1. The excretory system: V renal excretory ducts ‹ renal calyces ‹ renal pelvis V ureters V urinary bladder V male and female urethra SPLANCHNOLOGY The excretory system
° The excretory system:
V kidney, ren:
‹ renal calyces – minor and major
‹ renal pelvis
V ureter, ureter
V urinary bladder, vesica urinaria
V urethra, urethra:
‹ male urethra, urethra masculina
‹ female urethra, urethra feminina
Prof. Dr. Nikolai Lazarov 2 SPLANCHNOLOGY Excretory ducts of the kidney
° Minor calyces, calyces renales minores: V 8-9 in number V fornix ° Major calyces, calyces renales majores: V 2(3) in number ° Renal pelvis, pelvis renalis: V in the renal sinus V pelvis ampullaris et ramificans ° Forms of the excretory system: V embryonic V fetal V mature Prof. Dr. Nikolai Lazarov 3 SPLANCHNOLOGY Ureter, ureter
° Ureter, ureter: V muscular tube V length 30 cm V diameter 7-8 mm ° Anatomical parts: V abdominal part – – retroperitoneal position V pelvic part V intramural part ° Three anatomical constrictions: V diameter 3-4 mm
Prof. Dr. Nikolai Lazarov 4 SPLANCHNOLOGY Microscopic anatomy ° tunica mucosa : V lamina epithelialis – transitional epithelium V lamina propria – 350-700 µm ‹ fibroelastic connective tissue ‹ lymphocytes and lymphatic follicles ° tunica muscularis – 750-800 µm: V stratum longitudinale V stratum circulare V stratum longitudinale – lower ⅓ ° tunica adventitia: V nerves V loose connective tissue V blood and lymph vessels
Prof. Dr. Nikolai Lazarov 5 SPLANCHNOLOGY The roentgen anatomy ° Retrograde pyelography ° Intravenous urography ° Normal course of ureters ° Three major forms of the excretory tree ° Ureteral abnormalities – duplicated ureter
Prof. Dr. Nikolai Lazarov 6 SPLANCHNOLOGY Urinary bladder, vesica urinaria
° Urinary bladder, vesica urinaria (Gr. cystis): V reservoir – collects urine, 120-230 (max. 500) ml V on the pelvic cavity floor V sphere- or pear-shaped ° Anatomical parts: V fundus, fundus vesicae V neck, cervix vesicae V body, corpus vesicae V summit , apex vesicae Ù lig. umbilicale medianum ° Internal surface: V trigone, trigonum vesicae ‹ ostium ureteris ‹ ostium urethrae internum V plica interureterica, uvula
Prof. Dr. Nikolai Lazarov 7 SPLANCHNOLOGY Imaging Anatomy
cystourethrography
retrograde ureteropyelography
paramedian MRI Prof. Dr. Nikolai Lazarov 8 SPLANCHNOLOGY Microscopic anatomy
° tunica mucosa – wrinkled or folded: V lamina epithelialis – transitional epithelium V lamina propria – 350-700 µm ‹ areolar connective tissue ‹ lymphocytes and lymph follicles ° tela submucosa – mucosal rugae, mucosal stroma ° tunica muscularis – detrusor muscle V internal longitudinal layer V circular layer Ù m. sphincter vesicae V external longitudinal layer ° tunica serosa (adventitia): V superior-posterior surface – serosa V loose connective tissue V blood and lymph vessels Prof. Dr. Nikolai Lazarov 9 SPLANCHNOLOGY Blood supply to the ureter and urinary bladder ° Blood supply : V the ureter – branches from: ‹ a. renalis, a. testicularis (ovarica), aorta abdominalis, a. iliaca communis et a. iliaca interna, a. rectalis media, aa. vesicales inferiores V the urinary bladder: ‹ a. vesicalis superior ‹ a. vesicalis inferior ° Venous drainage: V ureter Ù homonymous veins Ù inferior vena cava V bladder Ù plexus venosus vesicalis Ù v. iliaca int.
Prof. Dr. Nikolai Lazarov 10 SPLANCHNOLOGY Lymphatic drainage
° Ureter: V lymph nodes around abdominal aorta V iliac lymph nodes ° Urinary bladder: V internal iliac lymph nodes
Prof. Dr. Nikolai Lazarov 11 SPLANCHNOLOGY Innervation of the ureter and urinary bladder ° Ureter: V parasympathetic – pelvic nerves V sympathetic ‹ nerves along the arteries V somatosensory ‹ Spinal nerves ° Urinary bladder – plexus vesicalis: V sympathetic ‹ plexus vesicalis V parasympathetic ‹ nn. pelvici V somatosensory ‹ nerve fibers of spinal origin
Prof. Dr. Nikolai Lazarov 12 SPLANCHNOLOGY Innervation of the ureter and urinary bladder ° Ureter: V parasympathetic – pelvic nerves V sympathetic ‹ nerves along the arteries V somatosensory ‹ Spinal nerves ° Urinary bladder – plexus vesicalis: V sympathetic ‹ plexus vesicalis V parasympathetic ‹ nn. pelvici V somatosensory ‹ nerve fibers of spinal origin
Prof. Dr. Nikolai Lazarov 13 SPLANCHNOLOGY
Male and female urethra
Prof. Dr. Nikolai Lazarov 14 SPLANCHNOLOGY Male urethra
° Urethra masculina ~20 cm: V intarmural part V prostatic part – 3 cm V membranous part – 1-2 cm V spongy (penile) part – 15 cm
Prof. Dr. Nikolai Lazarov 15 SPLANCHNOLOGY Microscopic anatomy
° tunica mucosa : V lamina epithelialis ‹ transitional epithelium ‹ pseudostratified columnar epithelium ‹ stratified squamous nonkeratinized – in the navicular fossa V lamina propria – basement membrane; stroma ‹ urethral glands (Littre ); urethral lacunae (Morgagni) ° tunica muscularis – prostatic and membranous parts V str. circulare Ù m. sphincter urethrae (externus) V str. longitudinale
Prof. Dr. Nikolai Lazarov 16 SPLANCHNOLOGY Female urethra ° Urethra feminina: V ostium urethrae internum V ostium urethrae externum V length 3-4 cm V diameter 6-10 mm ° Microscopic anatomy: V tunica mucosa – longitudinal folds, urethral crest ‹ transitional epithelium ‹ stratified squamous nonkeratinized epithelium ‹ stratified squamous keratinized ‹ lamina propria o urethral glands o urethral lacunae V tela submucosa ‹ tunica spongiosa V tunica muscularis ‹ internal layer, smooth muscle fibers ‹ external layer, striated muscle fibers Prof. Dr. Nikolai Lazarov 17 SPLANCHNOLOGY Female urethra ° Urethra feminina: V ostium urethrae internum V ostium urethrae externum V length 3-4 cm V diameter 6-10 mm ° Microscopic anatomy: V tunica mucosa – longitudinal folds, urethral crest ‹ transitional epithelium ‹ stratified squamous nonkeratinized epithelium ‹ stratified squamous keratinized ‹ lamina propria o urethral glands o urethral lacunae V tela submucosa ‹ tunica spongiosa V tunica muscularis ‹ internal layer, smooth muscle fibers ‹ external layer, striated muscle fibers Prof. Dr. Nikolai Lazarov 18 SPLANCHNOLOGY Thank you ....
Prof. Dr. Nikolai Lazarov 19