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 Kidney (ren) Efferent urinary tract: renal calices renal pelvis ureter urinary bladder urethra PARTS 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 A.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. aruateae 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 ren topo 1 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 ren topo 2 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. 1.Fascia renalis 5. Corpus adiposum pararenale 2.Lamina praerenalis 6. Peritoneum 3.Lamina retrorenalis 7. Fascia transversalis 4.Capsula adiposa REN MIGRANS Nll. lumbales (paraaortici) tr. lumbalis dx. et sin. Lymphatic vessels, Vasa lymphatica, lymph nodes, Nodi lymphatici, of the pelvic wall in the female; the pelvis has been sectioned in the median plane; the uterus has been pulled sinistroventrally; most of the peritoneum has been removed; lateral view (right). The lymph nodes shown here are often much smaller but always present. Via the lymphatic vessels in the round ligament (Lig. teres uteri) tumor cells may spread from the uterus to the superficial inguinal lymph nodes. • renculi marking • ren arcuatus • ren duplex • ren sigmoideus • ren fungiformis • agenesia renis ANd9GcS6wUK1Sx2zfJNzZrxAyp3sZI5n1LSrxoNBtyH2T50QDxOB0EB_ Ectopic kidney x ren migrans anatomy_Horseshoe_Kidney Horseshoe kidney 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% CALICES RENALES – minores et majores PELVIS RENALIS (PYELUM) URETER 1.pars abdominalis 2.pars pelvina 3.pars intramuralis ostium ureteris kidney-stones Point of LANZ 3 physiological constrictions image1134 Plicae longitudinales Adventitia 39 VESICA URINARIA -fundus vesicae -corpus vesicae -apex vesicae - lig. umbilicale medianum -cervix vesicae Male - dorsal aspect of urinary bladder Ductus deferens Female – ventral aspect 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 URETHRA FEMININA Crista urethralis Lacunae urethrales Glandulae urethrales Ductus paraurethrales IVU Retrograde pyelography Vesicoureteral reflux (VUR) – voiding cystourethrogram (VCU) Retrocaval ureter Ureter duplex Horseshoe kidney MALE GENITAL ORGANS (ORGANA GENITALIA MASCULINA) Organa genitalia interna: Testis Epididymis Ductus deferens Urethra masculina Vesicula seminalis Prostata Organa genitalia externa: Penis Scrotum Development: Wolffian ducts Müllerian ducts 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 A. testicularis Plexus pampiniformis - vv. testiculares Nll. lumbales EPIDIDYMIS Caput epididymidis Corpus epididymidis Cauda epididymidis Sinus epididymidis Lig. epididymidis sup. et inf. Lig. scrotale (Gubernaculum testis) Lobuli epididymidis Ductus epididymidis DESCENSUS TESTIUM Retentio testis (cryptorchidism). Ectopia testis. Gubernaculum testis → Lig. scrotale Processus vaginalis → Tunica vaginalis Lig. vaginale 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) CANALIS INGUINALIS Posterior wall: Fascia transversalis: Falx inguinalis Trigonum inguinale (Hesselbachi) Lig. interfoveolare Anulus inguinalis prof. Tractus iliopubicus Anulus femoralis CANALIS INGUINALIS Inferior wall: Lig. inguinale CANALIS INGUINALIS Anterior wall: Aponeurosis m. obliqui externi abdominis Anulus inguinalis spf. - crus mediale - crus laterale - fibrae intercrurales - lig. inguinale reflexum CANALIS INGUINALIS Superior wall: M. obliquus internus abdominis M. transversus abdominis - M. cremaster Fossa supravesicalis Fossa inguinalis medialis (trig. Inguinale) Fossa inguinalis lateralis (anulus inguinalis prof.) Plica umbilicalis mediana - lig. umbilicale medianum Plica umbilicalis medialis - lig. umbilicale mediale (laterale) (pars occlusa a. umbilicalis) Plica umbilicalis lateralis - vasa epigastrica inf. Fossa supravesicalis - hernia supravesicalis (c) Fossa inguinalis medialis - hernia inguinalis directa (b) Fossa inguinalis lateralis - hernia inguinalis indirecta (a) http://upload.wikimedia.org/wikipedia/commons/4/44/Inguinal_fossae.PNG VESICULA SEMINALIS Ductus excretorius Ductus ejaculatorius PROSTATA Basis Apex Facies anterior Facies posterior Facies inferolaterales Lobus medius Lobus dexter et sinister Isthmus 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) http://upload.wikimedia.org/wikipedia/commons/e/e0/Digital_rectal_exam_nci-vol-7136-300.jpg http://www.sternurology.com/images/prostate-cancer-illustration.jpg http://lh6.ggpht.com/_cEPdz7M9ILE/TM0nZCFA0UI/AAAAAAAAAfY/CMFUYhdywRU/s800/prostate%20-%20zonal%20a natomy.jpg http://wildiris4.securesites.net/cms_prod/files/course/404/bph.jpg 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 Glandulae praeputiales Collum glandis Smegma praeputii Corona glandis Frenulum praeputii Dorsum penis Corpus cavernosum Facies urethralis Corpus spongiosum Raphe penis Tunica albuginea Praeputium Trabeculae Ostium praeputii 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 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 A. et v. pudenda interna, n. pudendus – canalis pudendalis - aa., 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 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.