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Urological Anatomy and Physiology Mr Andrew Sinclair

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Urological Anatomy and Physiology Mr Andrew Sinclair Consultant Urological Surgeon Stockport NHS Foundation Trust Overview Introduction Anatomy and clinical relevance ... – PowerPoint PPT presentation

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Title: Urological Anatomy and Physiology Mr Andrew Sinclair


1
Urological Anatomy and Physiology
  • Mr Andrew Sinclair
  • Consultant Urological Surgeon
  • Stockport NHS Foundation Trust

2
Overview
  • Introduction
  • Anatomy and clinical relevance
  • Kidney
  • Ureter
  • Bladder
  • Urethra
  • Prostate
  • Scrotum
  • Physiology
  • Renal
  • Bladder Function
  • Erection and Ejaculation

3
Introduction
  • Need to know the BASICS only
  • Broad knowledge base
  • Identify life threatening problems
  • Dont harm the patient

4
Surface markings of the kidneys
  • 2 Kidneys
  • Retroperitoneal Organs
  • Each side of vertebral column
  • From T12 to L3
  • Right slightly lower because displaced inferiorly
    by the liver
  • Hilum at L1

5
Anatomy of the Kidneys Renal Vein
6
Anatomy of the Kidneys Renal Artery
7
Anatomy of the Kidneys
  • Longer left renal vein crosses anterior to the
    Aorta
  • From Anterior to Posterior
  • Vein, Artery, Renal Pelvis
  • Left gonadal vein drains into Left renal vein
  • Right gonadal vein drains directly into IVC

8
Microanatomy of the kidney
  • 1.Renal Vein
  • 2. Renal Artery
  • 3. Renal Calyx
  • 4.Medullary Pyramid
  • 5.Renal Cortex
  • Vasculature
  • 6.Segmental Artery
  • 7.Interlobar Artery
  • 8.Arcuate Artery
  • 9.Arcuate Vein
  • 10.Interlobar Vein
  • 11. Segmental Vein
  • 12.Renal Column
  • 13.Renal Papillae
  • 14.Renal Pelvis
  • 15.Ureter

9
Anatomy of the Ureter
adrenal
  • Ureters continue from the renal pelvis at L1
  • 25 cm long
  • Run inferomedially along the transverse processes
    of lumbar vertebrae
  • Crosses pelvic brim at the SIJ anterior to the
    origins of the external iliac artery
  • Runs anterior to the internal iliac artery in the
    pelvis
  • Passes towards the ischial spine before turning
    towards the pubic tubercle and entering the
    bladder

kidney
ureter
bladder
urethra
10
Relevance of Anatomy
11
Anatomy of the Bladder
12
Anatomy of Lower Male GU Tract
Prostatic Urethra
Membranous Urethra
Bulbar Urethra
Penile urethra
13
Anatomy of the prostate
14
Relevance of anatomy
Female catheterisation
Suprapubic catheterisation
Digital Rectal Examination
Male catheterisation
15
Anatomy of the scrotum
Embryology
  • Important area for medical students
  • Chronic conditions
  • Easily palpable
  • Limited diagnoses
  • Therefore easy to bring to exams

16
Spermatic cord
  • Runs through Inguinal canal
  • The coverings of the cord arise from the layers
    from the inguinal canal
  • Internal spermatic fascia from transversalis
    fascia
  • Cremasteric fascia and muscle from transversus
    abdominis internal oblique
  • External spermatic fascia from external oblique
    aponeurosis
  • Contents of spermatic cord
  • Ductus deferens (45cm)
  • Testicular artery
  • Artery to the ductus deferens
  • Cremasteric artery
  • Pampiniform plexus
  • Sympathetic nerves
  • Parasympathetic nerves
  • Genital branch of genitofemoral nerve
  • Lymphatics

17
Layers of the spermatic cord and scrotum
  • Peritoneum
  • Transversalis fascia
  • Transversus abdominis internal oblique
  • External oblique
  • Subcutaneous fat
  • Skin
  • CV Cavity of tunica vaginalis
  • T Testis
  • E Epididymis

18
Scrotal Contents
  • Testis covered by visceral layer of tunica
    vaginalis except where the testis is attached to
    the epididymis and spermatic cord.
  • Parietal layer attached to internal spermatic
    fascia
  • Fluid between layers allows movement

19
Relevance of Anatomy Identify origins of scrotal
lumps
  • Is it attached / part of the testicle
  • Is it separate from testicle
  • Is it transilluminable
  • Can you feel the testicle
  • Can you get above it

20
Relevance of Anatomy Identify origins of scrotal
lumps
Epididymal cyst
Inguinal Hernia
Hydrocele
Testicular cancer
21
Physiology
22
Renal Physiology
  • General understanding
  • Complex physiology
  • General principles

23
Loop of Henle
  • Countercurrent multiplier
  • Relies on a concentration gradient between the 2
    limbs of the loop
  • Requires energy
  • Relatively small gradient BETWEEN the 2 limbs is
    magnified by the countercurrent to a relatively
    large gradient ALONG the limb of the loop
    involved
  • Thick ascending limb
  • continuous active transport of NaCl into
    interstitium
  • Impermeable to H2O
  • Descending loop
  • Tonicity in equilibrium with the interstitium

Impermeable to H2O
24
Salt and water balance
25
Physiology of Micturition
Lateral corticospinal tract
Sympathetic T10-L2
Parasympathetic
S2, 3, 4
Intermediolateral column parasympathetic
Pelvic nerve Onufs nucleus - rhabdosphincter Ante
rior Horn Cell Nucleus pudendal nerve
periurethral striated muscle
somatic
26
Physiology of erections and ejaculation. Central
erectile stimulation
Inhibitory stimuli anxiety fear
depression
Cerebral cortex
PVN
Spinal cord
27
Neural input to erections
  • In the flaccid state sympathetic dominance keeps
    arterioles and smooth muscle contracted
  • Erections are primarily vascular in nature BUT
    from parasympathetic stimulation
  • This leads to arteriolar dilation and trabecular
    smooth muscle relaxation.
  • Pudendal nerve also has an input causing
    ischiocavernosus muscle contraction further
    increasing intracavernosal pressure

NB Nervi erigentes now called pelvic splanchnic
nerves NB The 2 Inferior hypogastic plexuses make
up the pelvic plexus
28
Trabecular smooth muscle relaxation
  • Dominant mediator is Nitric oxide NO released
    from parasympathetic nerve terminals
  • Parasympathetic nerve terminal also releases Ach
    which stimulates vascular endothelium to also
    release NO

29
Peripheral erectile stimulation
Parasympathetic and Sympathetic nerves from the
pelvic plexus pass within the cavernous nerve to
the penis
PDE5 Inhibitors Phosphodiesterase 5 Inhibitors
Examples of PDE5 inhibitors are Viagra, Cialis
and Levitra
30
Physiology and anatomy of Erection
Erect State
Flaccid State
31
Physiology of Ejaculation
  • Ejaculation has 3 processes
  • Closure of bladder neck (sympathetic)
  • Emission (sympathetic)
  • 1stly prostatic secretions
  • Then seminal vesicle emptying
  • Antegrade ejaculation (sympathetic and somatic)
  • Somatic is the pudendal nerve causing contraction
    of the bulbocavernosus muscle.

Inferior mesenteric plexus
Superior hypogastric plexus
(sympathetic)
32
Thank you
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