anatomy sistem urologi

7/28/2019 anatomy sistem urologi

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The urinary organs comprise the kidneys,which secrete the urine, the ureters, orducts, which convey urine to the urinary

bladder, where it is for a time retained; andthe urethra, through which it is dischargedfrom the body.


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1. The Kidneys (Renes)The kidneys aresituated in the posterior part of theabdomen, one on either side of the vertebral

column, behind the peritoneum, andsurrounded by a mass of fat and loose areolartissue. Their upper extremities are on a levelwith the upper border of the twelfth thoracic

vertebra, their lower extremities on a levelwith the third lumbar. The right kidney isusually slightly lower than the left, probablyon account of the vicinity of the liver


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the upper extremity is in relation with the rightsuprarenal gland.

A large areajust below this and involving aboutthree-fourths of the surface, lies in the renalimpression on the inferior surface of the liver,

medial border is in contact with the descendingpart ofthe duodenum.

The lower part of the anterior surface is incontact laterally with the right colic flexure,

medially, as a rule, with the small intestine. The areas in relation with the liver and small

intestine are covered by peritoneum; the suprarenal, duodenal, and colic areas are

devoid of peritoneum.


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the upper part of the medial border is in relation with theleft suprarenal gland,

the lateral border is a long strip in contact with the renalimpression on the spleen.

the middle of the anterior surface, marks the site of

contact with the body of the pancreas, and lienal vessels. Above this is a small triangular portion, between the

suprarenal and splenic areas, in contact with the postero-inferior surface of the stomach.

the lateral part is in relation with the left colic flexure, the medial with the small intestine. The areas in contact with the stomach and spleen are

covered by the peritoneum of the omental bursa, while that in relation to the small intestine is covered by

the peritoneum of the general cavity. The suprarenal,pancreatic, and colic areas are devoid of peritoneum.


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It lies upon the diaphragm, the medial andlateral lumbocostal arches, the Psoas major,the Quadratus lumborum, and the tendon of

the Transversus abdominis, the subcostal,and one or two of the upper lumbar arteries,and the last thoracic, iliohypogastric, andilioinguinal nerves.


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The lateral border (margo lateralis;external border) is convex, and is directedtoward the postero-lateral wall of theabdomen. On the left side it is in contact at

its upper part, with the spleen. The medial border (margo medialis;

internal border) is concave in the center andconvex toward either extremity. The fissure

is named the hilum, and transmits thevessels, nerves, and ureter. Above the hilumthe medial border is in relation with thesuprarenal gland; below the hilum, with theureter.


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.The kidney is invested by a fibrous tunic,smooth covering to the organ. The tunic canbe easily stripped off.

The kidney is dense in texture, but is easilylacerable by mechanical force.


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The renal calyces, from seven to thirteen innumber, are cup-shaped tubes, each of whichembraces one or more of the renal papill;

they unite to form two or three short tubes,and these in turn join to form a funnel-shaped sac, the renal pelvis.

The renal pelvis, wide above and narrow

below where it joins the ureter, is partlyoutside the renal sinus.


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The medullary substance (substantiamedullaris) consists of a series of red-colored striated conical masses, termed therenal pyramids

The cortical substance (substantiacorticalis) is reddish brown in color and softand granular in consistence. The partsdipping in between the pyramids are named

the renal columns (Bertini), while theportions which connect the renal columns toeach other and intervene between the basesof the pyramids and the fibrous tunic arecalled the cortical arches).


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blood vessel

Glomerulus is composed of two parts: acentral glomerulus of vessels, and a

membranous envelope, the glomerularcapsule (capsule of Bowman), which is thesmall pouch-like commencement of a renaltubule.


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This capillary net-work is derived from a smallarterial twig, the afferent vessel, which entersthe capsule, and the resulting vein, the efferentvessel, emerges from the capsule at the same

point. The afferent vessel is usually the larger ofthe two

The glomerular or Bowmans capsule,whichsurrounds the glomerulus, consists of a basementmembrane, lined on its inner surface by a layer

of flattened epithelial cells, which are reflectedfrom the lining membrane on to the glomerulus,at the point of entrance or exit of the afferentand efferent vessels.


