Module 8 Urinary System Flashcards
– urine and endocrine function
Kidneys
– conveys urine from kidneys to urinary bladder; A conduit only, like a host
Ureters
- stores urine
- A hollow muscular organ contained in the pelvic cavity that stores urine temporarily just until the person can hold it
Urinary bladder
– conducts urine from bladder to outside
o Males: It also conducts spermatozoa from ejaculatory ducts to outside
o For females, it is relatively short. For males, it is relatively longer. Dahil mahaba ang urethra, bihira magkaroon ng infection than females. Contamination in females is very high, especially those who do not wash their perineum.
Urethra
FUNCTIONS OF THE URINARY SYSTEM 1
- Elimination of waste products
o Nitrogenous wastes (creatinine, uric acid)
Serum creatinine dictates renal function. If slightly elevated, it means something is wrong with your kidneys.
o Toxins
o Drugs
FUNCTIONS OF THE URINARY SYSTEM 2
- Regulates aspects of homeostasis
o Water balance - The function of the kidney is to hold water as much as possible para in cases na hindi tayo umiinom, may reserve
o Electrolytes
o Acid-base balance in the blood
o Blood pressure- When you have high BP, dapat urologist kasi the kidneys are the one responsible for maintaining your BP.
o Red blood cell production
o Activation of vitamin D
KIDNEYS: Location
Location: Retroperitoneal, in lumbar region
KIDNEYS: Position
o Left kidney higher than the right - Because of the presence of the liver on the right that pushes the right kidney a little bit lower
o Upper poles: T12 vertebrae
o Lower poles: L3 vertebrae
o Hilum/Hili: Lie at Transpyloric plane opposite L1 vertebrae
The __ is reddish-brown in color and soft in consistency. It is about 11 cm in length, 6 cm wide, and 3 cm in thickness at the middle. It has upper and lower poles, anterior and posterior surfaces, concave medial and convex lateral borders.
kidney
- A vertical slit on the medial border
- Through it, branches of the renal artery enter the gland, and the veins and ureter leave
- Leads into the renal sinus (wide space inside the kidney)
Hilum
Structures found in the sinuses:
- Branches of renal artery
- Tributaries of the renal veins
- Renal calyces
- Renal pelvis
- Lymph vessels, nerves and fats
Kidney: Relations (Anterior)
Anterior: peritoneum and abdominal organs
Kidney: Relations (Posterior)
muscles on posterior abdominal wall namely: o Psoas major o Quadratus lumborum o Transversus abdominis o Diaphragm
Right Kidney: Relations (Anterior)
To liver, hepatic flexure, descending part of the duodenum, and adrenal gland.
Left Kidney: Relations (Anterior)
To splenic flexure, stomach, pancreas, jejunum, spleen and adrenal.
- Surrounds each kidney but easily stripped off
- Fits the kidneys tightly but is not bound to it
Renal capsule/ True capsule
- Surrounds the kidney
- Provides protection to the kidney
- Helps keep the kidney in its correct location
Adipose capsule or perirenal fat
- Lies in the fascial plane underneath renal fascia (space of Gerota)
- Forms the fatty capsule of the kidney
- Passes medially into the hilum
- Insinuates itself between renal vessels
Perirenal fat
- Derived from fascia transversalis or endoabdominal fascia
- Consist of anterior and posterior layers that splits at the lateral border of the kidney
- Between layers is Gerota’s space
o This space gives you access to your blood vessels - Believed to be open inferiorly
Renal Fascia of Gerota
- Anterior layer fuses with the opposite side and blends with walls of renal blood vessels, aorta and vena cava
Renal Fascia of Gerota
- Posterior layer blends with fascia of psoas and quadratus lumborum muscles
Renal Fascia of Gerota
- Fused superiorly and form separate compartment for adrenal gland
Renal Fascia of Gerota
Very important itong Gerota’s Fascia for surgeons, because when you locate this fascia you will have easy access sa vessels. In doing renal surgery, it is important to have full control of the blood vessels. Normally, there should only be 1 renal artery and 1 renal vein for each kidney. But sometimes we have what you call the normal anatomic variations, wherein you have 2-3 renal arteries and 2-3 renal veins. If these will go to your hilum, we call this __.
