URINARY SYSTEM FUNCTIONS • Removal of waste product from the body • Regulation of electrolyte balance • Regulation of acid-base homeostasis (blood pH) • Controling blood volume and maintaining blood pressure PARTS Kidney (ren) Efferent urinary tract: renal calices renal pelvis ureter urinary bladder urethra REN, NEPHROS - facies anterior et posterior - margo lateralis et medialis - hilum renale - sinus renalis - extremitas superior et inferior R L Capsula fibrosa Sinus renalis Cortex renalis Medulla renalis – 6-20 pyramides renales Columnae renales Papilla renalis Ductus papillares Foramina papillaria Area cribrosa Lobus renalis NEPHRON - Corpusculum renale (Malpighi) - Glomerulus - Capsula glomeruli (Bowman) - Tubulus proximalis - Henle’s loop - Tubulus distalis Tubulus colligens Ductus papillaris Foramen papillare 200 µm .renalis r. anterior – 4 rr. praepelvici r. posterior – r. retropelvicus Segmenta renalia – s. superius - s. anterius superius - s. anterius inferius - s. inferius - s. posterius - aa. lobares – aa. interlobares – aa. arcuatae Aa. interlobares: 1. A. arcuata 2. A. interlobularis 3. Vas afferens 4. Vas efferens 5. Peritubular capillary plexus 6. Arteriola recta 7. Capillary plexus in the medulla 8. Capillary plexus around papillary duct 9. Venulae stellatae 10.V. interlobularis 11.V. arcuata 12.Vein from the peritubular plexus 13.Venulae rectae Aa. renales accessoriae 1.Diaphragma 2.11th rib 3.12th rib 4. M. transversus abdominis 5. M. quadratus lumborum 6. M. psoas major N. subcostalis N. iliohypogastricus N. ilioinguinalis .Gl. suprarenalis dx. .Liver .Duodenum .Flexura coli dx. .Jejunum .Gl. suprarenalis sin. .Stomach .Spleen .Pancreas .Flexura coli sin. .Jejunum SIN. 1.Fascia renalis 2.Lamina praerenalis 3.Lamina retrorenalis 4.Capsula adiposa 5. Corpus adiposum pararenale 6. Peritoneum 7. Fascia transversalis REN MIGRANS Cross-sectional image through the L1 obtained with CT Transverse section through the intervertebral disc between T12 and L1 Nephrolithiasis Calcium oxalate crystals – 80% Uric acid – 5 - 10% Horseshoe kidney CALICES RENALES – minores et majores PELVIS RENALIS (PYELUM) URETER 1.pars abdominalis 2.pars pelvina 3.pars intramuralis ostium ureteris 3 physiological constrictions Point of LANZ (appendix vermiformis) Adventitia Plicae longitudinales Duplicated ureter VESICA URINARIA - fundus vesicae - corpus vesicae - apex vesicae - lig. umbilicale medianum - cervix vesicae Male - dorsal aspect of urinary bladder Ductus deferens Female – anterosuperior aspect A. uterina Trigonum vesicae – ostia ureterum – ostium urethrae internum – plica interureterica – fossa retrotrigonalis – uvula vesicae – m. detrusor – m. sphincter vesicae – m. sphincter urethrae Median section through the male pelvis 1. Excavatio rectovesicalis Median section through the female pelvis 1.Excavatio rectouterina 2.Excavatio vesicouterina Paracystium URETHRA FEMININA Ostium urethrae internum M. sphincter urethrae Ostium urethrae externum Intravenous urography IVU Retrograde pyelography Cystography MALE GENITAL ORGANS (ORGANA GENITALIA MASCULINA) Organa genitalia interna: Testis Epididymis Ductus deferens Urethra masculina Vesicula seminalis Prostata Organa genitalia externa: Penis Scrotum TESTIS Facies medialis Facies lateralis Extremitas superior Extremitas inferior Margo anterior Margo posterior Lamina visceralis tunicae vaginalis (Epiorchium) Tunica albuginea Mediastinum testis Septula testis Lobuli testis Hilum testis Tubuli seminiferi contorti Spermatozoa Interstitial cells of Leydig Tubuli seminiferi recti Rete testis Ductuli efferentes testis EPIDIDYMIS Caput epididymidis Corpus epididymidis Cauda epididymidis Sinus epididymidis Lig. epididymidis sup. et inf. Lig. scrotale (Gubernaculum testis) Lobuli epididymidis Ductus epididymidis DESCENSUS TESTIUM Gubernaculum testis → Lig. scrotale Processus vaginalis → Tunica vaginalis Lig. vaginale Retentio testis (cryptorchidism). Ectopia testis. DUCTUS DEFERENS (VAS DEFERENS) Pars epididymica Pars funicularis Pars inguinalis Pars pelvina Ampulla ductus deferentis - diverticula ampullae Ductus ejaculatorius – colliculus seminalis FUNICULUS SPERMATICUS: A. testicularis Plexus testicularis Plexus pampiniformis Ductus deferens A. ductus deferentis Plexus deferentialis COVERINGS OF THE TESTIS, EPIDIDYMIS AND SPERMATIC CORD Epiorchium (Lamina visceralis tunicae vaginalis) Periorchium (Lamina parietalis tunicae vaginalis) Cavum serosum scroti Fascia spermatica interna (Fascia transversalis) Fascia