anatomy of the upper and lower urinary tract quest
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ANATOMY OF THE UPPER AND LOWER
URINARY TRACT
reters
- The ureters are muscular tubes, 25 to 30 cm in length, that convey urine from the kidneys
to the bladder through peristaltic (wavelike) action
- Both the abdominal and the pelvic parts of the ureters are retroperitoneal along their entire
course.
Course of ureters
Water runs under the bridge
- Uterine artery is the "bridge," Ureter is "the water." In men, it would be the Ductus deferens
instead of uterine artery.
- The abdominal part of the ureter descends along the anterior surface of the psoas muscle
where it is crossed by the gonadal vessels
- The ureter crosses over the pelvic brim to enter the pelvis at the bifurcation of the common
iliac artery into internal and external iliac branches.
- The pelvic part of the ureter travels anteriorly along the lateral pelvic wall before it enters
the urinary bladder at the ureterovesical junction.
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normal sites of ureter constriction
the ureters normally demonstrate relative constrictions in three places:
(1) at the junction of the ureters and renal pelvis,
(2) where the ureters cross the brim of the pelvic inlet, and
(3) during their passage through the wall of the urinary bladder
These constricted areas are potential sites of obstruction by ureteric stones (calculi).
, blood supply, innervation and lymphatic drainage of the ureters
- The arterial supply to the ureters can be divided into abdominal and pelvic supply:
> Abdominal: Renal artery and testicular/ovarian artery.
> Pelvic: Superior and inferior vesical arteries.
- Venous drainage is carried out by vessels that correspond to the aforementioned arteries.
- Nervous supply to the ureters is delivered via the renal, testicular/ovarian and hypogastric
plexuses. - Sensory fibres from the ureters enter the spinal cord at T11-L2, with ureteric pain
referred to those dermatomal areas.
anatomy of the urinary bladder
- Embryologically, the bladder is derived from the hindgut.
- The bladder largely serves two functions:
> Temporary store of urine - The bladder is a hollow organ. The walls are very distensible,
with a folded internal lining (known as rugae), this allows it to hold up to 600ml.
> Assists in the expulsion of urine - During voiding, the musculature of the bladder contracts,
and the sphincters relax.
- The morphological appearance of the bladder varies with filling.
> When full, it exhibits an oval shape, and when empty it is flattened by the overlying
intestines.
- Urine enters the bladder by the left and right ureters, and exits via the urethra.
- Internally, these orifices are marked by the trigone - a triangular area located within the
fundus.
> In contrast to the rest of the internal bladder, the trigone has smooth walls.
- There are two sphincters controlling the outflow of urine:
> the internal and external urethral sphincters.
External Features of the Bladder
Apex - This is located superiorly, pointing towards the pubic symphysis. It is connected to the
umbilicus by the median umbilical ligament (a remnant of the urachus).
Body - The main part of the bladder, located between the apex and the fundus
Fundus (or base) - Located posteriorly. It is triangular-shaped, with the tip of the triangle
pointing backwards.
Neck - Formed by the convergence of the fundus and the two inferolateral surfaces. This
structure joins the bladder to the urethra.
bladder musculature
- In order to contract during micturition, the bladder wall contains specialised smooth muscle,
known as detrusor muscle.
> Its fibres are orientated in three directions, thus retaining structural integrity when
stretched.
> It receives innervation from both the sympathetic and parasympathetic nervous systems.
- There are also two muscular sphincters located in the urethra:
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