Title: Urological Anatomy and Physiology Mr Andrew Sinclair
1Urological Anatomy and Physiology
- Mr Andrew Sinclair
- Consultant Urological Surgeon
- Stockport NHS Foundation Trust
2Overview
- Introduction
- Anatomy and clinical relevance
- Kidney
- Ureter
- Bladder
- Urethra
- Prostate
- Scrotum
- Physiology
- Renal
- Bladder Function
- Erection and Ejaculation
3Introduction
- Need to know the BASICS only
- Broad knowledge base
- Identify life threatening problems
- Dont harm the patient
4Surface markings of the kidneys
- 2 Kidneys
- Retroperitoneal Organs
- Each side of vertebral column
- From T12 to L3
- Right slightly lower because displaced inferiorly
by the liver - Hilum at L1
5Anatomy of the Kidneys Renal Vein
6Anatomy of the Kidneys Renal Artery
7Anatomy of the Kidneys
- Longer left renal vein crosses anterior to the
Aorta - From Anterior to Posterior
- Vein, Artery, Renal Pelvis
- Left gonadal vein drains into Left renal vein
- Right gonadal vein drains directly into IVC
8Microanatomy of the kidney
- 1.Renal Vein
- 2. Renal Artery
- 3. Renal Calyx
- 4.Medullary Pyramid
- 5.Renal Cortex
- Vasculature
- 6.Segmental Artery
- 7.Interlobar Artery
- 8.Arcuate Artery
- 9.Arcuate Vein
- 10.Interlobar Vein
- 11. Segmental Vein
- 12.Renal Column
- 13.Renal Papillae
- 14.Renal Pelvis
- 15.Ureter
9Anatomy of the Ureter
adrenal
- Ureters continue from the renal pelvis at L1
- 25 cm long
- Run inferomedially along the transverse processes
of lumbar vertebrae - Crosses pelvic brim at the SIJ anterior to the
origins of the external iliac artery - Runs anterior to the internal iliac artery in the
pelvis - Passes towards the ischial spine before turning
towards the pubic tubercle and entering the
bladder
kidney
ureter
bladder
urethra
10Relevance of Anatomy
11Anatomy of the Bladder
12Anatomy of Lower Male GU Tract
Prostatic Urethra
Membranous Urethra
Bulbar Urethra
Penile urethra
13Anatomy of the prostate
14Relevance of anatomy
Female catheterisation
Suprapubic catheterisation
Digital Rectal Examination
Male catheterisation
15Anatomy of the scrotum
Embryology
- Important area for medical students
- Chronic conditions
- Easily palpable
- Limited diagnoses
- Therefore easy to bring to exams
16Spermatic cord
- Runs through Inguinal canal
- The coverings of the cord arise from the layers
from the inguinal canal - Internal spermatic fascia from transversalis
fascia - Cremasteric fascia and muscle from transversus
abdominis internal oblique - External spermatic fascia from external oblique
aponeurosis
- Contents of spermatic cord
- Ductus deferens (45cm)
- Testicular artery
- Artery to the ductus deferens
- Cremasteric artery
- Pampiniform plexus
- Sympathetic nerves
- Parasympathetic nerves
- Genital branch of genitofemoral nerve
- Lymphatics
17Layers of the spermatic cord and scrotum
- Peritoneum
- Transversalis fascia
- Transversus abdominis internal oblique
- External oblique
- Subcutaneous fat
- Skin
- CV Cavity of tunica vaginalis
- T Testis
- E Epididymis
18Scrotal Contents
- Testis covered by visceral layer of tunica
vaginalis except where the testis is attached to
the epididymis and spermatic cord. - Parietal layer attached to internal spermatic
fascia - Fluid between layers allows movement
19Relevance of AnatomyIdentify origins of scrotal
lumps
- Is it attached / part of the testicle
- Is it separate from testicle
- Is it transilluminable
- Can you feel the testicle
- Can you get above it
20Relevance of AnatomyIdentify origins of scrotal
lumps
Epididymal cyst
Inguinal Hernia
Hydrocele
Testicular cancer
21Physiology
22Renal Physiology
- General understanding
- Complex physiology
- General principles
23Loop of Henle
- Countercurrent multiplier
- Relies on a concentration gradient between the 2
limbs of the loop - Requires energy
- Relatively small gradient BETWEEN the 2 limbs is
magnified by the countercurrent to a relatively
large gradient ALONG the limb of the loop
involved - Thick ascending limb
- continuous active transport of NaCl into
interstitium - Impermeable to H2O
- Descending loop
- Tonicity in equilibrium with the interstitium
Impermeable to H2O
24Salt and water balance
25Physiology of Micturition
Lateral corticospinal tract
Sympathetic T10-L2
Parasympathetic
S2, 3, 4
Intermediolateral column parasympathetic
Pelvic nerve Onufs nucleus - rhabdosphincter Ante
rior Horn Cell Nucleus pudendal nerve
periurethral striated muscle
somatic
26 Physiology of erections and ejaculation.Central
erectile stimulation
Inhibitory stimuli anxiety fear
depression
Cerebralcortex
PVN
Spinal cord
27Neural input to erections
- In the flaccid state sympathetic dominance keeps
arterioles and smooth muscle contracted - Erections are primarily vascular in nature BUT
from parasympathetic stimulation - This leads to arteriolar dilation and trabecular
smooth muscle relaxation. - Pudendal nerve also has an input causing
ischiocavernosus muscle contraction further
increasing intracavernosal pressure
NB Nervi erigentes now called pelvic splanchnic
nerves NB The 2 Inferior hypogastic plexuses make
up the pelvic plexus
28Trabecular smooth muscle relaxation
- Dominant mediator is Nitric oxide NO released
from parasympathetic nerve terminals - Parasympathetic nerve terminal also releases Ach
which stimulates vascular endothelium to also
release NO
29Peripheral erectile stimulation
Parasympathetic and Sympathetic nerves from the
pelvic plexus pass within the cavernous nerve to
the penis
PDE5 Inhibitors Phosphodiesterase 5 Inhibitors
Examples of PDE5 inhibitors are Viagra, Cialis
and Levitra
30Physiology and anatomy of Erection
Erect State
Flaccid State
31Physiology of Ejaculation
- Ejaculation has 3 processes
- Closure of bladder neck (sympathetic)
- Emission (sympathetic)
- 1stly prostatic secretions
- Then seminal vesicle emptying
- Antegrade ejaculation (sympathetic and somatic)
- Somatic is the pudendal nerve causing contraction
of the bulbocavernosus muscle.
Inferior mesenteric plexus
Superior hypogastric plexus
(sympathetic)
32Thank you