Urinary System Flashcards
Zones affected by BPH
Transitional zone
Arterial supply of the ovaries
Ovarian artery (branch of aorta)
Describe the 3 fascial layers of the spermatic cord and their origins
- External spermatic fascia from the external oblique aponeurosis
- Cremasteric fascia and cremaster from internal oblique aponeurosis
- Internal spermatic fascia from the transversalis fascia
What features must substances have to be used to measure GFR
- Inert
- Free filtration from the plasma at the glomerulus
- Not absorbed or secreted in at the tubules
- Plasma concentration constant during urine collection
3 divisions of the male urethra
- Prostatic
- Membranous
- Penile (Bulbous)
Testicular lymphatic drainage
Para-aortic nodes
Lateral relations of the uterus
- Broad ligament
- Ureter lies superolateral to the supravaginal cervix
Arterial supply of the testes
Testicular artery (branch of the aorta)
Describe the course of the ovarian ligament
Runs within the broad ligament to the cornu of the uterus
Describe the course of the left renal vein
- Longer
- Passes in front of the aorta at the level of the SMA (L1)
- Receives the adrenal vein and gonadal vein
Describe the structure of the uterine wall
- Perimetrium - outer serous coat
- Myometrium - middle coat of smooth muscle - vascular layer
- Endometrium - inner mucous coat - active in the menstrual cycle
Where is the timing of micturition controlled
Pontine micturition centre
What is the forward continuation of the bulb of the penis and what does it contain
Corpus spongiosum surrounds the penile urethra
Scrotal exploration - layers of incision
- Skin
- Dartos muscle (superficial fascia)
- External spermatic fascia
- Cremaster muscle
- Internal spermatic fascia
- Parietal layer of tunica vaginalis
(7. Visceral layer of tunica vaginalis)
What converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol
1-alpha-hydroxylase
Capillary pressure within the afferent capillaries
50mmHg
Layout of the hilum of the kidney
From anterior to posterior:
- Renal vein
- Renal artery
- Pelvis of the ureter
Venous drainage of kidney
Renal vein into IVC
Where is calcium and phosphate reabsorbed and how is this regulated
- Both actively reabsorbed in PCT and ascending loop of Henle
- Any remaining is reabsorbed in DCT/collecting duct
- Absorption in the DCT/collecting duct is regulated by PTH
- PTH stimulates calcium reabsorption and phosphate excretion
Venous drainage of testes
Pampiniform venous plexus forms right and left testicular veins
Level of the kidneys
T12-L3
What occurs in the descending loop of Henle
- Water is removed
- NaCl is added from medulla
- More concentrated from addition of NaCl and reduction in volume from removal of H2O (1200mosmol/L)
Describe the division and distribution of the renal artery
- Anterior (75% of flow)
- Posterior (25% of flow)
Actions of angiotensin 2
Stimulates:
- Arterial vasoconstriction
- Release of ADH
- Drinking
- Release of aldosterone
Superior relations of left kidney
- Spleen
- Adrenal gland
Describe the posterior relations of the right kidney
- Diaphragm
- 12th rib
- Psoas major, quadratus lumborum, transversus abdominis
- Subcostal, iliohypogastric, ilioinguinal nerves
Where is the prostate plexus of veins and nerves situated
True (fibrous) capsule
Describe the lobes of the prostate
- Posterior lobe - posterior to urethra and inferior to plane defined by ejaculatory ducts
- Median lobe - lies between ejaculatory ducts and is posterior to urethra
- Right and left lobes - separated by a shallow posterior median groove
- Isthmus - narrow, anterior to urethra
Describe ductus deferens
- Thick wall and small lumen
- Begins at tail of epididymis
- Ascends posterior to testes
- Penetrates anterior abdominal wall via inguinal canal
- Crosses over external iliac vessels to enter pelvis
- Ends by joining duct of the seminal gland to form ejaculatory duct
At what BP does autoregulation fail
- <80
- >180
Name of opening of fallopian tube
Ostium
Describe the suspensory ligament
- Prominent fold of peritoneum
- Attached to superior poles of the ovaries
- Passes up over the pelvic brim and external iliac vessels to blend with the peritoneum over psoas major
- Contains ovarian vessels, lymphatics, and nerves
- Becomes continuous with mesovarium
Anterior relations of the uterus
