Kidneys and Urinary System Kidneys

• Move as much as 1 inch during respiration

• Kidneys • The kidneys lie in a retroperitoneal position on
the posterior abdominal wall in the superior
• Ureters lumbar region T11-T2
• Urinary • The right kidney is lower than the left
• The lateral surface is convex; the medial surface
Bladder is concave - hilum
• Renal vein, 2 branches of the renal artery, the
• Urethra ureter, another branch of renal artery (VAUA)
• Lymph vessels and sympathetic fibres also pass
through hilum

Location and Relations – Right

Kidney
• Anteriorly
– Adrenal gland, the liver, 2nd duodenum, right
colic flexure

• Posteriorly
– Diaphragm (and costodiaphragmatic recess),
12th rib, psoas,
– subcostal (T12) iliohypogastric and ilioinguinal
nerves (L1) run downwards and laterally

Location and Relations – Left

Coverings of the Kidneys
Kidney
• Anteriorly • Renal / fibrous capsule - that prevents
– Adrenal, spleen, stomach, pancreas, left colic kidney infection
flexure
• Perirenal fat – fatty mass that cushions the
kidney and helps attach it to the body wall
• Posteriorly
• Renal fascia – outer layer of dense fibrous
– Diaphragm (and costodiaphragmatic recess),
11th and 12th rib, psoas, connective tissue that anchors the kidney
– subcostal (T12) iliohypogastric and ilioinguinal • Pararenal fat – external to the renal fascia
nerves (L1) run downwards and laterally

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 Renal capsule
Renal fascia
Perirenal fat
Pararenal fat

Renal Structure • Major calyces – large branches of the

• Cortex – the light colored, granular
superficial region
• Medulla – exhibits dozen cone-shaped
medullary (renal) pyramids separated by
columns
• Each apex of renal pyramid projects into
minor calyces
• 2-3 minor calyces – major calyx
renal pelvis
– Collect urine draining from papillae
– Empty urine into the renal pelvis
• Renal pelvis – flat funnel shaped tube -
expanded upper end of the ureter
• The renal sinus – space within the hilum
which contains the renal pelvis and
vessels
• Urine flows through the pelvis and ureters
to the bladder

columns

cortex
Minor calyx

medullary Major calyx

pyramid

pelvis

Renal papilla
ureter

Figure 25.71

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 Blood Supply The Kidneys and Adrenal Glands
• Approximately 1/4 (1200 ml) of systemic
cardiac output flows through the kidneys
each minute
• Arterial flow into and venous flow out of
the kidneys follow similar paths
• Renal artery – segmental arteries (2-4 ant,
1 post) – lobar arteries (1 per pyramid)
• Renal vein emerges at hilum anterior to
arteries
• Lymph drainage to lateral aortic lymph
nodes

Nerve Supply Ureters

• The nerve supply is via the renal plexus
– Sympathetic, Parasympathetic, Visceral
afferent
– From thoracic and lumbar splanchnics and
vagus nerve
• The afferent fibres that travel through the
renal plexus enter T10-12
Referred pain to small of back, flank (lumbar
quadrant, and genitals (calculi)
• Retroperitoneal, muscular tubes
• Pass over the pelvic brim at bifurcation of
common iliac arteries
• Run on lateral walls of pelvis
• Opposite ischial spine, curve
anteromedially
• Oblique entrance into bladder – one way
flap valve
• posterosuperior angles of the bladder

Ureters
• Ureters have a trilayered wall
– Transitional epithelial mucosa
– Smooth muscle muscularis
– Fibrous connective tissue adventitia
• Ureters actively propel urine to the bladder
via response to smooth muscle stretch

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 Urinary Bladder
• Smooth, collapsible, muscular sac that
stores urine
• It lies retroperitoneally on the pelvic floor
posterior to the pubic symphysis
• It is connected anteriorly to the umbilicus –
median umbilical ligament (urachus)
• The bladder is distensible and collapses
when empty
• As urine accumulates, the bladder
expands without significant rise in internal
pressure

Male Bladder
• 2 vas deferentia lie posterior surface of
bladder between seminal vesicles
• Peritoneum – rectovesical pouch
• prostate gland surrounds the neck
inferiorly

Ureteric orifices

Urinary Bladder – Internal Anatomy peritoneum

• The bladder wall has three layers

– Transitional epithelial mucosa
Detrusor
– A thick muscular layer muscle

– A fibrous adventitia
prostate
trigone
• Trigone – triangular area outlined by the
openings for the ureters and the urethra
– Clinically important because infections tend to
Internal
persist in this region Urethral
Orifice

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 Urethra Urethra
• Muscular tube that:
– Drains urine from the bladder • The female urethra is
– Conveys it out of the body tightly bound to the
anterior vaginal wall
• Sphincters keep the urethra closed when
urine is not being passed • Its external opening
– Internal urethral sphincter – involuntary lies anterior to the
sphincter at the bladder-urethra junction vaginal opening and
– External urethral sphincter – voluntary posterior to the clitoris
sphincter surrounding the urethra as it passes
through the urogenital diaphragm
– Levator ani muscle – voluntary urethral
sphincter

peritoneum
peritoneum

Paravesical Paravesicular fascia

fascia

Detrusor
muscle Obturator internus

Levator ani ureter Levator ani

prostate
trigone
Crus of clitoris
Internal Pubic ramus
urethral
orifice Crus of penis
Bulb of vestibule + bulbospongiosus
Levator ani
Bulbospongiosus / corpus cavernosum

Rectovesical pouch
Ureteric orifice
Seminal vesicle

trigone

Internal Internal urethral orifice prostate

Urethral
trigone
spincter
Prostatic
Membranous
Spongey
urethra
Prostatic urethra

Sphincter
Urethrae and
Spongey urethra
Perineal membrane

Ejaculatory duct

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Micturition (Voiding or Urination)
• The act of emptying the bladder
• Distension of bladder walls initiates spinal
reflexes that:
– Stimulate contraction of the external urethral
sphincter
– Inhibit the detrusor muscle and internal
sphincter (temporarily)
• Voiding reflexes:
– Stimulate the detrusor muscle to contract
– Inhibit the internal and external sphincters