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At their junction with the glomerular capsule theyexhibit a somewhat constricted portion, which istermed the neck. Beyond this the tubule becomesconvoluted, and pursues a considerable course in thecortical substance constituting the proximalconvoluted tube.

They now enter the medullary substance, suddenlybecome much smaller, quite straight in direction, anddip down for a variable depth into the pyramids,constituting the descending limb ofHenles loop.Bending on themselves, they form what is termed theloop of Henle, and reascending, they becomesuddenly enlarged, forming the ascending limb ofHenles loop, and renter the cortical substance.


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Aorta gives off right and left renal arteries

Renal arteries divides into 5segmentalarteries as entershilus of kidney

25

Segmentalsbranch into

lobar arteries

Lobarsdivide into

interlobarsInterlobarsinto arcuate in

junction of medulla and

cortex

Arcuatessend interlobulararteries into cortexto glomerular arter io les


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They have small ganglia developed uponthem, and are derived from the renal plexus,which is formed by branches from the celiacplexus, the lower and outer part of theceliac ganglion and aortic plexus, and fromthe lesser and lowest splanchnic nerves.

They communicate with the spermatic

plexus, a circumstance which may explainthe occurrence of pain in the testis inaffections of the kidney.


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The lymphatics of the right kidney drain intolymph nodes located between the inferiorvena cava and the aorta, lateral paracavalnodes, and anterior and posterior inferiorvena caval lymph nodes. They also drainupward toward the right diaphragm, anddownward to the common iliac lymphnodes. Other pathways are into the thoracicduct or crossing the midline into the leftlateral aortic lymph nodes.


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The ureters are the two tubes which conveythe urine from the kidneys to the urinarybladder, 25 to 30 cm. It runs downward andmedialward in front of the Psoas major and,entering the pelvic cavity, finally opens intothe fundus of the bladder.


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The abdominal part (pars abdominalis) liesbehind the peritoneum on the medial part ofthe Psoas major

And crossed obliquely by the internalspermatic vessels. It enters the pelvic cavityby crossing either the termination of thecommon, or the commencement of the

external, iliac vessels.


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The pelvic part (pars pelvina) runs at firstdownward on the lateral wall of the pelviccavity.

Finally, the ureters run obliquely for about 2cm. through the wall of the bladder andopen by slit-like apertures into the cavity ofthe viscus at the lateral angles of the

trigone.


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Vessels and Nerves.The arteries supplyingthe ureter are branches from the renal,internal spermatic, hypogastric, and inferiorvesical.

The nerves are derived from the inferiormesenteric, spermatic, and pelvic plexuses.


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The urinary bladder is amusculomembranous sac which acts as areservoir for the urine; and as its size,position, and relations vary according to theamount of fluid it contains


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The anterior angle of the trigonum vesic isformed by the internal orifice of the urethra:its postero-lateral angles by the orifices ofthe ureters

The lateral parts of this ridge extend beyondthe openings of the ureters, and are namedthe plic ureteric; they are produced by

the terminal portions of the ureters as theytraverse obliquely the bladder wall.


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The bladder is composed of the four coats:serous, muscular, submucous, and mucouscoats.

The serous coat (tunica serosa) is derivedfrom the peritoneum.

The muscular coat (tunica muscularis) consistsof three layers of unstriped muscular fibers: anexternal layer, composed of fibers having for themost part a longitudinal arrangement (musculi

pubovesicales); a middle layer, in which the

fibers are arranged, more or less, in a circularmanner; and an internal layer, in which thefibers have a general longitudinal arrangement(Detrusor urin muscle.)


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The submucous coat (tela submucosa)consists of a layer of areolar tissue,connecting together the muscular andmucous coats, and intimately united to thelatter.


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The mucous coat (tunica mucosa) is thin,smooth, and of a pale rose color.

The loose texture of the submucous layer

allows the mucous coat to be thrown intofolds or rug when the bladder is empty.

Over the trigonum vesic the mucousmembrane is closely attached to the

muscular coat, and is not thrown into folds,but is smooth and flat.