- Uterovesical pouch of peritoneum
- Lies on superior surface of bladder
- Supravaginal cervix directly related to bladder
Ureter narrowings
- Pelviureteric junction
- Cross the pelvic brim
- Passage through wall of the urinary bladder
Course of spermatic cord
- Begins at the deep inguinal ring lateral to the inferior epigastric vessels
- Passes through inguinal canal
- Exits at superficial ring
- Ends in the scrotum
Location of female urethral orifice
Vestibule of vagina directly anterior to the vaginal orifice
What stimulates renin release
- Decrease in afferent arteriole pressure
- Reduction in Na+ (detected by macula densa)
- Renal sympathetic nerve stimulation
What do the juxtaglomerular cells secrete
Renin
Describe dartos fascia
- Fat-free fascial layer
- Includes smooth muscle fibres (dartos muscle)
- Continuous anteriorly with Scarpa’s fascia
- Continuous posteriorly with Colle’s fascia
What forms the juxtaglomerular apparatus
- Juxtaglomerular cells of the afferent arteriole
2. Macula densa cells in the DCT
What encapsulates the testes
Visceral layer of tunica vaginalis (closed peritoneal sac)
Where is the penis anchored to the body
Right and left crura are attached to the inferior pubic rami and the perineal membrane
Lymphatic drainage of the male urethra
- Prostatic and membranous = obturator and internal iliac nodes
- Penile = deep and superficial inguinal nodes
Venous drainage of the ovaries
- Right ovarian vein drains into IVC
- Left ovarian vein drains into left renal vein
Where is potassium reabsorbed and how is this regulated
- Active reabsorption in PCT and ascending loop of Henle
- Aldosterone stimulates secretion of K+ into the DCT
Describe the cardinal ligament
- Located at base of broad ligament
- Extends from cervix to lateral pelvic walls
- Contains uterine artery and vein
Embryological origins of the adrenal gland
- Medulla = neural crest (ectoderm)
- Cortex = mesoderm
Anatomical relations of the vagina
- Anterior = fundus of bladder and urethra
- Lateral = levator ani, visceral pelvic fascia, ureters
- Posterior = anal canal, rectum, recto-uterine pouch
Lymphatic drainage of prostate
Internal iliac nodes
Describe the structure of the fallopian tubes
- Covered by peritoneum (apart from intramural part)
- Outer longitudunal muscle coat
- Inner circular muscle layer
- Columnar ciliated lining
List the parts of the fallopian tubes
- Infundibulum
- Ampulla
- Isthmus
- Uterine
Function of Onuf’s nucleus
The neurons of Onuf’s nucleus are responsible for controlling external sphincter muscles of the anus and urethra in humans
Zones affected by carcinoma
Peripheral zone
Describe atonic bladder
- Occurs in initial phase of spinal shock and can last weeks
- Bladder wall muscle relaxed
- Sphincter vesicae is contracted
- Urethral sphincter relaxed
- Bladder becomes distended and eventually empties as overflow
Embryological origin of the urethra
Cloaca
Describe how the ureters enter the bladder
- Pass obliquely through the muscular wall
- Ureteric orifice is in the trigone
What is Gerotas fascia
Eponymous name for renal fascia
Describe the round ligament
- Remnant of the Gebernaculum
- Extends from uterine horns to the labia majora via the inguinal canal
- Maintains anteverted position of uterus
Innervation of the penis
Pudendal nerve
Blood supply to the prostate
Prostatic arteries - derived from internal iliac (especially inferior vesical)
What stimulates EPO production
- Haemorrhage
- Respiratory disease
- High altitude
- Vasoconstriction
- Increased levels of RBC degradation products
Describe the anterior relations of the left kidney
- Suprarenal glands
- Spleen
- Stomach
- Pancreas
- Left colic flexure
- Jejunum
Describe the course of the membranous urethra
- Passes through the pelvic floor and deep perineal pouch
- Surrounded by external urethral sphincter
- Narrowest and least dilatable portion of urethra
What covers the outer surface of each penile crus
Ischiocavernosus muscle
Injury at what spinal level would a patient lose awareness of bladder distension
L1-2
What surrounds the three cylinders of erectile tissue
Buck’s fascia
What is the isthmus of the uterus
Internal OS
What is the role of renin
Stimulates the conversion of angiotensinogen to angiotensin 1
Describe the renal fascia
- Encloses the kidney, suprarenal glands, and perirenal fat
