GROUP 19:

1ST WEEK

Debby Mulya Rahmy

Nopriyanti Eka Pratiwi
Irawati Fauziah Fiska
Radhia Ashabul Kahfi
Bey
Radhiatul Mardhiah
Ruslan Kamil
Suhayatra Putra
Wira Lestiani Arif
Wulan Octaviani

LEARNING OBJECTIVES

Embryology of Urinary System

Anatomy of Urinary System
Hystology of Urinary System
Vascularization & Innervation of Urinary System
Congenital Disorder of Urinary System

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

EMBRYOLOGY OF URINARY SYSTEM

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Urogenital System

Functionally the urogenital system can be divided into

two entirely different components:

1. The urinary system
2. The genital system.
Embryologically and anatomically they are intimately
interwoven.
Both develop from a common mesodermal ridge
(intermediate mesoderm)
Initially the excretory ducts of both systems enter a
common cavity, the cloaca.

Urinary System
KIDNEY SYSTEMS

Three slightly overlapping kidney systems are formed in

a cranial to caudal sequence during intrauterine life in
humans:
1.The pronephros, (rudimentary and nonfunctional).
2.The mesonephros, (function for a short time during the
early fetal period).
3.The metanephros, (forms the permanent kidney)

Pronephros

At the beginning of the fourth week, the

pronephros is represented by 7 to 10 solid cell
groups in the cervical region.
These groups form vestigial excretory units,
nephrotomes, that regress before more caudal ones
are formed.
By the end of the fourth week, all indications of
the pronephric system have disappeared.

Relationship of the
intermediate mesoderm of
the pronephric,
mesonephric,
and metanephric systems.
In cervical and upper
thoracic regions
intermediate
mesoderm is segmented;
in lower thoracic, lumbar,
and sacral regions it forms a
solid,
unsegmented mass of
tissue, the nephrogenic
cord.
Note the longitudinal
collecting
duct, formed initially by the
pronephros but later by the
mesonephros

Unsegmented
mesoderm

Mesonephros

The mesonephros and mesonephric ducts are derived from

intermediate mesoderm from upper thoracic to upper lumbar
(L3) segments.
Early in the fourth week, the first excretory tubules of the
mesonephros appear.
They lengthen rapidly, form an S-shaped loop, and acquire a tuft
of capillaries that will form a glomerulus at their medial
extremity.
Around the glomerulus the tubules form Bowmans capsule,
and together these structures constitute a renal corpuscle.
Laterally the tubule enters the longitudinal collecting duct
known as the mesonephric or wolffian duct.

In the middle of the second month the mesonephros forms

a large ovoid organ on each side of the midline.
Since the developing gonad is on its medial side, the ridge
formed by both organs is known as the urogenital ridge.
The caudal tubules are still differentiating,
The cranial tubules and glomeruli show degenerative
changes, and by the end of the second month the majority
have disappeared.
In the male a few of the caudal tubules and the
mesonephric duct persist and participate in formation of
the genital system, but they disappear in the female.

Metanephros
The Definitive Kidney

The third urinary organ, the metanephros, or

permanent kidney, appears in the fifth week.
Its excretory units develop from metanephric
mesoderm in the same manner as in the
mesonephric system.
The development of the duct system differs from
that of the other kidney systems.

6 weeks

end of 6th week

7 weeks

Newborn

Note the
Development of the
renal pelvis, calyces, and
collecting tubules of the
metanephros.

pyramid form
of the collecting
tubules entering
the minor calyx.