cremasterica - M. cremaster (M. obliquus abdominis internus, M. transversus abdominis) Fascia spermatica externa (Fascia abdominis superficialis) Fossa supravesicalis - hernia supravesicalis (c) Fossa inguinalis medialis - hernia inguinalis directa (b) Fossa inguinalis lateralis - hernia inguinalis indirecta (a) VESICULA SEMINALIS Ductus excretorius Ductus ejaculatorius PROSTATA Basis Apex Facies anterior Facies posterior Facies inferolaterales Lobus medius Lobus dexter et sinister Isthmus Seminal vesiculography Crista urethralis Colliculus seminalis Utriculus prostaticus Ductus ejaculatorii Sinus prostatici Capsula propria Plexus venosus prostaticus Fascia periprostatica Lig. puboprostaticum Lig. sacrogenitale Septum rectovesicale (Denonvilliersʼ fascia) GLANDULAE BULBOURETHRALES Ductus gl. bulbourethralis URETHRA MASCULINA Ostium urethrae internum Ostium urethrae externum Pars intramuralis – M. sphincter vesicae Pars prostatica Pars membranacea – M. sphincter urethrae Pars spongiosa – Ampulla urethrae Corpus spongiosum penis Fossa navicularis Valvula fossae navicularis Glandulae urethrales Lacunae urethrales Curvatura subpubica Curvatura praepubica Urethra mobilis (anterior) Urethra fixa (posterior) EXTERNAL GENITAL ORGANS PENIS: Radix Corpus Glans Praeputium SCROTUM PENIS Glans penis Collum glandis Corona glandis Dorsum penis Facies urethralis Raphe penis Praeputium Ostium praeputii Glandulae praeputiales Smegma praeputii Frenulum praeputii Corpus cavernosum Corpus spongiosum Tunica albuginea Trabeculae Cavernae A. penis prof. → aa. helicinae Corpus cavernosum - crura penis - crista phalica A. profunda penis Corpus spongiosum - bulbus penis - glans penis COVERINGS OF PENIS: Fascia penis profunda (Aa., Nn. dorsales penis, V. dorsalis penis profunda) Fascia penis superficialis (Vv. dorsales penis spf.) Lig. fundiforme penis Lig suspensorium penis SCROTUM Raphe scroti Pubes Tunica dartos scroti Septum scroti Cavitas scroti ANATOMICAL BASIS OF ERECTION Parasympathetic stimulation – relaxation of smooth muscle in cavernae and aa. helicinae, compression of venous plexuses by bulbospongious and ischiocavernous muscles → erection Sympathetic stimulation - contraction of smooth muscle of aa. helicinae, relaxation of bulbospongious and ischiocavernous muscles, drainage of blood into v. dorsalis penis prof. → detumescence EJACULATION OF THE SEMEN 1. Emission of sperms and genital glands secretion - sympathetic stimulation 2. Expulsion of the semen from the spongy urethra (ejaculation) – parasympathetic stimulation Drainage of the male pelvis PELVIC FLOOR DIAPHRAGMA PELVIS M. levator ani – pars iliaca (M. iliococcygeus) - pars pubica (M. pubococcygeus) (- M. puborectalis) M. coccygeus Hiatus urogenitalis Arcus tendineus m. levatoris ani Fascia obturatoria Canalis pudendalis (Alcock) Fascia sup. diaphragmatis pelvis Fascia inf. diaphragmatis pelvis Fossa ischioanalis/ - rectalis PERINEUM Fossa ischioanalis/-rectalis M. sphincter ani externus Lig. anococcygeum N. pudendus – nn. rectales inf. A. pudenda int. – aa. rect. inf. V. pudenda int. – vv. rect. inf. Fascia perinei (superficialis) Spatium superficiale perinei M. ischiocavernosus M. bulbospongiosus Membrana perinei Saccus profundus perinei/diaphragma urogenitale Recessus pubicus fossae ischioanalis/ - rectalis M. transversus perinei spf. Membrana perinei/Fascia inf. diaphragmatis urogenitalis V. dorsalis penis prof. SACCUS PROF. PERINEI M. transversus perinei profundus – Centrum perineale M. sphincter urethrae Lig. transversum perinei Glandulae bulbourethrales FEMALE SACCUS PROF. PERINEI (M. transversus perinei profundus) Lig. transversum perinei M. sphincter urethrae externus (M. sphincter urethrovaginalis) M. compressor urethrae M. transversus perinei superficialis Centrum perineale M. ischiocavernosus M. bulbospongiosus (M. constrictor cunni) M. sphincter ani externus Lig. anococcygeum . et v. pudenda interna, n. pudendus – canalis pudendalis a., vv. et nn. rectales inf. A.dorsalis penis (clitoridis) N. dorsalis penis (clitoridis) V. dorsalis penis (clitoridis) profunda A.,v. et n. perinealis Gl. bulbourethralis Fascia sup. diaphragmatis pelvis Arcus tendineus fasciae pelvis Fascia inf. diaphragmatis pelvis ustrations were copied from: tlas der Anatomie des Menschen/Sobotta. utz,R., und Pabst,R. 20. Auflage. München: rban & Schwarzenberg, 1993) etter: Interactive Atlas of Human Anatomy. Windows Version 2.0 ihák R: Anatomie 2 (Splanchnologia). Avicenum, dravotnické nakladatelství, Praha, 1988.