18.02.2019 1 URINARY SYSTEM AND MALE GENITAL SYSTEM Ren Calices renales Pelvis renalis Ureter Vesica urinaria Urethra masculina Urethra feminina 4 cm 3 cm Kidney Extremitas superior Extremitas inferior Facies anterior Facies posterior Margo lateralis Margo medialis Capsula fibrosa Hilus (hilum) renalis Calices renales Pelvis renalis Arteria renalis Vena renalis SINUS RENALIS: Morphology of the kidney Capsula fibrosa Cortex renalis Medulla renalis Columnae renales Pars radiata corticis Pyramides renales Papilla renalis Foramina papillaria (ductus papillares) Area cribrosa Lobulus renalis (renculus) 18.02.2019 2 Renal corpuscle (glomerulus+capsula glomeruli) Proximal tubulus juxtaglomerular apparatus Distal tubulus The loop of Henle Kidney vessels Collector duct Collector duct NEFRON tubulus distalis tubulus proximalis glomerulus vas afferens vas efferens Basal membranecapillaries Filtration of urine (150-200 l) Bowmann´s space Cortex: Malphighi´s corpuscles 1 mill. (corpusculum renale) Medulla: Tubuli renales Tubuli colligentes Ductus papillares 2-4 rami praepelvici ramus retropelvicus ARTERIA RENALIS Arteriae interlobares Arteriae arcuatae Arteriae rectae (medullares) Arteriae interlobulares Vasa afferentia Rami capsulares Vasa efferentia Venulae stellatae Venae interlobulares Venae arcuatae Venae rectae (medullares) Venae interlobares Vena renalis 18.02.2019 3 Arteriae renales accesoriae Position of the kidney Primary retroperitoneal organ 4 cm 3 cm L1 SIN. DX. dIAPHRAGM Musculus transversus abd. Musculus quadratus lumborum Musculus psoas major Facies: suprarenalis, hepatica, duodenalis, colica, jejunalis DX. Sin. Facies: suprarenalis, gastrica, lienalis, pancreatica, colica, jejunalis Coverings of the kidney Capsula adiposa Fascia renalis Lamina praerenalis Lamina retrorenalis Corpus adiposum pararenale 18.02.2019 4 Transplantation of the kidney ren arcuatus ren duplex ren sigmoideus ren fungiformis CALICES RENALES Calices renales minores 7-14 Calices renales majores 3-4 PELVIS RENALIS Capacity: 2-5 ml Positioin: sinus renalis hilus renalis Dendritic type Ampular type 18.02.2019 5 URETER 25-35 cm Pars abdominalis pelvis renalis - linea terminalis Pars pelvina linea terminalis - vesica urinaria Pars intramuralis wall of urinary bladder - ostium ureteris Mucous membrane: Transitional epithelium plicae longitudinales Muscular layer: longitudinal (inner) circular (outer) Adventicia Ureter Point of Lanz Isthmus ureteris Constrictions on the ureter Urinary bladder 250-300ml, max. app. 750 ml Fundus vesicae Cervix vesicae Corpus vesicae Apex vesicae Ultrastructure of urinary bladder Mucous membrane Transitional epithelium folds trigonum vesicae Submucous tissue Muscular layer Peritoneum, adventicia Trigonum vesicae Ostia ureterum (plicae uretericae) Ostium urethrae internum (uvula, anulus urethralis) Plica interureterica Fibres of Bell Fossa retrotrigonalis Fossae paratrigonales Musculus trigonalis 18.02.2019 6 Opened ostium ureteris Closed ostium ureteris Adventicia fascia vesicae, paracystium Excavatio vesicouterina Excavatio rectouterina Excavatio rectovesicalis Peritoneum Praeperitoneal a subperitoneal position of urinary bladder Position of urinary bladder Spatium retropubicum (fascia vesicoumbilicalis) Plica umbilicalis mediana lig. umbilicale medianum (urachus) Plicae umbilicales mediales Obliterated aa. umbilicales Fossae supravesicales Fossae paravesicales Plica vesicalis transversa Urethra feminina Pars intramuralis m. sphincter vesicae (m. sphincter urethrae int.) (m. lissosphincter urethrae) Pars pelvina Pars perinealis m. sphincter urethrae (ext.) (m. rhabdosphincter urethrae) (m. sphincter urethrovaginalis) 18.02.2019 7 Ureter fissus Male genital system ORGANA GENITALIA MASCULINA INTERNA TESTIS EPIDIDYMIS DUCTUS DEFERENS SPERMATIC CORD (FUNICULUS SPERMATICUS) SEMINAL VESICLES (VESICULAE SEMINALES) PROSTATE MALE URETHRA (URETHRA MASCULINA) ORGANA GENITALIA MASCULINA EXTERNA PENIS SCROTUM 4-4,5 cm 20-30 g Extremitas superior Extremitas inferior Facies medialis Facies lateralis Margo anterior Margo posterior TESTIS 18.02.2019 8 MORPHOLOGY OF TESTIS tunica albuginea hilum testis mediastinum testis septula testis lobuli testis (200-300) tubuli seminiferi contorti (50-70 cm) tubuli seminiferi recti, rete testis ductuli efferentes testis (10-14) intersticial Leydig´s cells (testosteron) EPIDIDYMIS Caput epididymidis Corpus epididymidis Cauda