- Extends along the ureter as periureteric fascia
- Superiorly is continuous with the fascia of the diaphragm
- Medially blends with fascia of aorta and IVC
- Laterally continuous with the transversalis fascia
Anatomical relations of the bladder
- Anterior = pubic symphysis
- Posterior: Males = rectum and seminal vesicles. Females = vagina and supravaginal cervix
- Superior = peritoneum, coils of small bowel, sigmoid, body of uterus
- Lateral = loose connective tissue
Innervation of the external urethral sphincter
Pudendal nerve
Pressure within Bowman’s capsule
10mmHg
Where does fertilisation typically occur
Ampulla of the tube
Lymphatic drainage of the kidney
Directly into the para-aortic nodes
Describe the sympathetic innervation of the bladder
- Runs in the hypogastric plexus
- L1-2
- Inhibits micturition
Outline the venous drainage of the bladder
- Males = Vesicoprostatic plexus
- Females = vesicouterine plexus
*Both plexuses drain into the internal iliac vein
Posterior relations of the uterus
- Rectouterine pouch of Douglas
Where is the internal spermatic fascia derived
Transversalis fascia
Arterial supply of the female urethra
Internal pudendal and vaginal arteries
Lymphatic drainage of the scrotum
Superficial inguinal nodes
Level of hilum of left kidney
L1 (Transpyloric plane)
Best substance for GFR calculation
Inulin
Fundus of bladder
Opposite apex. Formed by convex posterior wall.
Describe the course of the penile (bulbous) urethra
- Passes through the bulb and corpus spongiosum of the penis
- Ends at the external urethral orifice (meatus)
- Receives the bulbourethral glands proximally
Lymphatic drainage of the ovaries
Para-aortic nodes
What inhibits FSH production in males
Inhibin
What guides the testes on their descent from posterior abdominal wall to scrotum
Gubernaculum
Describe the course of the prostatic urethra
- Begins as continuation of the bladder neck
- Passes through prostate gland
- Receives the ejaculatory ducts
- Widest part
Line of Brodel
Avascular line which delineates the segments supplied by the anterior and posterior branches of the renal artery
Describe the anterior relations of the right kidney
- Suprarenal gland
- Liver
- Duodenum
- Right colic flexure
Describe the parasympathetic innervation of the bladder
- Run in the sacral outflow (S2/3) and innervate detrusor and internal sphincter
- Fibres in the pudendal nerve control the external sphincter
What separates bladder from pubic symphysis
Retropubic space of Retzius
Where is aldosterone released from
Zona glomerulosa of the adrenal cortex
Length and diameter of female ureter
- 4cm long
- 6mm wide
Lymphatic drainage of the bladder
External iliac nodes to para-aortic nodes
What connects the ovaries to the posterior aspect of the broad ligament
Mesovarium
Actions of atrial natriuretic peptide
- Increased GFR
- Inhibits reabsorption of Na+
Leads to the increased excretion of both sodium and water
Action of aldosterone
Causes retention of Na+ in the DCT in exchange for K+/H+
What is the navicular fossa
Dilation of the bulbous urethra in the glans of the penis
Course of ureter in the pelvis
- Enters pelvis after crossing iliac bifurcation
- Runs down ischial spine
- Crosses obturator nerve and anterior branches of internal iliac
- Turns medial to reach bladder
5 (Male). Passes under vas deferens
5 (Female). Crosses close to lateral fornix of vagina and below uterine artery
Where is the cremasteric fascia derived
Internal oblique
How is glucose reabsorbed
With Na+ bound to a protein carrier in the PCT
Where is ADH produced and then released from
- Produced in supraoptic nucleus of the hypothalamus
- Released from posterior pituitary
Anatomical relations of the adrenal glands
- Posterior = diaphragm
- Inferior = upper pole of kidney
- Anterior (right side) = liver, IVC
- Anterior (left side) = stomach across the lesser sac
Arterial supply of the scrotum
- Posterior scrotal branches of perineal artery
- Anterior scrotal branches of deep external pudendal artery
- Cremasteric artery
What is the tributary of the testicular veins
Pampiniform plexus
What surrounds the two corpus cavernosa
Tunica albugenia
Arterial supply of seminal glands
- Inferior vesical
- Middle rectal
Dimensions of the uterus
7cm x 5cm x 3cm
Length and diameter of ureters
- 25-30cm
- 3mm