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The arteriessupplying the bladder are thesuperior, middle, and inferior vesical, derivedfrom the anterior trunk of the hypogastric. Theobturator and inferior gluteal arteries alsosupply small visceral branches to the bladder,and in the female additional branches arederived from the uterine and vaginal arteries.

The veins form a complicated plexus on theinferior surface, and fundus near the prostate,

and end in the hypogastric veins. The nerves of the bladder are (1) third and

fourth sacral nerves, and (2) the hypogastricplexus.


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The membranous portion (pars membranacea)is the shortest, least dilatable, and, with theexception of the external orifice, thenarrowest part of the canal. It extendsdownward and forward, with a slight anteriorconcavity, between the apex of the prostateand the bulb of the urethra, perforating theurogenital diaphragm about 2.5 cm.

The membranous portion of the urethra is

completely surrounded by the fibers of theSphincter urethr membranace; on eitherside near its termination are the bulbourethralglands.


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The cavernous portion (pars cavernosa; penileor spongy portion) is the longest part of theurethra, and is contained in the corpuscavernosum urethr. It is about 15 cm. long,and extends from the termination of themembranous portion to the external urethralorifice.

The lining membrane of the urethra,especially on the floor of the cavernous

portion, presents the orifices of numerousmucous glands and follicles situated in thesubmucous tissue, and named the urethralglands (Littr).


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The male genitals include the testes, theductus deferentes, the vesicul seminales,the ejaculatory ducts, and the penis,together with the following accessorystructures, the prostate and thebulbourethral glands


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.The testes are two glandular organs, whichsecrete the semen; they are suspended inthe scrotum by the spermatic cords.

At an early period offetal life the testes arecontained in the abdominal cavity, behindthe peritoneum. Before birth they descend tothe inguinal canal, along which they passwith the spermatic cord, and, emerging atthe subcutaneous inguinal ring, they descendinto the scrotum


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The Scrotum is a cutaneous pouch whichcontains the testes and parts of the spermaticcords. It is divided on its surface into two lateralportions by a ridge or raph or septum ofscrotum

The scrotum consists of two layers, theintegument and the dartos tunic.

The Integument is very thin, of a brownishcolor, and generally thrown into folds or rug. It

is provided with sebaceous follicles, thesecretion of which has a peculiar odor, and isbeset with thinly scattered, crisp hairs, the rootsof which are seen through the skin.


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The Dartos Tunic (tunica dartos) is a thinlayer of non-striped muscular fibers,continuous, it sends inward a septum, whichdivides the scrotal pouch into two cavitiesfor the testes, and extends between theraph and the under surface of the penis, asfar as its root.


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The arteries supplying the coverings of thetestes are: a. pudendal branches of thefemoral, a .inferior epigastric. The veinsfollow the course of the corresponding

arteries. The lymphatics end in the inguinallymph glands. The nerves are theilioinguinal and lumboinguinal branches ofthe lumbar plexus, pudendal nerve


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funiculus spermaticus extends from theabdominal inguinal ring to the back part ofthe testis.

The left cord is rather longer than the right,consequently the left testis hangs somewhatlower than its fellow.


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Structure of the Spermatic Cord.

Thespermatic cord is consist of a. spermaticus,a.vas deferent, plexus pampiniformis,lymphatic vessel, nerve the spermatic

plexus from the sympathetic,vas deferentduct.


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The epididymis consists of a central portionor body; an upper enlarged extremity, thehead (globus major); and a lower pointedextremity, the tail (globus minor), which is

continuous with the ductus deferens theduct of the testis.


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The testis is invested by three tunics: thetunica vaginalis, tunica albuginea, andtunica vasculosa.

The Tunica Vaginalis (tunica vaginalispropria testis) is the serous covering of thetestis, derived from the saccus vaginalis ofthe peritoneum.


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The Tunica Albuginea is the fibrous coveringof the testis. It is a dense membrane, of abluish-white color, composed of bundles ofwhite fibrous tissue which interlace in every

direction


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The glandular structure of the testisconsists of numerous lobulesis estimatedby Berres at 250, and by Krause at 400.

Each lobule is contained in one of theintervals between the fibrous septa whichextend between the mediastinum testisand the tunica albuginea, and consists of

from one to three, or more, minuteconvoluted tubes, the tubuli seminiferi.