accessory renal arteries
FACTORS MAINTAINING KIDNEYS IN POSITION
- Renal fascia
- Adipose Capsure
- Renal pedicle
- Consist of structures at the hilus namely renal vessels, ureters, and nerves
- Cushioning effect of the adjacent organs
Renal pedicle
Kidney: Gross Structure
- Convex anterior and posterior surface
- Parenchyma consists of cortex and the medulla
Kidney: Gross Structure 2
- Medial concave margin called HILUS, leading to a cavity called RENAL SINUS
o Within sinus lie the renal pelvis, calyces, and the renal blood vessels
o Sinus is lined by fibrous membrane continuous with the true capsule and fibrous coats of the vessels and collecting system
Structures of the Renal Sinus
- Renal Artery
- Renal Vein
- Nerves
- Lymphatics
- Renal Pelvis
- Calyces
- Adipose Tissue
When you remove all of the pedicles, arteries, veins including your pelvis and your calyces, you will have there a space known as your __.
renal sinus
- Consists of subdivisions called renal pyramids
- Between the pyramids are the renal columns of Bertini
o The renal columns of Bertini is part of your renal cortex, not the medulla - BASES OF THE PYRAMIDS are directed towards cortex
- Apices called renal papilla are received into minor calyces
Renal Medulla
(Renal Medulla)
– perforated tips of the papilla; through which the urine will pass going to the minor calyces
Cribosa
Cortex – consists of the following:
a. cortex cortices
b. cortical arches
c. medullary rays
– refers to the subcapsular zone of cortex
cortex cortices
– portion of the cortex between pyramids and cortex
cortical arches
– radially directed striations representing bundles of tubules.
medullary rays
- Refers to the kidney parenchyma served by one papilla
- One renal pyramid and its overlying cortex
Renal Lobe
- Refers to the medullary ray with the immediately associated cortical tissue
Renal Lobule
- Constitute the tubular functional unit of the kidney
- Part 1: Nephron
- Part 2: Collecting Tubules
- These 2 parts arises from separate embryonic primordia
Uriniferous Tubules
o Secretory part concerned with urine formation
o Each part occupies a definite position
o The cortex and medulla is lined by specific lining epithelium specialized for a particular role in urine formation
Nephron
o Concentrates urinary solute to form a hypertonic urine
o Your collecting tubules are basically your renal pyramids
Collecting Tubules
(Excretory Ducts)
– From 4-14 in number; Cup-shaped tubes, each of which embraces on or 2 or more or the renal papilla
Minor Calyces
(Excretory Ducts)
– formed by the union of minor calyces
o 3 major calyces: superior, middle, and inferior
Major calyces
(Excretory Ducts)
- Formed by union of major calyces
- Funnel-shaped structure occupying renal sinus
- Represents the expanded beginning of the ureter
Renal pelvis
Blood supply of the kidneys (from artery and vein)
Aorta»_space; Renal artery»_space; Segmental Artery»_space;
Lobar artery» interlobar artery»_space; Arcuate artery
» interlobular artery»_space; Afferent arteriole
» Glomerulus»_space; Efferent arteriole
» Peritubular capillaries and vasa recta
» Interlobular vein»_space; Arcuate vein
» Interlobar vein»_space; Renal vein
» Inferior vena cava
Blood supply of the kidneys
- Both renal arteries arise from the aorta.
- Both renal veins drain into the IVC.
- Both arteries and veins arise/drain just opposite each other.
- The kidneys consume 20% of the heart’s cardiac output.
- The arteries generally lie posterior to the vein within the renal hilum.
- The renal pelvis is generally infero-posterior to the vessels.
Kidney: Length
- Right renal artery is longer than the left.
- Right renal vein is shorter than the left.