Outline the arterial supply of the male urethra
- Prostatic urethra = inferior vesical artery
- Membranous urethra = bulbourethral artery (branch of internal pudendal)
- Penile urethra = directly by branches of the internal pudendal
Where is Onuf’s nucleus
Located in the ventral part of the anterior horn of the sacral region (S1-3)
Kidney filtration rate
120ml/minute
Ureter abdominal relations
- Anterior = peritoneum, colic vessels, gonadal vessels, ileum, mesentery (right side), sigmoid (left side)
- Posterior = psoas major, psoas minor tendon, genitofemoral nerve, iliac bifurcation
Location of the bulbo-urethral (Cowper) glands
Posterolateral to the intermediate part of the urethra, largely embedded in the external urethral sphincter
What occurs in the DCT
- Water is reabsorbed due to low osmolality
- Na+ reabsorption under the control of Aldosterone
Lymphatic drainage of vagina
- Upper and middle 1/3rd = external iliac
- Lower 1/3rd = superficial inguinal
Apex of the bladder
Points towards the pubic symphysis when bladder empty
Describe the internal urethral sphincter
- Males ONLY
- Prevents retrograde ejaculation
Describe the posterior relations of the left kidney
- Diaphragm
- 11th and 12th ribs
- Psoas major, quadratus lumborum, transversus abdominis
- Subcostal, iliohypogastric, ilioinguinal nerves
Number of minor calyces
12
Length of ductus deferens
45cm
What occurs in the PCT
- Reabsorption of 70% of NaCl (Na+ via ATP-dependent pump)
- Reabsorbs all amino acids and glucose
- Volume of ultrafiltrate decreases
- Osmolality is unchanged
- Vulnerable to ischaemic change
Osmolality of ultrafiltrate
300mosmol/L
Where is the external spermatic fascia derived
External oblique
What stimulates the release of atrial natriuretic peptide
Release from the heart in response to increased atrial stretch as a result of raised ECF
What stimulates ADH release
- Osmoreceptors in the hypothalamus detect increases in the osmolality of the ECF
- Reduced circulating volume
- Reduced arterial pressure
- Angiotensin 2
Structure of epithelium in Bowman’s capsule
- Podocytes
- Do not form continuous layer
- Contain foot processes
Tributaries of the ejaculatory ducts
- Duct of seminal glands
- Ductus deferens
Describe the shape and position of the right adrenal gland
- Pyramidal
- Embraces upper pole of kidney
Describe the uterosacral ligament
Extends from cervix to sacrum
Location and size of the seminal glands
- 5cm long
- Lie between fundus of bladder and rectum
- Superior to prostate
Describe the shape and position of the left adrenal gland
- Crescentic
- Embraces medial border of the kidney above the hilum
Superior relations of right kidney
- Liver
- Adrenal gland
How is autoregulation achieved
- Myogenic - increase in pressure due to increase in flow causes distension of vessels, which causes smooth muscle contraction to reduce flow
- Metabolic
Arterial supply to ductus deferens
Artery to ductus deferens - arises from superior vesical artery
- Anastomoses with testicular artery
Function of FSH in males
Acts on sertoli cells of the testes and is important for spermatogenesis
Outline the capsules of the prostate gland
- True capsule = thin, fibrous sheath surrounding the prostat
- False capsule = condensed extraperitoneal fascia continuous with the fascia surrounding the bladder and Denonvilliers fascia posteriorly
- Pathological capsule = BPH compresses the normal peripheral part of the gland, creating a capsule
Urethral epithelium
Stratified columnar
List the coverings of the kidney from in to out
- Renal capsule
- Perirenal fat (perinephric fat)
- Renal fascia
- Pararenal fat
Describe the arterial supply of the bladder
- Superior vesical arteries = anterosuperior parts of bladder
- Inferior vesical arteries (A.K.A. vaginal arteries in females) = fundus and neck
Volume of semen provided by the prostate
20%
Describe the vascular course within the kidney
- Renal arteries enter hilum
- Branches to form interlobar arteries which ascend between pyramids
- Branch to form arcuate arteries
- Branch to form interlobular arteries
- Afferent arteries arise from interlobular arteries
- Give rise to glomerular capillaries
Normal resting bladder pressure
3cmH2O
What is the fate of angiotensin 1
Converted to angiotensin 2 by ACE in the lungs
Innervation of the scrotum
- Anterolateral = genital branch of genitofemoral
