Urinary system Systema urinarium

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Urinary systemSystema urinarium

• Anatomy a glimpse of histology and embryology

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• Upper urinary tract
• Nephron
• Tubuli colligentes
• Lower urinary tract
• Calices renales (Renal calices)
• Pelvis renalis (Renal pelvis)
• Ureter
• Vesica urinaria (Urinary bladder )
• Urethra feminina / masculina

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Kidney (Ren, Nephros)

• margo, hilum, sinus, facies, extremitas /polus/
• capsula fibrosa, lobi renales
• Cortex labyrinthus, columnae renales Bertini,
  radii medullares
• Medulla pyramides renales ? papillae renales
  (area cribrosa foramina papillaria)
• zona interna externa

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Position and fixation of kidneys
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Synthopy and impressions
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Kidney

• Microcopic structure
• Nephron
• Interstitium
• Vessels

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Nephronfunctional unit

• Corpusculum renale Malphigi
• glomerulus (vessel skein)
• capsula glomeruli Bowmani
• Proximal tubule
• Intermediate tubule
• Distal tubule
• Juxtaglomerular apparatus

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Corpusculum renale(ledvinné telísko Malpighi)

• Glomerulus
• vas afferens ? vas efferens ( arterioles)
• fenestrated capillars without diaphragm

• Capsula glomeruli (Bowmans capsule)
• parietal lamina (flat monolayer epithelium)
• visceral lamina (podocytes with pedicles)

• Filtration barrier
• basal membrane - colagen IV. typ and heparan
  sulfate
• negative charge

• Mesangial cells
• cleaning function of filter

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Proximal tubule

• single layer of cuboidal epithelium rich in
  microvilli
• resorption of NaCl and water (80-95)
• Na passive transport into cells,
• active transport out of cells

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Intermediate tubulus

• thin segment of ansa nephroni (Henles renal
  loop)
• descending and ascending limb
• flat cells, few organels
• descending segment permeable for water
• ascending not!! ?
• juxtamedullary nephrons with long H. loop
• countercurrent together with vasa recta

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Distal tubule

• cuboid eptihrelium with few microvilli
• back-resorption Na and secretion K-
• macula densa - chemoreceptors (Cl-)
• includes the thick segment of Henles loop

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Juxtaglomerullar apparatus

• components
• macula densa of distal tubulus
• granullar cells (transformed smooth muscle cells)
  of vas afferens efferens
• mesangial cells
• function
• regulation of blood pressure by hormone renin

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Kidney - arterial supply I.

• a. renalis (paired visceral branch of abdominal
  aorta at level of discus intervertebralis L1/2,
  left L1)
• accessory renal artery (30)
• rate flow 1,2-1,3 l blood/min
• arteries are terminated no arterio-arterial
  anastomosis

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Kidney - arterial supply II.

• a. renalis ? r. anterior ? 4 segmental branches
• ? r. posterior for 1 dorsal
  segment
• aa. segmentales ? a. lobares (about 12) ? 2-3 aa.
  interlobulares ? aa. arcuatae ? a. interlobulares
  ? arteriolae glomerulares afferentes ? glomerulus
  of capillars ? arteriolae glomerulares efferentes
  ? peritubullar capillary plexus or arteriolae
  rectae along intermediate tubulus of
  juxtaglomerullary nephrons

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Kidney - venous supply

• vv. stellatae (from surface) venulae rectae
  (along intermediate tubulus of juxtaglomerullary
  nephrons) peritubullar capillary plexus ? vv.
  interlobulares ? vv. arcuatae ? vv. interlobares
  ? v. renalis ? v. cava inferior
• Portal system ( rete mirabile) 2 capillary
  nets one after the other
• migthy veno-venous anastomosis

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Kidney Lymph drainage and innervation

• 3 plexus (peritubullar, subcapsullar and from
  adipose capsule)
• nodi lymphoidei lumbales
• plexus renalis (autonomous, viscerosensitive)
  from ganglion coeliacum plexus coeliacus,
  from ganglion aorticorenale
• from n. splanchnicus minor and plexus aorticus

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Kidney examination

• Native X-ray snap
• Sonography
• Excretory urography
• Ascending pyelography
• Clearence
• CT, MR

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Kidney diseases

• Development defects agenesis, shape
  deformities
• - cysts
• Glomerulonephritis
• Pyelonephritis
• Hydronephrosis
• Nefrohydrosis
• Diabetes mellitus nephropathy
• Tumours
• Grawitzs (solitary metastasis)
• Wilms (autosomally heridatory - children)
• Renal colic

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Development of urinary system

• Development of kidney
• Pronephros
• Mesonephros
• Metanephros
• Development of urinary tract

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Pronephros

• From intermediate mesoderm of cranial 12-13
  somites
• from 21st day (4 primary segments)
• rudimentary, disappears quickly
• common presistent ductus mesonephricus Wolffi

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Mesonephros

• origin from nephrogenic blastema
• sac elongates to ductus Wolffi
• approximately from 23rd day
• glomerulus and collective tubules
• caudal parts are origin for genital organs
• urinary system of fish

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Metanephros

• definitive stadium of kidney
• nephrogenic blastema 3rd to 5th lumbar somites
• development begins at the end of 5th week
• relative ascent during development
• ureteral bud sprins upwards from ductus
  mesonephricus Wolffi and grows in blastema
• induction of maturation of nephron
• ureteral bud ? ureter, pelvis, calices,
  collecting tubules
• metanephrogenic blastema ? nephron

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Development malformations

• Atypical shapes
• Cystic, polycystic kidneys
• Agenesis of kidney
• Ureter duplex, fissus