Kidney: Crossings
- Right renal artery crosses the IVC posteriorly
- Left renal vein crosses the aorta anteriorly
Renal Artery: Major Branches
- Renal artery branches into the anterior and posterior segmental arteries
- Posterior segmental artery – supplies the posterior segment of the kidney
- Anterior segmental artery 4 additional segmental arteries:
- These 5 segmental branches are responsible for dividing the kidney into segments (Interlobar, arcuate, interlobular arteries, and afferent arteriole
Anterior segmental artery: 4 additional segmental arteries
o Apical – superior segmental artery
o Upper – anterosuperior segmental artery
o Middle – antero-inferior segmental artery
o Lower – inferior segmental artery
- Ascend between the pyramids and renal columns
- No branches to the renal parenchyma
Interlobar Artery
- Located at the corticomedullary junction
- On top of the pyramids
Arcuate Artery
- Lie between medullary rays
Interlobular Artery
- Goes to the renal glomeruli
- A terminal branch
- Delivers blood to glomerulus for filtration
Afferent Arteriole
KIDNEY: NERVE SUPPLY AND LYMPHATIC DRAINAGE
- From renal sympathetic plexus distributed along branches
of renal vessels - Afferent fibers travel through renal plexus and enter spinal
cord in the T10-12 spinal nerves
- Conveys urine produced in the kidney to the bladder through peristaltic motion
- Thick walled expandable muscular ducts with a narrow lumen that carry urine from the kidneys to the urinary bladder
URETERS
- Usually 25 cm in length in adults
- Continuous with the renal pelvis
- Completely retroperitoneal but adheres closely to the
parietal peritoneum - Descends anterior to the psoas
URETERS
- To the right of the inferior vena cava
- Pelvis is covered by the 2nd part of the duodenum
- The blood vessel crossing in front of it are the Right colic artery, the testicular artery or ovarian artery, ileocolic artery and the superior mesenteric artery in the root of the mesentery
Right Ureter
- To the left side or lateral to the inferior mesenteric vein
- Its pelvis is more exposed than the right and covered only by the peritoneum below the renal vessels
- The blood vessel crossing its anterior surface are upper left colic, the testicular testicular or ovarian artery and 3 or more left colic vessels
Left Ureter
Ureter: Relations
- Emerges from the renal hilus
- Runs behind peritoneum of psoas in which separates it
from tips of lumbar vertebra transverse processes - Enters pelvic cavity by crossing bifurcation of the common
iliac artery in front of sacroiliac joints and enters bladder at
lateral angle - Male: Crossed by vas deferens at its termination
- Female: Related to uterine artery (beneath it)
- Enters bladder obliquely. No valve at point of entrance
Ureters: Physiologic Constrictions
- Ureteropelvic junction – at the junction between the ureter and the renal pelvis
- At the pelvic brim, where ureter crosses the common iliac artery
- Ureterovesical junction – as the ureter inserts into the urinary bladder
Blood supply of the Ureter: Abdominal Portion (Artery)
- Renal artery
- Testicular / Ovarian artery
- Superior vesical artery
Blood supply of the Ureter: Pelvic Portion (artery)
- Vesical Artery
2. Middle vesical artery
Blood supply of the Ureter: Venous drainage
- Renal vein
- Testicular / Ovarian vein
- Superior vesical vein
URETER: NERVE SUPPLY
- Derived from the adjacent autonomic plexus which contain pain fibers
- Renal, aortic, superior, and inferior hypogastric
- Afferent fibers from the ureters enter the spinal cord via dorsal roots T11-L1
URETER: LYMPHATIC DRAINAGE
- Generally follow the course of the renal vein and drain into the lumbar (lateral aortic) lymph nodes
URETER: LYMPHATIC DRAINAGE 2
- Upper ureteral lymphatics join those of the kidney
- Middle ureteral lymphatics drain to the common iliac lymph nodes
- Lower ureteral lymphatics drain to the common, external, or internal iliac lymph nodes
The __, a hollow viscus with strong muscular walls, is characterized by its distensibility. It is a temporary reservoir for urine.
urinary bladder
URINARY BLADDER: Location
o Pelvis
o Anterior and inferior to the peritoneal cavity
o Posterior to the pubic bone
URINARY BLADDER: Relations (Female - Infero-lateral)
– prevesical space of Retzius
URINARY BLADDER: Relations (Female - Posteriorly)
– vagina and cervix,separated from them by vesicovaginal septum
URINARY BLADDER: Relations (Female - Inferiorly)
– rests directly o pelvic floor.
