Urinary system 2 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 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 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 homonymous veins inferior vena cava V bladder plexus venosus vesicalis 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 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.