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This lecture includes the slides that the doctor read and I added the doctors words right in the boxes.

The doctor started by making a correction, which is the additional slides on the website.

UreDers Muscular Tube Measuring About 25 Cm. Begin

at Renal Pevis, then descend retroperitoneally and anterior to psoas muscle to posterior surface of Urinary bladder.

Then cross pelvic inlet into minor (true) pelvis where they are still retroperitoneal and cross anterior to Common Iliac Bifurcation And Anterior To Sacro-iliac Joint. Then it follows the course of internal iliac artery (which goes to the pelvis).

Could Be Compromised By Aneurysm Of Common Iliac

End at ureterovesical and open into bladder and define upper border of urinary bladder trigone.

3 Normal Constrictions (Kidney Stones Get Stuck): (1) At Ureteropelvic( the beginning of the ureter

as it leaves the kidney) (2) Where Ureters Cross Pelvic Inlet (Brim) (bending) (3) And At Ureterovesical (Intramural) (the end of it)

Right Ureter Relations:

Anteriorly: Duodenum, ileum right testicular/ovarian vessels, Right colic vessels, and mesentery of small

intestine. Posteriorly: Right Psoas muscle and bifurcation of common iliac artery.

Left Ureter Relations: Anteriorly: Sigmoid colon and mesocolon and left Colic vessels, Testicular/Ovarian artery. Posteriorly: Left Psoas muscle and bifurcation of common iliac artery.

It is a muscular tube lined by surface epithelium, then we have connective tissue, then we have the muscular layer, then the serosa or adventitia.

The doctor said many times that the ureDer end at the SUPERIOR POSTERIOR aspects of the urinary bladder.

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Blood Supply of the ureter:

Upper Part: Renal Artery.

Mid-part: Ovarian/Testicular Artery. (branches

of aorta)

Lower/Pelvic Part: Superior Vesical artery.

Venous Blood Supply: Correspond to arteries.

Lymphatic drainage: Correspond to LN along

the course of arteries.

Nerve Supply:

Upper part: Renal nerve.

Mid-part: Ovarian/Testicular Nerve.

Lower/Pelvic Part: Hypogastric Plexus.

Afferent fibers enter spinal cord at L1-2 (thats why the referred pain to that region during renal colic of

the ureter.)

Clinical Points

Long = 25 cm, Narrower and 3 constrictions:

Hence susceptible to renal stones lodgment at constriction sites.

Renal Colic:

Severe pain experienced when renal stones are lodged.

Afferent fibers enter spinal cord at T 11-12 and L 1-2 (Skin of Flank loin and

Groin Areas).

Renal stone arrest at Lower Part referred pain felt at Tip of Penis/Testicles

or labia in case of females.

* Males: pass posterior to ductus deferens Females: pass posterior & inferior to uterine artery. ***During hysterectomy (surgical removal of the uterus) ureter can be ligated with uterine artery. (it is posterior to artery near cervix).

Ovarian and Testicular Artery are

branches from the aorta, because

during embryogenesis testicles

develop intra-abdominally (around

8th week), so testicles have to take

their blood supply form aorta and

after they develop they begin to

descend and exit through internal

ring of the inguinal canal then to the

external ring to the scrotal sac.

In a male infant you have to check

that both testicles are within the

scrotal sac and if there is

undescended testis , this mean it is

within higher a temperature than

the body because spermatogenesis

occur at lower temperature and this

will lead in the future to infertility

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Organ Of Urine Storage (500 Ml). Lies behind Pubic symphysis and is Pelvic Organ When Empty but rises into Hypogastric region of abdominal cavity as it fills up.

It is Triangular and has an Apex, Base, A Superior Surface And 2-inferiolateral Surfaces.

Apex: Points Anteriorly and connected to Umblicus by Median Umblical Ligament (remnant of Urachus).

The Posterior Surface; has Two -lateral angles where Ureters join the bladder and 2-Vasa deferens run separating the Seminal Vesicles fro each other.

Superior Surface: Is covered by peritoneum and related to Ileum and Sigmoid Colon.

The Neck of Urinary bladder is Surrounded by Prostate Lobes where Prostatic Urethra lies.

The Interior of Urinary bladder Presents Folds/Rugae when Empty. But A triangular area joining the three openings; 2-ureters and one internal sphincter is clear of Folds and called Trigone

During pregnancy there will be more

pressure on Urinary Bladder, so as

long as pregnancy on the first 3

months within pelvic there will

pressure symptoms on the urinary

bladder this will result in frequency

of Micturition in the first 3 months

The problem here, as male age (>45)

Prostate undergo Hypertrophic

changes and because prostate have

very dense capsule present at very

constricted anatomical position ,this

hypertrophy it does not extend

outward but also it push inward

where the urethrae pass and this will

lead to different degree of urinary

retention (complete or partial ).

