Urinary system and male genital/Department of anatomy1 URINARY SYSTEM Dentistry-spring https://www.colorado.edu/intphys/iphy3410saul/outlines08fall/nephron.gif 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 Kidney (ren) Efferent urinary tract: renal calices renal pelvis ureter urinary bladder urethra PARTS Syntopy Topography dorsaly – abdominal wall diaphragm muscles Co 12 nerves (plx. lumbalis) Th 12 L2 KIDNEY Ren (nephros) 1. Diaphragma 4. M. transversus abdominis 2. 11th rib 5. M. quadratus lumborum 3. 12th rib 6. M. psoas major N. subcostalis N. iliohypogastricus N. ilioinguinalis Ventraly – peritoneal cavity liver, colon, stomach, pancreas, spleen dx sin Transverse section through the intervertebral disc between T12 and L1 1. Gl. suprarenalis dx. 2. Liver 3. Duodenum 4. Flexura coli dx. 5. Jejunum 1. Gl. suprarenalis sin. 2. Stomach 3. Spleen 4. Pancreas 5. Flexura coli sin. 6. Jejunum SIN. Fascia renalis l. prerenalis l. retrorenalis (fused cran. and lat.) inside: capsula adiposa (+ noradrenal gland) behind: corpus adiposum pararenale Peritoneum Fascia transversalis Facies anterior posterior Margo lateralis medialis Hilum renale (L1) Sinus renalis Extremitas superior inferior Ant. 120-170g Post. Capsula fibrosa Sinus renalis Cortex renalis (5-8 mm) ↓ columnae renales Medulla renalis ↑ pars radiata cort. pyramides renales (6-20) papillae renales area cribrosa (ductus papillares) Lobi renales (6-20) Segments (5) Segmenta renalia – s. superius - s. anterius superius - s. anterius inferius - s. inferius - s. posterius tubulus distalis Tubulus distalis Henley´s loop Tubulus colligens Ductus papillaris – foramen papillare Bowman capsule (capsula glomeruli) Glomerulus Corpusculum renale (Malpighi) + Tubuli Main functional unit - NEPHRON Rr. ant. (4 rr. prepelvici) R. post. (1 retropelvicus) A. renalis A. RENALIS a.interlobaris aa.arcuatae aa.interlobulares → a.lobaris vas afferens vas efferens Peritubular capillary plexus Peritubular plexuses Glomerulus  Glomerular filtration→ primary urine- 170-200 l  Reabsorption of water and substances from filtrate to the blood  Secretion of ions and substances from the blood to the urine → define urine 1-1,5 l Aa. renales accessoriae • renculi marking • ren arcuatus • ren duplex • ren sigmoideus • ren fungiformis • agenesia renis VARIATIONS Ectopic kidney x Ren migrans Horseshoe kidney Cross-sectional image through the L1 obtained with CT Nephrolithiasis Calcium oxalate crystals – 80% Uric acid – 5 - 10% Excretory urinary tract Calices renales minores 7-12 majores 3-4 Pelvis renalis 3-5ml 3-8 ml ampular dendritic Ureter syntopy Parts abdominalis pelvina intramuralis - ostium ureteris 25-30cm Crossed by a.v. test. / ovarica a.v. iliaca comm dct. def. / a. uterina Ureteric point Sinus renalis linea terminalis pars intramuralis 3 physiological constrictions Plicae longitudinales Adventitia Intravenous urography Retrograde pyelography Vesica urinaria Localisation Parts apex vesicae→ lig. umbilicale med. corpus fundus cervix→ urethra. structure Mucosa Musculature Adventitia 250-300 ml (700 ml and more) Trigonum vesicae Ostia ureterum Ostium urethrae int.  Mucosa without folds  plica interureterica  fossa retrotrigonalis  uvula vesicae (♂ lobus medius of the prostate) m. detrusor Mucosa – fundus vesicae Submucose tissue sparse (no in trig. vesicae) musculature reticular (internal) circular (m. sphincter vesicae et urethrae – Smooth muscle) longitudinal (external) Adventitia paracystium Median section through the male pelvis 1. Excavatio rectovesicalis Median section through the female pelvis 1. Excavatio rectouterina 2. Excavatio vesicouterina Paracystium Cystography Urethra feminina 4-6cm Localisation pars intramuralis diaphragmatica perinealis Ostium urethrae internum M. sphincter urethrae Ostium urethrae externum mucosa  crista urethralis  lacunae urethrales - gll. urethrales, ductus paraurethrales  Transitional epithelium muscle smooth striated- m. sph. urethrae fibers from the muscles of the pelvic floor Adventitia Ostium urethrae externum (papilla urethralis) MALE GENITAL ORGANS (ORGANA GENITALIA MASCULINA) Organa genitalia interna: Testis Epididymis Ductus deferens Urethra masculina Vesicula seminalis Prostata Organa genitalia externa: Penis Scrotum „storage“ of sperm Epididymis Testes Production of sperm endocrine function (testosteron) Descensus of the testes and epididymis Preliminary position: abdominal cavity Descend to the scrotum At the birth should be located in the scrotum! 