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Section 5F Genitourinary System > Lower Urinary Tract & Ureters > Flashcards

Lower Urinary Tract & Ureters Flashcards

1
Q

What is the function of the ureters?

A

Passage of urine from kidneys to bladder

  • via peristaltic contractions of smooth mm in ureter wall, and filtration pressure of glomeruli
  • convey approx 1.2L of urine daily
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2
Q

Describe the anatomy of the ureters

A
  • paired narrow tubes between kidneys and bladder
  • 25cm long
  • retroperitoneal
  • thick muscular tubes
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3
Q

Describe the anatomical course of the ureters

A

Abdominal section (from kidney to bladder):

  • runs along psoas
  • crosses over genitofemoral nerve at L1-2 level

Pelvic section:

  • at bifurcation of common iliac a (L5-S1)
  • ureters leave psoas and pass over SIJ to enter pelvis
  • terminal parts pierce posterior lateral angle of bladder
    (males: ureters crossed by vas deferens before entering bladder)
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4
Q

at which spinal levels:

  • do the ureters cross over the genitofemoral nerve and change from the abdominal to the pelvic section?
  • do the ureters leave the psoas and cross the SIJ to enter the pelvis?
A

L1-2:

  • ureters cross genitofemoral nerve
  • change from abdominal ureters to pelvic ureters

L5-S1:
- ureters leave psoas and cross over SIJj to enter pelvis

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5
Q

What are the histological layers of the ureters?

A

Mucosa:

  • transitional epithelium (specialized epithelium designed to distend to accomodate fluid; basal layer cells are cuboidal or columnar)
  • continuous with mucosa of renal pelvis (superiorly) and bladder (inferiorly)

Muscularis:

  • internal longitudinal
  • external circular
  • additional external longitudinal in lower 1/3

Serosa / adventita:

  • anterior surface: serosa (in contact with peritoneum)
  • posterior surface: adventitia
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6
Q

What are the features of transitional epithelium, and in which components of the urinary tract are they found?

A

Located:

  • renal pelvis
  • ureters
  • bladder

Features:

  • specialized epithelum
  • change to accomodate fluid
  • cells f basal layer are cuboidal or columnar
  • appearance transitions between stratified coboidal and stratifeid squamous depending on the degree of distension
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7
Q

What is the innervation of the ureters and bladder?

A

SNS: T10-L2 via renal, coeliac and hypogastric plexi

PNS: pelvic splanchnic nerves (S2-4)

visceral afferents

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8
Q

What is the arterial supply and vascular drainage of the ureters?

A

Arterial:

  • upper: uretric branch of renal artery
  • middle: branches from abdominal aorta, gonadal arteries, common iliac artery, and internal iliac artery
  • lower: branches from superior and inferior vesical arteries and uterine arteries

Venous drainage:
- veins with same names as supplying arteries

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9
Q

What is the lymphatic drainage of the ureters?

A

Abdominal section: para-aortic nodes

Pelvis section: common iliac and internal iliac nodes

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10
Q

Describe the structure and anatomy of the bladder

A

Surfaces:

  • 1 x infero posterior (base)
  • 1 x superior
  • 2 x infero-lateral

Apex:

  • points to top of pubic symphysis
  • separated from pubic bones by retropubic space
  • median umbilical ligament (remnant of urachus)

Base / fundus:
- formed by posterior wall

Body:
- between apex and fundus

Neck:

  • junction of base and inferolateral surfaces
  • pierced by urethra at internal urethral orifice

Trigone:

  • triangular region at base of bladder
  • between 2 uretral oifices and internal urethral orifice
  • flaps of bladder mucosa act as valves and prevent vesicouretric reflex
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11
Q

What are the uretral orifices?

A

Openings of the ureters (right and left) into the base of the bladder
- triangular region between the 2 uretral orifices and the internal urethral orifice is the trigone

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12
Q

What are the peritoneal and visceral relationships of the bladder?

A

Peritoneal:

  • the superior surface and 1cm of base are intraperitoneal
  • the rest of the bladder is subperitoneal

Fascia:

  • bladder covered by vesical fascia
  • fascia contains vesical venous plexus

Male:

  • prostate gland below bladder
  • between posterior surface of bladder and the rectum: seminal vesicles, vas deferens and retro-vesical pouch

Female:

  • superior surface sits below uterus
  • infero-posterior surface contacts anterior wall of vagina
  • uterovesical pouch: shallow empty pouch that separates bladder from uterus
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13
Q

What is the location of the bladder?

A

Empty: within pelvic cavity

Full:

  • domes up to abdominal cavity as far as umbilical level
  • in front of rectum (M)
  • in front of vagina (F)
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14
Q

Describe the histological layers of the bladder

A

Mucosa

  • transitional epithelium
  • continuous with transitional epithelium of ureters (superiorly)
  • rugae (folds) in relaxed state

Muscularis:

  • smooth mm referred to as detrusor muscle
  • 3 layers: inner and outer layers of longitudinal, middle layer of circular

Adventitia:

  • outer layer
  • variable amounts of peri-vesical fat
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15
Q

What is the detrussor muscle?