URINARY BLADDER: Relations (Female - superiorly)
– loosely covered by peritoneum which allows distension of the organ. Superior surface related to ileum and pelvic colon, uterus lies on it.
URINARY BLADDER: Relations (Male - Inferolateral)
– rectum, separated from it by the 2 seminal vesicles and ductus deferens and by fascia of Denonvillier’s (prostatoperitoneal membrane)
URINARY BLADDER: Relations (Male - Superiorly)
– Loosely covered by perineum which allows distension of the organ
URINARY BLADDER: Relations (Male - Inferiorly)
– pelvic floor
- Found between pubic and bladder
- Limited below by puboprostatic ligament in males
- Laterally extends as far as internal iliac artery
- Superiorly, continues with interval between peritoneum and transversalis fascia which extends up to umbilicus, limited on each side by lateral umbilical ligaments. Surgeons utilize space to enter the bladder extraperitoneally
PREVESICAL SPACE OF RETZIUS
Parts of the Urinary Bladder
- fundus
- apex
- body – with 2 ureteral orifice
- base
- neck
(Parts of the Urinary Bladder)
– points toward the superior edge of pubic symphysis
Apex
(Parts of the Urinary Bladder)
– opposite the apex, formed by the somewhat convex posterior wall
Fundus
(Parts of the Urinary Bladder)
– the major portion of bladder between apex and fundus
Body
(Parts of the Urinary Bladder)
– where the fundus and inferolateral surfaces meet inferiorly
Neck
(Ligament)
- From back of symphysis pubis to bladder neck and prostate
Medial puboprostatic ligament
(Ligament)
- From pelvic fascia at the area of levator ani muscle to the neck of the bladder and prostate
Lateral puboprostatic ligament
(Ligament)
- From apex of the bladder to the umbilicus
Median umbilical ligament
(Ligament)
- with the median ligament, stabilizes bladder anteriorly
Lateral umbilical ligament
__ are considered as your TRUE bladder ligaments.
Medial and Lateral PUBOPROSTATIC ligaments
__ are your FALSE ligaments though all of them will hit the bladder in its proper position.
Medial and Lateral UMBILICAL ligaments
INTERIOR OF THE BLADDER
- RUGOSE MUCOSA if empty, smooth of distended
- VESICAL TRIGONE
- URETERAL ORIFICE
- RETROTRIGONAL FOSSA
o A triangular area bounded by the right and left ureteral orifices
o Found at the posterior bladder wall that remains smooth even of empty
o The ureteral orifices are interconnected by one elevated mucous fold called interureteric ridge
o The most sensitive part of the bladder
VESICAL TRIGONE
- is not circular due to vesical crest or uvula (a bulging produced by the middle lobe of prostate)
URETERAL ORIFICE
o Found at the interior bladder fundus
o Usually deepens by an increase in the intravesical pressure
o Urine usually stagnate in the said fossa
RETROTRIGONAL FOSSA
BLOOD SUPPLY: URINARY BLADDER
- From Internal iliac artery
1. Superior vesical artery
2. Inferior vesical artery
o Supply superolateral wall
o Branches out after the gluteal artery
Superior vesical artery
o Continuation of the internal iliac artery
o Female: it arises from uterine artery
o Supplies bladder floor, prostate, and prostatic urethra
Inferior vesical artery
URINARY BLADDER: VENOUS DRAINAGE
- From Prevesical plexus which drain into inferior vesical vein
- Like the arteries, which are all derived from the internal iliac artery, the veins are all tributaries of the internal iliac veins
Venous Drainage of the Bladder (Male)
- Vesical venous plexus and prostatic plexus – envelops the base of the bladder and prostate, including the seminal vesicles, ampulla of the vas, and inferior ends of the ureters
- These go through the internal iliac veins through the inferior vesical veins
- There is also some drainage into the sacral veins thus entering the vertebral venous plexus (aka Batson’s plexus)
Venous Drainage of the Bladder (Female)
- The vesical venous plexus which envelops the proximal urethra and bladder neck drains into the vaginal venous plexus.