- Anterior = anterior scrotal (branch of ilioinguinal)
- Posterior = perineal branch of pudendal
- Postero-inferior = perineal branches of posterior cutaneous nerve of thigh
Embryological origin of the ureter
Mesonephric duct
Length of male urethra
15-20cm
Describe the internal structure of the kidney
- Medulla
- Cortex (which extends into the medulla to divide it into triangular renal pyramids)
What substance is used to measure renal plasma flow and why
- Para-aminohippuric acid (PAH)
- Completely removed from the plasma in a single pass through the kidney
Parts of the cervix
- Supravaginal - between isthmus and vagina
2. Vaginal
Ligaments of the neck of the bladder
- Men = puboprostatic ligament
- Women = pubovesical ligament
How much is total renal blood flow
- 1.25L/minute
- 25% of cardiac output
Describe automatic reflex bladder
- Seen after spinal shock in injuries above S2-4
- Bladder empties reflexly every 3-4 hours
What is the narrowest part of the male urethra
Membranous urethra
What occurs in the ascending loop of Henle
- IMPERMEABLE TO WATER
- Responsible for active NaCl reabsorption
- Osmolality of fluid leaving ascending limb 100mosmol/L
Venous drainage of the penis
Dorsal vein of the penis runs in groove between the corporal bodies and drains into the prostatic venous plexus
Outline the lymphatic drainage of the uterus
- Fundus = para-aortic, inguinal
- Body = iliac
- Cervix = external iliac, sacral, internal iliac
Outline the structure of the uterus
- Fundus
- Body
- Cervix
Blood supply of uterus
Uterine artery - branch of internal iliac
Outline the venous drainage of the adrenal glands
- Right = short vein direct to IVC
- Left = long vein which contributes to left renal vein
3 divisions of the ureters
- Abdominal
- Pelvic
- Intravesical
Origin of cremasteric artery
Inferior epigastric artery
Describe the Mesosalpinx
Broad ligament of the peritoneum that drapes over the fallopian tubes
3 common bladder abnormalities following spinal cord injury
- Atonic bladder
- Automatic reflex bladder
- Autonomous bladder
Outline the two possible courses of efferent arterioles in the kidney
- Supply of capillaries to the renal tubules (peri-tubular)
- Vasa recta that supply blood to the medulla
Lymphatic drainage of the penis
- Glans and distal spongy urethra = Deep inguinal (bilateral)
- Skin of penis = superficial inguinal
Length of the vagina
7cm
List the contents of the spermatic cord
- Testicular artery (from aorta)
- Cremasteric artery (from inferior epigastric)
- Artery of Vas deferens (from inferior vesical)
- Genital branch of the genitofemoral cremaster
- Sympathetic fibres (run on arteries)
- Parasympathetic fibres (run on ductus deferens)
(- Ilioinguinal nerve - runs on cord and not in it) - Ductus deferens
- Pampiniform plexus
- Lymphatic
Innervation of the prostate
Sympathetic, parasympathetic, sensory from inferior hypogastric plexus
Structure of the testes
- Outer Tunica albuginea
- Inward-reaching septum between lobules of minute
- Highly coiled semineferous tubules (joined to rete testes by straight tubules)
Origin of the tunica vaginalis
Closed sac of peritoneum
Arterial supply of the penis
Common penile artery - terminal branch of the internal pudendal artery
Outline the parts of the epididymis
- Head
- Body
- Tail - continuous with vas deferens
Name given to the apex of the renal pyramids and what do they represent
Renal papilla - where urine is screted into the renal calyces of the renal pelvis
Ureter epithelium
Transitional
Function of LH in males
Stimulates Leydig cells to produce testosterone
Position of the ureters
Overly the transverse processes of L2-L5
What stimulates the release of aldosterone
- Angiotensin 2
- Raised potassium
- Raised ACTH
Describe the clinical divisions (zones) of the prostate
- Central zone - surrounds ejaculatory ducts (25% vol)
- Transitional zone - central, surrounds urethra (5-10% vol)
- Peripheral zone - main body of gland (65% vol)
Length of fallopian tubes
10-12cm
What forces govern glomerular filtration
- Hydrostatic
2. Osmotic (plasma proteins which arent filtered oppose hydrostatic pressure)
Length of cervix
2.5cm
Rate of urine production
1ml/kg/hr
Outline the blood supply of the ureters
Segmental:
- Renal
- Testicular and ovarian
- Internal iliac
- Inferior vesical