A

The muscularis layer of the bladder
- contractions eject urine

3 layers:

  • inner and outer longitudinal layers
  • middle circular layer
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16
Q

What is the lymphatic drainage of the bladder?

A
  • superior surface: external iliac nodes

- fundus: internal iliac nodes

17
Q

What is the arterial and venous supply of the bladder?

A

Arterial:

  • branches of internal iliac artery
  • superior vesical artery supplies antero-superior bladder
  • inferior vesical (M) or vaginal (F) arteries supply fundus and neck

Venous:

  • veins correspond to names of arteries
  • drain into internal iliac vein
18
Q

What is the nervous supply of the bladder?

A

Visceral plexus (continuous with hypogastric plexus)

SNS: T10-12

PNS: pelvic splanchnic S2-4; motor supply to detrusor muscle and inhibition of internal urethral sphincter

19
Q

Describe the internal and external urethral sphincters

A

Internal urethral sphincter (IUS):

  • between neck of bladder and urethra
  • formed by thickening of detrusor muscle
  • under involuntary (ANS) control
  • SNS innervation: IUS tonically contracted
  • PNS: causes IUS to relax

External urethral sphincter (EUS):

  • between urethra and external urethral orifice
  • composed of striated mm where the urethra passes through the pelvic floor
  • in females levator ani contributes to continece
  • under voluntary control
  • maintains constant muscle tone (only relaxes during micturition)
  • innervated by pudendal nerve (S2-4)
20
Q

What are the functions of the urethras?

A

Both:
- urinary functions (passage of urine from bladder to outer environment during micturition)

Male only:
- reproductive function

21
Q

What are the histological layers of the male and female urethras?

A

Male:

Mucosa:

  • mostly transitional epithelium continuou with epithelium of bladder
  • navicular fossa: stratified squamous epithelium (continuous with epithelium of glans penis)
  • mucous secreting glands produce a protective mucous layer

Muscularis:
- urethral smooth muscle a continuation of the detrusor muscle of the bladder

Female:

Mucosa:

  • non-keratinized stratified squamous epithelium
  • mucous glands in wall of urethra (largest glands are the paired paraurethral glands)
22
Q

Describe the location and anatomical course of the male and female urethras

A

Male

  • 20cm long
  • runs from neck of bladder to externaal urethral orifice at tip of penis
  • passes through prostate and corpus spongiosum

Female:

  • 4cm long
  • runs from bladder neck to external urethral orifice (antero-inferior direction)
  • mostly embedded within anterior vaginal wall
23
Q

Where is the female external urethral orifice located?

A

Posterior to the clitoris and anterior to the vaginal orifice

24
Q

What are the 3 components of the male urethra?

A
  1. preprostatic and prostatic urethra
    - 2-4cm
    - receives openings of ejaculatory ducts (union of vas deferens and ducts of seminal vesicles)
  2. intermediate membranous urethra
    - 1-2cm
    - from apex of prostate to bulb of penis
    - surounded by external urethral sphincter and perineal membrane
  3. spongy penile urethra
    - 15cm
    - passes through bulb and corpus spongiosus of penis
    - bulbourethral ducts open into dilated proximal region
    - mucous secreting glands along length
    - navicular fossa: short dilated region proximal to external urethral orifice
    - ends at EUO
25
Q

What is the arterial and venous supply of the urethras?

A

Male:
Arterial:
- internal pudendal (from internal iliac)

Venous:
- internal pudendal

Female:
Arterial:
- upper: vaginal artery
- lower: internal pudendal artery

Venous:
- into vesical plexus then internal pudendal veins

26
Q

What is the lymphatic drainage of the male and female urethras?

A

Male:
- external iliac, deep iliac, and internal iliac lymph nodes

Female:
- mostly into internarl iliac nodes, some into external iliac nodes

27
Q

What is the innervation of the male and female urethra?

A

IUS in both; prostatic & intermediate urethra in males:

  • ANS fibres from inferior hypogastric plexus
  • SNS: T10-L2
  • PNS: pelvic splanchnic (S2-4)

EUS in both; spongy urethra in males:
- pudendal (S2-4)

visceral afferents

28
Q

Describe the control of micturition

A

Micturition and storage centres in pons regulate descending circuits involving SNS, PNS and somatic innervation to control micturition

  1. contraction of detrusor muscle (ejects urine from bladder into urethras)
  2. relaxation of IUS (involuntary control via PNS pelvic splanchnics S2-4)
  3. relaxation of EUS (voluntary control via pudendal nerve S2-4)
29
Q

Describe the flow of urine from the upper to lower urinary tracts

A

Kidneys:

  • collecting ducts of nephrons
  • minor chalyces
  • major chalyces
  • renal pelvis

Ureters

Into bladder (via internal ureteral openings)

Into urethra (via internal urethral sphincter)

through urethra

expelled via external urethral sphincter and external urethral orifice

Section 5F Genitourinary System (3 decks)

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