Urinary Bladder: LYMPHATIC DRAINAGE
Anterior part of the bladder: External iliac lymph nodes Posterior part of bladder: Iliac lymph nodes
(URINARY BLADDER: NERVE SUPPLY)
- Considered the filling nerve since they inhibit the detrusor muscle and increased muscle tone of internal urethral sphincter
Hypogastric Plexus (SNS)
(URINARY BLADDER: NERVE SUPPLY)
- Considered the emptying nerve since they stimulate contraction of detrusor muscle and elevation of the trigone with relaxation of internal urethral sphincter
- Accompanied by voluntary relaxation of external sphincter via pudendal nerve
Pelvic Splanchnic Nerve (PSNS)
- Is from the superior surface of the bladder near its posterior border to the uterus, at the junction of the uterine body and cervix.
- The vesicouterine pouch of peritoneum is between the bladder and uterus.
- Normally empty
Peritoneal Reflections in the Female
- Is from the superior surface of the bladder, over the ductus deferens and seminal vesicles.
- The bladder is relatively free floating except for its neck where it is attached firmly by the puboprostatic ligaments.
Peritoneal Reflections in the Male
DIFFERENCES IN BLADDER BETWEEN MALE AND FEMALE (Between the bladder)
MALE: Between the bladder and the rectum are the ampulla of vas and seminal vesicles
FEMALE: Between the bladder and the rectum are the cervix and superior part of vagina
DIFFERENCES IN BLADDER BETWEEN MALE AND FEMALE (Bladder Neck)
MALE: Bladder neck opens into the prostatic lumen
FEMALE: Bladder neck opens into the short female urethra
DIFFERENCES IN BLADDER BETWEEN MALE AND FEMALE (Bladder Neck)
MALE: There is a bulge just beneath the trigone caused by the posterior lobe of the prostate
FEMALE: There is usually an extrinsic compression at the superior margin caused by the anteverted uterus
- Long muscular tube, 15 to 20 cm, conveys urine from the urinary bladder to the exterior through the external urethral orifice, located at the tip of the glans penis.
- Note: Do NOT confuse URETHRA from URETER!
URETHRA
PART OF THE MALE URETHRA
- Prostatic Urethra
- Membranous Urethra
- Penile Urethra
- Widest and most dilatable portion
- 3 cm long
- Posterior wall: Urethral crest (a longitudinal elevation)
- Grooves along sides of the crest are called prostatic
sinuses and receives openings of prostatic glands
o The secretory prostatic ducts open into the prostatic
sinuses. - Utricle – at the summit of the crest; opens into urethra
- Ejaculatory ducts open at the lateral margins of utricle
Prostatic Urethra
- Least dilatable
- Found within urogenital diaphragm
- Surrounded by the urethral sphincter
Membranous Urethra
- Enclosed in the bulb and corpus spongiosum of the penis
- Becomes dilated as fossa navicularis at the area of the
glans penis - Terminates at external urethral meatus
- External urethral meatus – narrowest part of the urethra
Penile Urethra
- 1.5 in long
- Extends from the neck of the bladder to vestibule where it
opens about 1 cm below clitoris - Traverses the sphincter urethrae
- Paraurethral glands
FEMALE URETHRA
- Homologue of prostate gland
- Open on either side of urethral orifice
Paraurethral glands
BLOOD SUPPLY: URETHRA
internal pudendal and vaginal arteries and veins.