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The ductus deferens, the excretory ductof the testis, is the continuation of thecanal of the epididymis. It is enters the

pelvic cavity, then crosses in front of theureter.

and runs medialward and slightly forwardbetween the fundus of the bladder and

the upper end of the seminal vesicle.


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Lastly, it is directed downward to thebase of the prostate, where it becomesgreatly narrowed, and is joined at an

acute angle by the duct of the seminalvesicle to form the ejaculatory duct.


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Structure.

The ductus deferens consistsof three coats: (1) an external or areolarcoat; (2) a muscular coat which in the

greater part of the tube consists of twolayers of unstriped muscular fiber(3) aninternal or mucous coat, which is pale,and arranged in longitudinal folds.


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The vesicul seminales are composed ofthree coats: an external or areolar coat;a middle or muscular coat thinner thanin the ductus deferens and arranged intwo layers, an outer longitudinal andinner circular; an internal or mucouscoat, which is pale, of a whitish brown

color, and presents a delicate reticularstructure.


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Vessels and Nerves.

The arteries supplyingthe vesicul seminales are derived from themiddle and inferior vesical and middlehemorrhoidal. The veins and lymphatics

accompany the arteries. The nerves arederived from the pelvic plexuses.


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The ejaculatory ducts are two in number,one on either side of the middle line. Each isformed by the union of the duct from the

vesicula seminalis with the ductus deferens,and is about 2 cm. long.


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is a pendulous organ suspended from thefront and sides of the pubic arch andcontaining the greater part of the urethra. Itis composed of three cylindrical masses of

cavernous tissue bound together by fibroustissue and covered with skin. Two of themasses are lateral, and are known as thecorpora cavernosa penis; the third is

median, and is termed the corpuscavernosum urethr.


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The Corpora Cavernosa Penis form thegreater part of the substance of the penis.Just before it meets its fellow it presents aslight enlargement, named by Kobelt the

bulb of the corpus cavernosum penis. The Corpus Cavernosum Urethr (corpus

spongiosum) contains the urethra.


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The body (corpus penis) extends from theroot to the ends of the corpora cavernosapenis, and in it these corpora cavernosa areintimately bound to one another.

The glans penis, the expanded anterior endof the corpus cavernosum urethr. It isseparated from the body by the constrictedneck, which is overhung by the coronaglandis.


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The integument covering the penis isremarkable for its thinness, its dark color, itslooseness of connection with the deeperparts of the organ, and its absence of

adipose tissue. At the root of the penis it iscontinuous with that over the pubes,scrotum, and perineum. At the neck it leavesthe surface and becomes folded upon itself

to form the prepuce or foreskin.


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Vessels and Nerves.

from the dorsalarteries of the penis branch of internalpudenda arteri


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The nerves are derived from the pudendalnerve and the pelvic plexuses. On the glansand bulb some filaments of the cutaneousnerves have Pacinian bodies connected with

them, and, according to Krause


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The prostate is a firm, partly glandular andpartly muscular body, which is placedimmediately below the internal urethralorifice and around the commencement of the

urethra. It is presents for examination abase, an apex, an anterior, a posterior andtwo lateral surfaces.


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Structure.

The prostate is immediatelyenveloped by fibrous capsule, It consists ofglandular substance and muscular tissue

Vessels and Nerves.The arteriessupplying the prostate are derived fromthe internal pudendal, inferior vesical,and middle hemorrhoidal. Its veins form a

plexus ,they receive in front the dorsalvein of the penis, and end in thehypogastric veins. The nerves are derivedfrom the pelvic plexus.


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The bulbourethral glands are two small,rounded, and somewhat lobulated bodies, ofa yellow color, placed behind and lateral tothe membranous portion of the urethra,

between the two layers of the fascia of theurogenital diaphragm.


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The excretory duct of each gland, nearly 2.5cm. long, passes obliquely forward beneaththe mucous membrane, and opens by aminute orifice on the floor of the cavernous

portion of the urethra about 2.5 cm. in frontof the urogenital diaphragm.


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Henry Gray (18211865). Anatomy of the

Human Body. 1918.


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anatomy sistem urologi

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