Case 8 Flashcards
The ureters are continuous with the renal pelvis at what junction?
The ureteropelvic junction
What is the ureters’ relationship to the peritoneum?
It is retroperitoneal
The ureters descend on the medial aspect of what muscle?
psoas major
The ureters cross what as they pass through the pelvic brim?
The end of the common illiac arteries or the start of the external iliac arteries
What are the three points where the ureter are constricted?
The uretopelvic junction, where they cross the common iliac vessels at the pelvic brim and where the ureters enter the wall of the bladder.
What supplies blood flow to the upper portion of the ureters?
the renal arteries
What supplies blood flow to the middle portion of the ureters?
branches of the abdominal aorta, the testicular/ovarian arteries and the common iliac arteries
What supplies blood flow to the ureter in the pelvic cavity?
branches of the internal iliac arteries
What are the three layers of the ureters from innermost to outermost?
inner mucosa, central muscular layer and an outer connective tissue (adventitial) layer
What type of structure is the inner mucosa of the ureters made of?
an internal transitional epithelium with a surrounding lamina propria, which is thick and elastic
What is the arrangement of the muscle of the upper two thirds of the ureters?
It has two layers of smooth muscle, an inner longitudinal one and an outer circular one
What is the arrangement of the muscle of the bottom third of the ureters?
There are three layers of smooth muscle a central circular layer with two longitudinal inbetween
What is the most anterior element of the pelvic viscera?
The bladder
The bladder is shaped like a three sided pyramid describe its surface and how it lies within the body
It has an apex and a base, two inferolateral surfaces and asuperior surface
The apex of the bladder is directed to what anatomical feature? It is supported by which ligament? What does this attach it to?
The apex of the bladder is pointed toward the pubic symphysis. The apex of the bladder is attached to the umbilicus by the median umbilical ligament
The base of the bladder is posed in what direction?
posteroinferiorly
What is the trigone of the bladder?
The smooth triangular shaped area at the base of the bladder where the mucosal lining of the bladder is smooth and firmly attached to the muscle coat of the wall
The inerolateral sides of the bladder are cradled between what muscles?
The levator ani muscles of the pelvic diaphragm and the adjacent obturator internus muscles
The neck of the bladder is connected to the inferioposterior aspect of the the pubic bone by tough fibromuscular bands what are they called?
pubovesical ligament in wommen and puboprostatic ligaments in men
What happens to the transitional epithelium of the bladder under pressure?
It an stretch until it resembles squamous epithelium
How long is the female urethra?
4cm long
What does the female urethra pass through what does it open to at the end?
it passes through the pelvic floor inferiorly into the perineum then through the deep perineal pouch and perineal membrane then opens in the vestibule between the labia minora
What is the name of the two small para-urethral mucous glands that open onto the lateral margins of the external urethral orifice?
skene’s glands
How long is the male urethra how many times does it bend throughout its course?
it is 20cm and bends twice
What are the four parts of the urethra?
preprostatic, prostatic, membranous and spongy
What is the role of the internal urethral sphincter?
it helps prevent retrograde movement of semen into the bladder during ejaculation
How long is the preprostatic part of the urethra? What structure is it associated with?
It is 2cm long and associated with the internal urethral sphincter
How long is the prostatic part of the urethra?
3-4cm long
The lumen of the prostatic portion of the urethra is marked by which fold of mucosa? What are the notable features on this structure?
It is marked by the urethral crest, each side of this has a depression called the prostatic sinus, it also is enlarged either side midway along its length to form a circular elevation called the seminal colliculus
What opens onto the semial colliculus?
the prostatic utricle/ the opening of the male ejaculatory duct
What does the membranous part of the urethra pass through? What is it surrounded by in men and women?
It passed through the deep perineal pouch, it is surrounded by the external urethral sphincter
Where do the bulbourethral glands open into the penis?
the bulb of the spongy urethra
What type of epithelium is the urethral lining composed of?
stratified squamous epithelium the starts as transition at the next then becomes stratified columnar at the midpoint and stratified columnar at the end. The lamina propria is thick and elastic and its mucosa is folded in the folds are mucin secreting cells and the lumen is kept closed when not uniating
What are the anatomical relations of the prostate?
it is inferior to the bladder, posterior to the pubic symphysis and anterior to the rectum
What are the four divisions of the prostatic parenchyma?
peripheral, central transitional and the anterior fibromuscular stroma
How much of the prostate is made up of the peripheral division?
70%
How much of the prostate is made up of the central division?
25%
How much of the prostate is made up of the transitional zones?
5%
How much of the prostate is made up of the anterior fibromuscular stroma?
5%
What is fibrinolysin? What is its role in semen?
It is a hydrolytic enzyme released in the prostate that liquefies coagulated semen allowing it to flow
What coordinates the flow of urine to the bladder via the peristalsis of the ureters?
The micturition reflex
What is the effect of bladder filling activating stretch receptors, what are the two consequences of this?
Afferent fibers in the pelvic nerves carry impulses to the sacral spinal cord increasing their activity. This both fascilitates parasympathetic motor neurons in the sacral spinal cord and stimulates interneurons that relay sensation via the thalamus and its projection fibers to the cortex making one aware of the fluid pressure in the bladder
What nerve innervates the external urethral sphincter?
The pudendal
Where it the micturation center that controls most of urination?
The pons
Men over what age typically experience BPH? What ethnicity experiences it less?
over 60, it is less common in asian individuals
What is the main hormone implicated in BPH?
dihydrotestosterone
What enzyme present in prostate stromal cells converts testosterone to DHT?
type 2 5 alpha reductase
What enzyme is present in the liver and skin can convert testosterone to DHT?
Type 1 5 alpha reductase
What receptor is activated by DHT? What is the most important growth factor that is produced in greater numbers because of this?
nuclear androgen receptor (AR) is activated. THe most imporant growth factor is FGF-7
Apart from FGF-7 what are three other important growth factors in BPH? What do they stimulate?
FGF-1 and FGF-2 and TGF-beta are important as they stimulate fibroblast proliferate
Medical treatments for BPH involve the inhibition of what?
alpha1 adrenergic receptor and 5-alpha reductase
What proportion of men over 80 will have a milignant foci in their prostatate?
80%
Prostatic cancer accounts for what proportion of cancer in men?
7%
Why are PSA tests so unreliable?
they can often give false positives and 20%of men with prostate cancer have normal PSA levels
What is pyuria?
White blood cells in excreted urine
The distribution of uretal pain is usually along what nerves?
T11-T12
What is oliguria?
reduced urine volume