URETHRA: LYMPHATICS
- Sacral lymph nodes
- Internal iliac lymph nodes
URETHRA: INNERVATION
- Pudendal nerves
- Pelvic splanchnic nerves
- On either side of the lower thoracic and upper lumbar spine
- Usual location: Between T11-L3
- In upright position descend by 2-3 cm
- Right is slightly lower than the left
- Long axis is directed DOWNWARDS, LATERALLY, AND ANTERIORLY
KIDNEYS
KIDNEYS: 2 poles
Upper – broad due to presence of adrenal glands
Lower – pointed
KIDNEYS: 2 borders
Lateral – convex
Medial – concave with hilum in the middle
KIDNEYS: 2 surfaces
Anterior – irregular
Posterior – flat
- Covers the kidneys
- May be separated from them
Fibrous Capsule
- Layer of fat surrounding the fibrous capsule
- Fills up area in the renal sinus
Perirenal Fat
- Fibroareolar sheath surrounding the kidney and perirenal fat
Renal Fascia of Gerota
- Fat that surrounds the renal fascia
- More abundant posteriorly and at lower pole
- Fills up paravertebral gutter
- Forms a cushion for kidney
Pararenal Fat
Cortex
Cortical arches – form caps over the bases of the pyramids
Renal columns – dip between pyramids
- About 10 conical masses called renal pyramids
- Tubules form pyramids with apices called papilla that discharge urine into the minor calyces
- Bases are covered by cortical arches
Medulla
- Bounded by the leaves of the Gerota’s fascia
- The leaves fuse superiorly, laterally, and medially
- It encloses the kidneys, adrenal glands, renal vasculature, and proximal ureter
- The fascial envelope is functionally open caudally just above the pelvic brim
- Ureter emerges from the perirenal space and traverses
caudad in anterior pararenal space
Perirenal Space
Anterior Pararenal Space (Boundaries)
Posterior: Anterior portion of renal fascia
Anterior: Posterior parietal peritoneum
Lateral: Lateral conal fascia
Anterior Pararenal Space (Contains)
- Pancreas
- Duodenum – 2nd-4th parts
- Ascending and descending colon
- Vascular supply to spleen, liver, pancreas and duodenum
Posterior Pararenal Space (Boundaries)
Posterior: Transversalis fascia
Anterior: Posterior portion of Gerota’s fascia
Posterior Pararenal Space (Contains)
Fat, scattered vessels and nerves
The long axis of the kidneys is directed __, parallel to the lateral border of psoas muscles.
downward and outward
ULTRASOUND (Kidney)
- Normal size of kidneys in adults: 11-15 cm
- Right kidney is shorter than the left kidney by generally not more than 1.5 cm
- Local bulge or convexity along the lateral aspect of the left kidney
- This may be either due to impression of the spleen or fetal lobulation or both
Dromedary Hump
Kidneys are visualized on the X-ray due to presence of __
perirenal fat
Kidneys are contained within renal capsule and surrounded by perirenal fat and enclosed within the __.
Gerota’s fascia
Perirenal hemorrhage, pus, and urine are contained within the fascia and detected on __.
CT and Ultrasonography
Renal Arteries
- Renal arteries branch from the abdominal aorta laterally
between L1 and L2, below the origin of the superior mesenteric artery - The right renal artery passes posterior to IVC
- There may be more than 1 renal artery (on one or both sides) in 20-30% cases
Renal Veins
- Renal veins drain into IVC
- Renal veins lie anterior to the arteries.
- Left renal vein is longer and passes anterior to the aorta
before draining into the IVC - The Left gonadal vein drains into left renal vein while the
Right gonadal vein drains directly into IVC - Common variants include retroaortic and circumaortic left
renal veins
This is where you can see if there is one or two artery going to the kidney.