epididymidis Lig. scrotale (gubernaculum testis) MORPHOLOGY OF EPIDIDYMIS Ductuli efferentes testis (12-15) Lobuli epididymidis Ductus epididymidis Ductus defferens DESCENSUS TESTIS Mesorchium Gubernaculum testis Processus vaginalis perit. Coverings of the testis skin Tunica dartos scroti Fascia spermatica ext. Musculus cremaster, fascie Fascia spermatica int. Tunica vaginalis testis lamina parietalis (periorchium) cavum serosum scroti lamina visceralis (epiorchium) Tunica albuginea Ectopia testisRetentio testis (cryptorchismus) 18.02.2019 9 CONGENITAL INGUINAL HERNIA DUCTUS DEFERENS App. 40 cm pars funicularis pars epididymica pars inguinalis pars pelvina (cross the ureter) Ampulla ductus deferentis Diverticula ampullae Connection with vesiculae seminales Ductus ejaculatorius Colliculus seminalis Sliznice Columnar epithelium (stereocilia) Muscular layer longitudinal, cirkular, longitudinal Adventicia ULTRASTRUCTURE OF DUCTUS DEFERENS Ductus deferens Arteria ductus deferentis Plexus deferentialis Arteria testicularis Plexus testicularis Plexus pampiniformis Lymphatic vessels SPERMATIC CORD 18.02.2019 10 SEMINAL VESICLES App. 4-5 cm Laterally from ampulla ductus deferentis subperitoneal (excavatio rectovesicalis, septum rectovesicale) ductus excretorius + ductus deferens = ductus ejaculatorius alkalic secret (50-80% ejaculate) PROSTATE Basis prostatae (facies vesicalis) Apex prostatae Facies anterior (ligg. puboprostatica) Facies posterior Facies laterales (inferolaterales) 30 – 50 tuboalveolar glands 15-30% of ejaculate Lobus anterior (isthmus prostatae) Lobus medius Lobus posterior Lobus dexter Lobus sinister 4 cm Capsula periprostatica (visc. list fascia pelvis) Plexus venosus prostaticus Capsula propria Fibromuscular stroma 30 – 50 tuboalveolar glands 15-30% ejaculate Ductuli prostatici (pars prostatica urethrae) Clinical division of the prostate Hypertrophy of medial lobe CYSTOSCOPY Hypertrophy of lateral lobes 18.02.2019 11 MALE URETHRA Ostium urethrae int. Ostium urethrae ext. Pars intramuralis (m. sphincter vesicae) Pars prostatica Pars membranacea (m. sphincter urethrae) Pars spongiosa PARS PROSTATICA URETHRAE Crista urethralis Colliculus seminalis Utriculus prostaticus Ductus ejaculatorii Sinus prostaticus Ductuli prostatici PARS MEMBRANACEA URETHRAE Diaphragma urogenitale Musculus sphincter urethrae Constricted part of urethra PARS SPONGIOSA URETHRAE Bulbus penis – ostium urethrae externum Ampulla urethrae Glandulae bulbourethrales Fossa navicularis Valvula fossae navicularis Recessus fossae navicularis CURVATURES OF URETHRA: Curvatura subpubica Curvatura praepubica CONSTRICTED PARTS OF URETHRA: Ostium urethrae externum Between fossa navicularis and ampulla urethrae Pars membranacea Pars intramuralis URETHRA MASCULINA - LUMEN Prostata - semilunar Diaphragma urog. - stellate Pars spongiosa – T Ostium urethrae ext. – Vertical fissure 18.02.2019 12 PENIS Radix penis Corpus penis Glans penis Corona glandis Collum glandis Dorsum penis Facies urethralis Facies urethralis PRAEPUTIUM Frenulum praeputii Ostium (orificium) praeputii Glandulae praeputiales Smegma preputii Phimosis Corpora cavernosa crura penis m. ischiocavernosus Corpus spongiosum bulbus penis m. bulbospongiosus Glandulae bulbourethrales Centrum perineale skin fascia penis superficialis fascia penis profunda tunica albuginea septum penis lig. fundiforme penis lig. suspensorium penis Coverings of the penis 18.02.2019 13 Tunica albuginea Trabeculae corporis cavernosi (spongiosi) Cavernae corporis cavernosi (spongiosi) Aa. helicinae Morphology of cavernous bodies ERECTION DETUMESCENCE Parasympaticus (spinal segment S3) Relaxation of the smooth muscles in the Ebner pads Dilation of the aa. helicinae Sympaticus (spinal segment L2-3) Contraction of the smooth in the Ebner pads Constriction of the aa. helicinae SCROTUM Raphe scroti, pubes Tunica dartos scroti Septum scroti Cavum scroti M. ischiocavernosus M. bulbospongiosus M. sphincter ani externus Fascia perinei superficialis Spatium perinei profundum Spatium perinei superficiale References: Putz, R. (2008): Atlas of Human Anatomy Sobotta. Elsevier Books. Keith L. Moore, Arthur F. Dalley (2005): Clinically Oriented Anatomy. Williams and Wilkins. Platzer, W., Kahle, W., Leonhardt H. (1992): Locomotor system. Georg Thieme Verlag, Stuttgart, New York, 4th edition. Čihák, R. (1987): Anatomie 1. Avicenum, Zdravotnické nakladatelství.