1. First to the priliminary scrotum - pouch of the parietal peritoneum - proc. vaginalis peritonei L1-2 Canalis inguinalis Mechanism growing of the abdominal wall Shortening of *gubernaculum testis Abdominal pressure + contraction of the muscles of the abdomen 2. Own descend * It pass through the inguinal canal and takes all the layers with = lamina visceralis, epiorchium Lamina that lines the scrotum = lamina parietalis, periorchium Testis + epididymis >to the pouch of the peritoneum > 2 laminas: Abdominal wall fascia transversalis m. transv., oblig. int., ext. fascia abdominis spf. Coverings of the testes and epididymis Coverings fascia spermatica int. m. cremaster fascia spermatica ext. peritoneum  epiorchium (l. visceralis)  periorchium (l. parietalis)  fascia spermaticas int.  m. cremaster  fascia spermatica ext. The course of the descensus testium is shown by the course of a.v. testicularis Fossa supravesicalis - hernia supravesicalis (c) Fossa inguinalis medialis - hernia inguinalis directa (b) Fossa inguinalis lateralis - hernia inguinalis indirecta (a) Extremitas superior (cr, ve) inferior (ca, dors) Facies medialis lateralis Margo anterior posterior (hilus) Testis Tunica albuginea Mediastinum testis (post) Septula testis Lobuli testis (200-300) Hilum testis In lobuli testis : tubuli seminiferi contorti → tubulus seminif. rectus → rete testis → ductuli eff. testis (10-14) → tubuli epididymidis dct. epididydimis → dct. deferens Spermatozoa Interstitial cells of Leydig EPIDIDYMIS Caput epididymidis Corpus epididymidis Cauda epididymidis Sinus epididymidis Lig. epididymidis sup. et inf. Lig. scrotale (Gubernaculum testis) Lobuli epididymidis Ductus epididymidis Ductus deferens course Scrotum funiculus spermaticus canalis inguinalis Small pelvis40 cm DUCTUS DEFERENS (VAS DEFERENS) Pars epididymica Pars funicularis Pars inguinalis Pars pelvina Ampulla ductus deferentis - diverticula ampullae Ductus ejaculatorius – colliculus seminalis  Crosses the ureter  Enlarges - ampulla  Ductus deferens + ductus excretorius from the seminal vesicles > ductus ejaculatorius  Passes through the prostate  Opens in urethra mucosa muscle Adventitia FUNICULUS SPERMATICUS: A. testicularis spermatic cord Plexus testicularis Plexus pampiniformis Ductus deferens A. ductus deferentis Plexus deferentialis COVERINGS VESICULA SEMINALIS Ductus excretorius Ductus ejaculatorius Localisation Alcalic secretion Seminal vesiculography Prostata On the surface capsula propria Around venous plexus prostaticus capsula periprostatica (visc. Lamina of pelvic fascie) Lokalizace Basis Apex Facies anterior (symphysis) Facies posterior (rectum) Facies inferolaterales (pelvic floor) Lobus medius Lobus dexter et sinister Isthmus Examination of seminal vesicles and prostate „per rectum“ Clinical window Urethra pass though the prostate Stavba Basis Apex 3x4 30-50 tuboalv. gll. prostaticae + stroma from connective tissue (lig.) + smooth muscle Crista urethralis Colliculus seminalis Utriculus prostaticus Ductus ejaculatorii Sinus prostatici Lobus dx. Lobus sin. Isthmus prostatae Lobus post. Lobus medius (urethra dct.ejaculat.) I M Laloky prostaty P Prostatic zones Most of the glands GLANDULAE BULBOURETHRALES Ductus gl. bulbourethralis Radix Corpus facies dorsalis facies urethralis (raphe penis) Glans collum glandis corona glandis ostium urethrae ext. Penis Praeputium: ostium praeputii gll. praeputiales (smegma praeputii) Fossa navicularis urethrae (valvula, recessus) frenulum praeputii Cavernous bodies(+ urethra) Stavba COVERINGS OF PENIS: Skin (+ smooth muscle= tunica dartos) Fascia penis superficialis (+ nerve+ vessels) (Vv. dorsales penis spf.) Fascia penis profunda (Aa., Nn. dorsales penis, V. dorsalis penis profunda) Corpus spongiosum penis bulbus corpus glans Corpora cavernosa penis crura corpus Cavernous bodies Pohled na spodní plochu penisu Tunica albuginea (no on the glans) → trabeculae Cavernae To them: aa. helicinae away: vv. cavernosae Structure of the cavernous bodies A Lig. fundiforme penis = fascia abdominalis from linea alba loops penis, push it up B Lig. susp. penis From symphysis hold penis to symphysis Fixation of the penis A B Posterior urethra p. intramuralis M. sphincter vesicae smooth p. prostatica p. diaphragmatica M. sphincter urethrae (striated) Anterior urethra p. spongiosa – ampulla urethrae Urethra masculina 0,5 cm 4 cm 1 cm 15 cm 20-25 cm Ostium urethrae int. et ext. Curvatura subpubica = urethra fixa Curvatura praepubica = urethra mobile Curvatures of the urethra Cystoscopy!!! skin (tunica dartos, raphe, pubes) Septum Function – temperature regulation of the testes Scrotum SCROTUM Tunica dartos scroti Septum scroti Cavitas scroti Illustrations were copied from: Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München: Urban & Schwarzenberg, 1993) Netter: Interactive Atlas of Human Anatomy. Windows Version 2.0 Čihák R: Anatomie 2 (Splanchnologia). Avicenum, zdravotnické nakladatelství, Praha, 1988.