus attaches to the L3 vertebral body.
• The left crus attaches to the L2 vertebral body.

Question 5

Through which opening of the diaphragm does the thoracic duct pass?

Which other structure pases through this opening?

Where in the diaphragm is this opening?

Answer 5

• The aortic hiatus.
• The aorta also passes through the aortic hiatus.
• The aortic hiatus is located posteriorly, near the spine.

Question 6

Which structure traverses the diaphragm immediately anterior to the aorta?

What is the name of the opening in the diaphragm through which this structure passes?

Answer 6

• The oesophagus.

- It passes through the oesophageal hiatus.

Question 7

Which nerves travel with the oesophagus through the oesophageal hiatus?

Answer 7

The anterior and posterior vagal trunks.

Question 8

Through which area of the diaphragm does the inferior vena cava pass?

Answer 8

The central tendon of the diaphragm.

Question 9

Which nerves innervate the diaphragm?

What are their roots?

Answer 9

• The left and right phrenic nerves.

- C3, 4 and 5.

Question 10

What is the function of latissimus dorsi?

Answer 10

They contract the arms to lift the body upwards.

Question 11

To which rib does the kidney have the closest relations?

Answer 11

The 12th rib.

Question 12

Which layer of connective tissue encloses the muscles surrounding the kidney?

Answer 12

Lumbodorsal fascia.

Question 13

Why might a patient with spinal tuberculosis (Pott’s spine) present with a lump in the groin?

Answer 13

Because pus from an abscess from the spine can flow through the lumbodorsal fascia into the femoral triangle.

Question 14

Describe the organisation of layers of the anterior abdominal wall from deep to superficial.

Answer 14

Two layers of fascia:

1 - Camper’s fascia.

2 - Scarpa’s fascia.

Three layers of aponeuroses:

3 - External oblique.

4 - Internal oblique.

5 - Transversus abdominis.

Question 15

Which hernias are the most common?

Answer 15

Inguinal hernias.

Question 16

What is the evolutionary function of the inguinal canal?

List the contents of the inguinal canal in males and females.

What was the tradeoff?

Answer 16

• The testes function best at 33 degrees C, so they developed outside the body.
• In males, the inguinal canal serves as a passage for the spermatic cord and ilioinguinal nerve.
• In females, the inguinal canal serves as a passage for the round ligament of the uterus, ilioinguinal nerve and genitofemoral nerve.
• The tradeoff is that the canal, like most ring structures in the body, are susceptible to hernias.

Question 17

List the layers of muscle bordering the posterior abdominal wall from deep to superficial.

Answer 17

1 - Psoas major.

2 - Quadratus lumborum.

3 - Latissimus dorsi and, at the same depth of the wall:

4 - Sacrospinalis.

Question 18

List the layers of peritoneum.

Answer 18

1 - Parietal peritoneum.

2 - Visceral peritoneum.

Question 19

What are the vertebral levels of the kidneys?

Why are the kidneys not at the same levels?

Answer 19

• The right kidney is between vertebral levels L1 and L3.
• The left kidney is between vertebral levels T12 and L3.
• The right kidney is lower because it is displaced by the liver superiorly.

Question 20

What is situs inversus?

Answer 20

A congenital condition in which the major visceral organs are reversed.

Question 21

What is dextrocardia?

Answer 21

A congenital condition in which the heart is rotated towards the right side of the chest rather than the left.

Question 22

List the relations of the right kidney.

Answer 22

Superior:

1 - The right adrenal gland.

2 - The liver.

3 - The hepatorenal ligament.

Middle:

4 - 2nd part of the duodenum (descending).

5 - Colic flexure.

Inferior:

6 - Small intestine.

Question 23

What is the hepatorenal ligament?

Answer 23

The ligament formed by the parietal peritoneum that attaches the kidney to the posterior liver.

Question 24

List the relations of the left kidney.

Answer 24

Superior:

1 - Left adrenal gland.

2 - Tail of the pancreas.

3 - Splenorenal ligament.

Middle:

4 - Splenic flexure.

5 - Descending colon.

Inferior:

Small intestine.

Question 25

What is the splenorenal ligament?

Answer 25

The ligament formed by the parietal peritoneum that attaches the kidney to the spleen.

Question 26

What is the splenic flexure?

Answer 26

The bend between the transverse and descending colon.

Question 27

What is the colic flexure?

Answer 27

The bend between the transverse and ascending colon.

Question 28

On a transverse CT scan, how can the aorta be told apart from the vena cava?

Answer 28

The aorta is on the left whereas the vena cava is on the right (of the patient).

Question 29

List the anatomical differences between the left and right blood supplies to the kidneys.

Answer 29

1 - The right renal vein is shorter than the left renal vein.

2 - The right renal vein receives blood directly from the right kidney and has no other branches, whereas the left renal vein has 3 other tributaries:

• Left gonadal vein.
• Left lumbar vein (there are other lumbar veins that branch directly from the vena cava).
• Left adrenal vein.

Question 30

Why does the right gonadal vein join directly with the vena cava whereas the left gonadal vein joins with the left renal vein?

Answer 30

Because the aorta is on the left side of the vena cava, preventing the gonadal vein from joining with the vena cava on the left side.

Question 31

What is a varicocele?

What causes it?

Answer 31

• An enlarged vein in the scrotum.

- It is caused by a distended left gonadal vein.

Question 32

List the 3 anterior branches of the aorta.

Answer 32

1 - Coeliac trunk.

2 - Superior mesenteric artery.

3 - Inferior mesenteric artery.

Question 33

How do testicular cancers spread to the lymph?

Answer 33

By rising through the left and right gonadal veins to the lymph nodes surrounding the great vessels.