Collecting System

Collecting ducts of the permanent kidney develop from the

ureteric bud.
The bud dilates, forming the primitive renal pelvis, and
splits into cranial and caudal portions (the future major
calyces).
Each calyx forms two new buds while penetrating the
metanephric tissue.
Meanwhile, at the periphery more tubules form until
the end of the fifth month.
The tubules of the second order enlarge and absorb those of
the third and fourth generations, forming the minor calyces
of the renal pelvis.
Collecting tubules of the fifth and successive generations
form the renal pyramid.

metanephric excretory unit Developm

Excretory System

Each newly formed collecting tubule is covered at its distal end by

a metanephric tissue cap.
Cells of the tissue cap form small vesicles, the renal vesicles,
Renal vesicles give rise to small S-shaped tubules.
Capillaries grow into the pocket at one end of the S and
differentiate into glomeruli.
These tubules, together with their glomeruli, form nephrons, or
excretory units.
The proximal end of each nephron forms Bowmans capsule.
The distal end forms an open connection with one of the
collecting tubules, establishing a passageway from Bowmans
capsule to the collecting unit. Continuous lengthening of the
excretory tubule results in formation of the proximal convoluted
tubule, loop of Henle, and distal convoluted tubule.

 The kidney develops from two sources:

(a) metanephric mesoderm, which provides excretory

units.
(b) the ureteric bud, which gives rise to the collecting
system.

POSITION OF THE KIDNEY

The kidney, initially in the pelvic region,

later shifts to a more cranial position in the abdomen.
This ascent of the kidney is caused by diminution of body
curvature and by growth of the body in the lumbar and sacral
regions.
In the pelvis the metanephros receives its arterial supply from
a pelvic branch of the aorta.
During its ascent to the abdominal level, it is vascularized by
arteries that originate from the aorta at continuously higher
levels.
The lower vessels usually degenerate, but some may
remain.

FUNCTION OF THE KIDNEY

The definitive kidney formed from the metanephros

becomes functional near the 12th week.
Urine is passed into the amniotic cavity and mixes with
the amniotic fluid.
The fluid is swallowed by the fetus and recycles
through the kidneys.
During fetal life, the kidneys are not responsible for
excretion of waste products,
The placenta serves this function.

BLADDER AND URETHRA

During the fourth to seventh weeks of development the cloaca

divides into the urogenital sinus anteriorly and the anal canal
posteriorly.
The urorectal septum is a layer of mesoderm between the
primitive anal canal and the urogenital sinus.

The tip of the septum will form the perineal body.

Three portions of the urogenital sinus can be distinguished:

The urinary bladder , (the upper and largest part).

The pelvic part of the urogenital sinus, (narrow canal)
The phallic part of the urogenital sinus,(flattened from side to side).

BLADDER AND URETHRA

Initially the bladder is continuous with the allantois,

but when the lumen of the allantois is obliterated, the urachus,
remains and connects the apex of the bladder with the
umbilicus.
In the adult, it is known as the median umbilical ligament.
The next part is a narrow canal, the pelvic part of the
urogenital sinus,
In the male gives rise to the prostatic and membranous parts of
the urethra.
The last part is the phallic part of the urogenital sinus.
It is flattened from side to side, and as the genital tubercle
grows, this part of the sinus will be pulled ventrally.

During Differentiation of the Cloaca

The caudal portions of the mesonephric ducts are absorbed into

the wall of the urinary bladder.
The ureters enter the bladder separately.
As a result of ascent of the kidneys, the orifices of the ureters
move farther cranially;
those of the mesonephric ducts move close together to enter the
prostatic urethra and in the male become the ejaculatory ducts.
The mucosa of the bladder formed by incorporation of the ducts
(the trigone of the bladder) is also mesodermal.
With time the mesodermal lining of the trigone is replaced by
endodermal epithelium, so that finally the inside of the bladder
is completely lined with endodermal epithelium.

Dorsal views of the bladder showing the relation

of the ureters and mesonephric ducts during
development
(A) Initially the ureters are formed
(C and D)the trigone
by an outgrowth of the
bladder formed by
mesonephric duct
(BD) with time they assume
a
incorporation
of the
separate entrance intomesonephric
the urinary
ducts.
bladder

of the

URETHRA

The epithelium of the urethra in both sexes

originates in the endoderm;

At the end of the third month, epithelium of the

prostatic urethra begins to proliferate and forms a
number of outgrowths that penetrate the surrounding
mesenchyme.

In the male, these buds form the prostate gland .

In the female, the cranial part of the urethra gives
rise to the urethral and paraurethral glands.

