the ureter, prostate and bladder Flashcards
What is the function of the ureters?
They transport urine from the kidneys to the urinary bladder.
Which system do the ureters belong to?
The urinary system.
What is the anatomical path of the ureters?
- Run inferiorly from the renal pelvis
- Cross over the bifurcation of the common iliac arteries
- Pass the pelvic brim (pelvic inlet)
- Run along the lateral pelvic wall
- Enter the urinary bladder
What are the three anatomical parts of the ureter?
Abdominal – From kidney to pelvic inlet
Pelvic – From pelvic inlet to bladder wall
Intramural – Passes through the bladder wall
After crossing the pelvic brim, which arteries do the ureters run alongside?
the internal iliac arteries.
How do the ureters enter the bladder?
They curve anteromedially and enter the bladder in an inferomedial direction.
What is the relationship between the ureter and the ductus deferens in males?
The ureter passes posterior to the ductus deferens.
What is the relationship between the ureter and the uterine artery in females?
The uterine artery crosses superoanteriorly over the ureter.
What is the significance of the phrase “water under the bridge”?
It describes how the ureter (“water”) runs beneath the uterine artery (“bridge”) in females.
Why does the blood supply to the ureter vary along its course?
Because the ureter is a long structure passing through different regions.
What are the main arterial branches supplying the ureter in the abdominal region?
Renal artery
Gonadal arteries (ovarian/testicular)
What artery supplies the ureter as it crosses the pelvic brim?
The common iliac arteries.
What are the main arteries supplying the ureter in the pelvic cavity?
Superior vesical artery (also supplies the bladder)
Inferior vesical artery (also supplies the bladder)
Uterine artery (in females, also supplies the uterus)
What is the significance of the uterine artery in ureteric blood supply?
It provides pelvic blood supply to the ureter in females.
How many normal constrictions do the ureters have?
Three main constrictions.
Where is the first ureteric constriction located?
At the ureteropelvic junction (junction of the ureter and renal pelvis).
Where is the second ureteric constriction located?
Where the ureters cross the brim of the pelvic inlet over the bifurcation of the common iliac artery.
Where is the third ureteric constriction located?
At the ureterovesical junction, where the ureter enters the bladder wall.
Why are ureteric constrictions clinically significant
They are common sites of obstruction by ureteric stones.
What is a possible fourth constriction?
Where the gonadal vessels pass anterior to the ureter.
Where is pain from ureteric stones referred?
T11-L2 dermatome (loin to groin region)
Can also be felt in the lower back
What is the function of the urinary bladder?
It is a reservoir for urine.
Where is the urinary bladder located when empty?
In the lesser pelvis, close to the pubic bones.
How high can the bladder extend when full?
It can reach as high as the umbilicus.
Is the bladder intraperitoneal or extraperitoneal?
It is mostly extraperitoneal, meaning it lies inferior to the peritoneum.
What structure lies posterior to the bladder in males?
The rectum.
What structure lies superoposterior to the bladder in females?
The uterus.
How does the peritoneum relate to the bladder?
It extends from the posterior abdominal wall to the superior bladder surface and reflects onto the organ posterior to it.
Where does the apex of the bladder point when empty?
Toward the superior edge of the pubic symphysis.
What is the fundus of the bladder?
The part opposite the apex, with the body of the bladder in between.
What muscle forms the walls of the bladder?
The detrusor muscle, composed of multiple layers running in different directions.
What is the function of the involuntary internal urethral sphincter?
Controls urine outflow
Prevents retrograde ejaculation (in males)
What is the trigone of the bladder?
A triangular region marked by the ureteric orifices and the internal urethral orifice.
Which nerves carry preganglionic sympathetic fibres to the bladder?
The lumbar splanchnic nerves (L1-L3).
Where do the preganglionic sympathetic fibres synapse?
In the inferior mesenteric ganglion.
Where do the postganglionic sympathetic fibres travel?
They pass through the superior hypogastric plexus, then descend to the inferior hypogastric plexus.
Which nerves provide parasympathetic innervation to the bladder?
The pelvic splanchnic nerves (S2-S4).
What stimulates the micturition reflex?
Stretching of the bladder wall, which activates visceral afferent fibres.
What type of innervation controls micturition?
Parasympathetic innervation.
What effect does parasympathetic innervation have on the bladder?
Contracts the detrusor muscle
Inhibits the internal urethral sphincter (causing relaxation)
What happens when the detrusor muscle contracts?
The bladder empties, and urine flows into the urethra.
Is there an internal urethral sphincter in females?
It is suggested that females do not have an internal urethral sphincter, and continence is maintained by the levator ani and external urethral sphincter.
Is there an internal urethral sphincter in males?
yes, both internal and external
How is the external urethral sphincter innervated?
By somatic nerve fibres.
How is the internal urethral sphincter innervated?
By autonomic nerve fibres.
What are the three accessory reproductive glands in males?
Prostate gland
Seminal vesicles
Bulbourethral glands
What is the function of the seminal vesicles?
They produce 70% of the ejaculate volume and provide an energy source for spermatozoa.
What is the function of the bulbourethral glands?
They secrete a clear watery fluid that prepares the urethra for sperm passage.
Where is the prostate gland located?
It is located at the bladder outlet, encircling the urethra, and anterior to the rectum.
What are the 2 functions of the prostate gland?
Produces 30% of the ejaculate volume
Plays a role in spermatozoa motility
How are the ejaculatory ducts formed?
By the union of the ducts of the seminal vesicles with the ductus deferens.
Where do the ejaculatory ducts originate?
Near the neck of the bladder.
How do the ejaculatory ducts travel through the prostate?
They pass anteroinferiorly through the posterior part of the prostate.
Where do the ejaculatory ducts open?
Into the prostatic urethra.
Which nervous system controls ejaculation?
The sympathetic nervous system.
Which nerves carry the preganglionic sympathetic fibres for ejaculation?
Lumbar splanchnic nerves (L1-L3).
Where do the preganglionic sympathetic fibres synapse?
In the hypogastric plexuses.
What are the two main effects of sympathetic stimulation during ejaculation?
- Contraction of the internal urethral sphincter (to prevent retrograde ejaculation).
- Rapid contraction of the ductus deferens and accessory glands (to expel semen).
What prevents retrograde ejaculation?
Contraction of the internal urethral sphincter.
What is benign hypertrophy of the prostate (BHP)?
A common enlargement of the prostate after middle age, which impedes urination by distorting the prostatic urethra.
What are the 3 main symptoms of BHP?
Shortened micturition interval (frequent urination)
Weak urinary stream
Strained efforts or pain during urination
What 4 complications can arise from sustained bladder outlet obstruction due to BHP?
- Bladder wall hypertrophy
- Residual urine retention
- Urine backup into ureters and kidneys
- Increased risk of infections