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Kidney transplantation

• since 50s
• 5 years of graft survival - 70
• including proximal part of ureter and its blood
  supply (branches of renal vessels)
• placed to fossa iliaca and renal artery joined to
  a. iliaca ext. (end-to-side) or to terminal part
  of a. iliaca int. (end-to-end)
• if present, a. renalis accessoria joined to a.
  epigastrica inferior

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Lower urinary tractgeneral wall structure

• Mucosa (tunica mucosa)
• epithelium transitional
• lamina propria mucosae (collagen)
• Smooth muscle (tunica muscularis)
• Adventitia (tunica adventitia)

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Renal pelvis (Pelvis, pyelon) Renal calices
(Calices renales)

• 7-14 calices minores around papilae ? 2-3 calices
  majores ? ureter
• ampullary / branching type (typus dendriticus)
• muscular layer strong circular
• projection processus costalis L1
• blood supply branches of renalartery,
  tributaries to renal vein

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Ureter

• 25-30 cm, lumen 4-7 mm
• 3 parts pars abdominalis, pelvina, intramuralis
• crossings of important structures
• 3 constrictions risk of stone impact ?
  obstruction ? hydronephrosis ? afunction of
  kidney
• 2 muscular layers
• inner longitudinal
• outer circular
• adventitia

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Ureter - supply

• Arteries a. renalis, aorta abdominalis, a.
  testicularis/ovarica, a. ductus deferentis /
  uterina, a. vesicalis inf. ? rr. ureterici
• Veins run along arteries
• Lymph drainage nll. lumbales (aortici lat.),
  iliaci int., ext., communes
• Nerves plexus uretericus ? plexus renalis,
  aorticus abd., hypogastricus sup., inf.

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Ascending (retrogade) pyelography
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Urinary bladder (Vesica urinaria, Kystos)

• description fundus, corpus, apex, cervix, uvula
• trigonum vesicae ostia ureterum, plica
  interureterica, ostium urethrae internum, Bells
  bands
• muscles smooth
• m. detrusor (parasympathetic)
• m. trigoni vesicae
• ?m. sphincter vesicae (sympathetic)
• projection behind symphysis pubica (in child
  over s.p.)

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Cystography
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Urinary bladder wall structure

• folds except trigonum vesicae
• smooth muscle fibres create 3 layers
• inner plexiform
• middle circular ? m. sphincter vesicae in male
  only!
• outer longitudinal
• upper surface covered with serosa (peritoneum)
  partially intraperitoneal organ

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Urinary bladder supply

• a. iliaca int. ? a. umbilicalis ? aa. vesicales
  sup.
• a. iliaca int. ? a. vesicalis inf.
• (a. obturatoria, a. glutea inf., a. uterina, a.
  vaginalis ? rr. vesicales)
• Veins plexus venosus vesicalis (connections to
  plexus venosus prostaticus/vaginalis) ? vv.
  vesicales ? v. iliaca int.
• Lymph drainage nodi paravesicales ? nodi iliaci
  int. et ext. ? nodi iliaci comunes
• Nerves plexus vesicalis ? plexus hypogastricus
  inf.

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Urinary bladder - fixation

• Ligaments pubovesicale, puboprostaticum,
  rectovesicale, vesicouterinum
• Smooth muscle pubovescalis, rectovesicalis
• Ligamentum umbilicale medianum ( chorda urachi)
• Fascia vesicoumbilicalis Delbeti
• Septum rectovesicale Denonvilliersi
• Septum vesicovaginale
• Spatium retropubicum Reztii

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Urinary bladder - peritoneum

• Fossae paravesicales
• ? excavatio rectovesicalis
• most caudal space of peritoneal cavity in male
  (in contact with top of glandula vesiculosa)
• ? exc. vesicouterina
• ? exc. rectouterina ( Douglasspace)
• most caudal space of peritoneal cavity in
  female (in contact with top of posterior vaginal
  vault)
• palpation and puncture in inflammation via
  vagina !

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Urethrae

• Male urethra is divided in 4 parts
• transitional epithelium in firts 2 parts
• pseudostratified or stratifoed columnar
  epithelium in the rest
• Female urethra
• transitional epithelium in intramural part
• squamous stratified

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Urethra feminina (Female urethra)

• 3 parts pars intramuralis, pelvina, perinealis
• ostium urethrae internum (trigonum vesicae)
• accipiens, evacuans
• ostium urethrae externum (vestibulum vaginae)
• crista urethralis, lacunae, glandulae urethrales
  (Skenei s. Guérini), ductus paraurethrales
  (Schülleri)
• smooth muscles, around urethra striated m.
  sphincter urethrae, m. compressor urethrae a m.
  sphincter urethrovaginalis
• adventitia

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Urethra feminina - supply

• Arteries paired branches of a. vesicalis inf. et
  a. vaginalis
• Veins ? plexus venosus vesicalis
• ? plexus venosus vaginalis
• ? vv. pudendae int.
• Lymph drainage nl.l. iliaci int., ext.
• Nerves plexus hypogastricus inf. ? plexus
  vesicalis, plexus uterovaginalis ? nn. vaginales

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Development of lower urinary tract

• Urinary bladder
• developed from cranial part of urogenital sinus
• urachus
• separation of excretory urinary trct and genital
  ducts
• Urethra
• ? developed from medial part of urogenital sinus
• ? developed from medial and caudal part of
  urogenital sinus and glandular plate

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Urine continence in female

• no smooth muscle sphincter in urinary bladder
• elastic fibres venous plexuses in urethra
• striated muscle m. sphincter urethrae (externus)
  /S2-S4/
• so-called periurethral muscles (in increased
  intra-abdominal pressure)
• m. levator ani (S3-S4)
• m. compressor urethrae, m. sphincter
  urethrovaginalis, m. bulbospongiosus (n. pudendus)

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Urethra masculina (Male urethra)

• 4 parts
• see male genital system

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