Renal Angiography
Relationship of the Right Kidney: Anteriorly
– Right adrenal gland – Liver – Second part of duodenum – Hepatic flexure of colon – Small intestine
Relationship of the Right Kidney: Posteriorly
– Diaphragm
– Medial and lateral arcuate ligaments
– Psoas major muscle, quadratus lumborum muscle, transversus abdominis muscle
– Subcostal vessels
– Subcostal, iliohypogstric and ilioinguinal nerves
– 12th rib
Right Kidney (Upper and Lower Pole)
Upper pole: Adrenal gland
Lower pole: 1 inch above the iliac crest
Right Kidney (Lateral and Medial Border)
Lateral border:
o Right lobe of liver
o Hepatic flexure of colon
Medial border:
o Above hilum: Adrenal gland
o At hilum: Renal artery and vein, and pelvis of ureter
o Below hilum: Ureter
Relationship of the Left Kidney: Anteriorly
– Left adrenal gland – Spleen – Stomach – Pancreas – Splenic vessels – Splenic flexure and descending colon – Jejunum
Relationship of the Left Kidney: Posteriorly
– Diaphragm
– Medial and lateral arcuate ligaments
– Psoas major muscle, quadratus lumborum muscle, transversus abdominis muscle
– Subcostal vessels
– Subcostal, iliohypogstric and ilioinguinal nerves
– 11th and 12th ribs
Left Kidney (Upper and Lower Pole)
- Upper pole – adrenal gland
* Lower pole – 1 inch above iliac crest
Right Kidney (Lateral and Medial Border)
Lateral border:
o Spleen
o Descending colon
Medial border:
o Above hilum: Adrenal gland
o At hilum: Renal artery and vein, and pelvis of ureter
o Below hilum: Ureter
- Consists of glomeruli and renal tubules
- Normal thickness: 2.5 cm
Renal Cortex
- Consists of multiple renal pyramids which have their base to the periphery and their conical end directed towards the renal hilum
- Their tips are called papillae
- Each minor calyx receives 1-3 papillae
Renal Medulla
- Shows corticomedullary differentiation
- This is approximately 100 seconds following contrast
administration - Shows renal lesions well
Nephrogram Phase
- Shows excretion of contrast into the collecting system
- This is approximately 8 minutes following contrast
administration - Shows urothelial lesions well, such as transitional cell
carcinoma, stones, blood clot
Pyelogram Phase
- 3D reconstructed image from CT scan of the badomen and pelvis
- Quickly replaces the conventional IV Urogram
- 3d reconstruction is performed through the right kidney and follows the normal ureter (arrows) all the way to the ureter’s insertion into the bladder
CT IVP
Calyces
Medulla sits in the fornix of the minor calyx
Fornix - sharp and concave
Papillae drain into minor calyces
Minor calyces coalesce to form 3-4 major calyces
Major calyces combine to form the pelvis
- Broad dilated part of the urine collecting system
- Located in the hilum
- Renal pelvis drains into the ureter
Renal Pelvis
- 25-30 cm in length and 3 mm diameter
- Course: downward from renal pelvis to midsacral region
- Then posterolaterally in an arc downwards
- Then inward and anteriorly to enter the bladder trigone on
either side of the midline
URETERS
- Lateral to the ductus deference and enter urinary bladder
posterosuperiorly just above the seminal vesicle
URETERS (MALES)
- Medial to the origin of the uterine artery and continues to the level of the ischial spine
- It is crossed superiorly by the uterine artery
- Then passes close to the lateral portion of the fornix of vagina to enter the posterosuperior angle of the bladder
URETERS (FEMALES)
URETERAL VASCULATURE
- Blood is supplied by the ureteral branches of renal and
testicular/ovarian arteries, and abdominal aorta - Renal and testicular/ovarian veins supply venous drainage
- Hollow muscular vesicle for storing urine temporarily
- Bladder is higher in position in children and slightly higher in males than females
- It is relatively larger in children than in adults
- Size and shape vary considerably
URINARY BLADDER
URINARY BLADDER: Shape
o Tetrahedral – when empty
o Transversely oval or round – when full
- When empty, it is completely within the pelvis
- Inferior aspect projects 5-10 mm above the symphysis pubis
- Separated from pubic bones by Retropubic space (Retzius)
- Floor is parallel to superior aspect of the pubic rami
- Dome is surrounded in male and flat or slightly concave in
female
URINARY BLADDER
o Lies 3-4 cm behind lower part of symphysis pubis
o Rests on the prostate in male
o It has the urethral orifice
Neck of bladder
URINARY BLADDER (Females)
- The peritoneum is reflected from the superior surface of the bladder to the anterior wall of the uterus at the junction
between the body and cervix - The enclosed space is the vesicouterine pouch
URINARY BLADDER (Males)
- The peritoneum is reflected from the bladder to the superior surface of the ductus deferens and seminal vesicles
- Bladder is relatively free to move except at the neck which is fixed by the puboprostatic ligaments (male) and
pubovesical ligaments (female)
Peritoneal reflection (Males and Females)
o Male: Rectovesical pouch
o Female: Vesicouterine and rectouterine pouch