ANATOMY OF URINARY SYSTEM

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Organs of the Urinary System

Kidneys
Ureters
Urinary bladder
Urethra

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.1a

Location and External Anatomy of Kidneys

Located retroperitoneally
Lateral to T12L3 vertebrae
Average kidney

12 cm tall, 6 cm wide, 3 cm thick

Hilus

On concave surface
Vessels and nerves enter and exit

Renal capsule surrounds the kidney

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Relationship of the Kidneys to Vertebra and Ribs

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.1b

Position of the Kidneys with in the Posterior Abdominal Wall

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.2a

Internal Anatomy of the Kidneys

Frontal section through the kidney

Renal cortex
Renal pyramids
Renal pelvis
Major calicies
Minor calicies

Gross vasculature

Renal arteries
Branch into segmental arteries
Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Internal Anatomy of the Kidneys

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.3b

Ureter

Urine, which is formed within

the nephrons, flows into the
ureter, a long fibromuscular
tube that connects each kidney
to the bladder.
The ureters are narrow,
muscular tubes, each 24 to 30
cm long, that originate at the
lower portion of the renal
pelvis and terminate in the
trigone of the bladder wall.

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Ureter
There are three narrowed areas of each ureter:
ureteropelvic junction
ureteral segment
ureterovesical junction

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Urinary Bladder

A collapsible muscular
sac
Stores and expels urine

Full bladder spherical

Expands into the
abdominal cavity

Empty bladder lies

entirely within the pelvis

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.13

Urinary Bladder

Urachus closed
remnant of the allantois
Prostate gland

In males
Lies directly inferior
to the bladder
Surrounds the urethra

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.14

Structure of the Urinary Bladder and Urethra

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.16a

Structure of the Urinary Bladder and Urethra

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.16b

Urethra

In females

Length of 34 cm

In males 20 cm in length three named regions

Prostatic urethra
Passes through the prostate gland

Membranous urethra
Through the urogenital diaphragm

Spongy (penile) urethra

Passes through the length of the penis

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

HYSTOLOGY OF URINARY SYSTEM

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Kidney & Nephrons

The human kidney has about four million filtering units

called nephrons:
The renal corpuscle: glomerulus and Bowman capsule
Proximal convoluted tubules (PCT, located in the renal
cortex)
Descending loop of Henle (LOH)
Ascending limb (which resides in the renal medulla,
leading to the thick ascending limb)
Thick ascending limb
Distal convoluted tubule
Collecting duct (which opens into the renal papilla)

 Blood from the afferent glomerular arteriole passes

through the juxtamedullary apparatus to the

glomerulus.
The glomerulus is a network of capillaries that
filters blood across Bowman capsule into the
proximal convoluted tubule.
The glomerulus contains podocytes and a
basement membrane allowing water and certain
solutes to be filtered across.

PCT reabsorbs glucose and various electrolytes

along with water as the filtrate passes through.
After being filtered at the glomerulus, the blood
passes into the efferent glomerular arteriole and
then descends into the renal pyramid.

Ureter

The ureter is roughly 3-4 mm in diameter.

Ureter is lined with transitional cell epithelium,

which consists of a short basal layer.

The thickest layer of the ureter is the muscularis,
which is composed of smooth muscles oriented in
an inner longitudinal and outer circular
arrangement.
The outer portion of the ureter is the adventitia, a
fibrous layer that harbors the vascular supply.

Bladder

The bladder mucosa is transitional epithelium, which

is loosely connected to the muscular wall by way of a
connective tissue layer called the lamina propria.
At the trigone, the epithelium is more densely
adherent to the underlying muscle.
Deep to the transitional epithelium, the bladder
submucosa with its microvasculature overlies the
detrusor muscle.
A layer of fatty connective tissue surrounds most of
the anterior and lateral bladder in the retropubic space.

Urethra (Male)

The male urethra is a fibromuscular tube.

The prostatic urethra is lined with transitional cell

epithelium (urothelium).
The membranous urethra is lined with stratified columnar
and pseudostratified epithelium.
A rich vascular submucosa exists in the membranous
urethra.
The entire posterior urethra is lined with a submucosa and
a series of muscular sphincters.
Small diverticula, called lacunae of Morgagni, and a larger
lacuna magna can be found at the fossa navicularis.

Urethra (Female)

The female urethra is a multilayered tube lined by

transitional cell epithelium proximally and by
nonkeratinizing stratified squamous epithelium
distally.
The submucosa is surrounded by a longitudinal
smooth muscle layer and then by a thicker circular
smooth muscle layer (the involuntary internal urethral
sphincter).
Surrounding these layers in the middle and distal
urethra is a striated muscle sphincter (the voluntary
external urethral sphincter).

VASCULARIZATION & INERVATION OF URINARY

SYSTEM

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Summary of Blood Vessels Supplying the Kidney

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Figure 23.3c

 The innervation of the ren is coming from :

1.Plexus coelicus
2.Plexus aorticus
3.The lower part of nervous splanchnicus

Ureter
Vascularization for ureter comes from the branch of :
- renalis arteries
- Spermatica interna arteries
- Hypogastrica arteries
- Vesicalis inferior arteries

Ureters innervation is from autonomic system :

Parasymphatic from nervous vagus and n.
splanchnicus
Symphatic from the T12-L2 segmentation

Vesica urinaria
The vascularization of it , are coming from :
Vesicalis superior arteries
Vesicalis caudalis arteries
Obturatoria arteries
Glutea inferior arteries

 The innervation of bladder:

1.Symphatic : L1-L2 , and become plexus
hypogastricus
2.Parasymphatic : n. splanchnicus , S2-3-4
segmentation

Congenital Disease

Ectopic Kidney
An ectopic kidney is a birth defect in which a kidney is located
below, above, or on the opposite side of its usual position.
About one in 900 people has an ectopic kidney.

Normal

An ectopic kidney An ectopic kidney

may remain in the may cross over
and
pelvis,
near the bladder. become fused with
the other kidney.

Renal Agenesis
Renal agenesis is the failure of kidney formation
during fetal development. Renal agenesis can be
unilateral, with one kidney present, or bilateral, with
no kidneys or very little kidney present. The two
types of renal agenesis have very different clinical
courses, with unilateral agenesis being more
favorable.

Duplex Kidney

Duplex kidney is if two ureters draining urine into the bladder.

Horseshoe Kidney
Horseshoe Kidney occurs during fetal development and it can
be seen in one in 500 children. When the kidneys of fetus rise
from the pelvic area and fuse together at the lower end,
forming "U" shape. That is how Horse Kidney gets its name.
This disorder is more common in male than female.
(a) Normal position of
the kidneys with
divergent axes and
medial exit of the
ureters. (b) Horseshoe
kidney in deep lumbar
position with convergent
axes and ventral exit of
the ureters.

Nephroblastoma (Wilms' tumour)

o
o
o

Wilms tumor is a cancer of the kidneys that usually

affects children by 5 years of age but may also occur in
the fetus.
Originates from the embryonal kidney
Pathologically contains renal tissue with various
degrees of differentiation
Affects about 1 in 10,000 live births
60% present before the age of three years
10% tumours are bilateral
The presentation is with an:
Abdominal mass (90%)
Abdominal pain (20%)
Haematuria (30%)

Exstrophy-epispadias
Separation of the primitive cloaca into the urogenital sinus and hindgut occurs during
the first trimester at approximately the same time as maturation of the anterior
abdominal wall. Failure of mesenchyme to migrate between the ectodermal and
endodermal layers of the lower abdominal wall leads to instability of the cloacal
membrane.

Open bladder plate and

urethra with bifid clitoris in
female patient with classic
bladder exstrophy. Note
low-set umbilicus and
anteriorly displaced anus

External view in female patient with epispadias.

Labia are separated anteriorly.

Female patient with epispadias with labia retracted.

The clitoris is bifid, and the urethra is open dorsally.

Penopubic epispadias in male patient.

Typical spadelike configuration of glans penis with incomplete
foreskin, dorsal urethral plate, and open bladder neck.

THANK YOU