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The interior of urinary bladder

The 2 ureters enter the urinary bladder at the 2 lateral angels in the superior posterior region. The

area above the entrance of the 2 ureters is called the fundus.

And notice in the picture the internal urethral orifice (which is under the autonomic nervous

system) and the external (which is voluntary).

Now regarding the interior aspect of the urinary bladder, like any organ in the body that is subjected

to distension (the stomach for e.g.). You can see that it's folded to allow it to extend. These folds are

called "Rugae".

- still in the interior aspect we have a triangular area that extend between the 2 upper lateral points

(which represent the opening of the 2 ureters) and the internal urethral orifice. This area is called

the "trigon".

Trigone of the bladder is not folded, it smooth; the significant of this is Because if its folded this will

affect the potency of the tube (ureter), that means the urine will not pass easily from the ureter to

the bladder.

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- At the neck of urinary bladder we have the prostatic urethra and prostate (regarding males) while in females related to urogenital diaphragm.

In females the UB and the urethra are

anterior to the uterus. There are 2 pouchs

(empty potential space) which are "Recto-

uterine" pouch behind the uterus

(between the uterus and the rectum) &

"viscero-uterine" pouch in front of the

uterus.

Regarding males as we said we have the prostate gland at the neck of the bladder. And in the

urethra there is an opening for the vas deference which passes within the substance of the prostate

gland carrying semen to the ejaculatory duct; this part of urethra is called prostatic urethra. Then

the urethra pass through the urogenital diaphragm.

The blood supply and innervation of the Urinary

bladder:

- It's supplied by Superior and Inferior Vesical arteries which are branches of Internal Iliac Artery.

- Regarding the venous drainage it's correspond to the arteries and drain into the internal iliac vein.

- Nerve Supply via the Inferior Hypogastric Plexus from Sympathetic fibers of L 1-2

The doctor scolded us for not

knowing what is the muscle tone -.-!

Anyone want to know the content,

refer to the record!

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The urinary bladder relation:

Posterior surface (fundus/base):

- In males related to rectovesical pouch, rectum, seminal vesicles, and ampulla of ductus

deferens

- In females related to anterior wall of vagina

Anterior surface:

Related to pubic symphysis and retropubic space of Retzius

Superior surface:

In males - peritoneal cavity

In females vesicouterine pouch (peritoneal cavity)

Apex:

related to median umbilical lig. or urachus

Neck:

in males related to prostatic urethra and prostate while in females related to urogenital

diaphragm

Trigone of the bladder:

on posterior surface of bladder and defined superiorly by ureters and inferiorly by urethra

(internal urethral meatus)

Bladder clinical:

1- In infants the empty bladder lies within the false abdominal cavity. As it mature (in adults) it

shifts and move into the minor pelvis (true pelvis), but when full can rise above pelvic inlet.

2- Prostatic Hypertrophy: Affects Males above 45 yrs. Hence

Pressure over Prostatic Urethra and cause Residual volume

and Urgency to Micturation and Possible Retention.

3- Incontinence (total, stress, urge, overflow types):

Uncontrolled passage of urine, it affects female more than males, it happens due to the emotional

nature of the female (stress, anxiety, pregnancy . ) and due to some anatomical (structural)

variation in female.

# Prostatic Hypertrophy: Sildenafil

(Viagra) is used as a TT by increasing

cGMP that cause Smooth muscle

relaxation said the doctor.

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URETHRA :

Muscular Tube Carries urine from the Bladder to the outside of the body

Internal Sphincter prevents urine from emptying; composed of smooth muscle; involuntary

External Sphincter at the upper portion of the urethra allows you to resist the urge to urinate; composed

of skeletal muscle; voluntary

Female Short and Wide opens to the outside at the urethral meatus, subjected more to UTI

Male longer and narrow, passes through the prostate gland; carries urine and sperm.

Hence Males more prone for Renal Stone arrest But Females more susceptible to Urinary Tract Infection

Males (3 parts) 1. Prostatic post. wall has urethral crest that contains 2 openings of ejaculatory ducts. Prostatic

ducts are lateral to urethral crest.

2. Membranous the narrowest crosses urogenital diaphragm and surrounded by deep

transverse perineal m. and sphincter urethrae m. (external sphincter)

-Both musc. by pudendal n.

- the place where lodgment of renal stone occur

3. Penile (spongy/cavernous) surrounded by corpus spongiosum, enlarges into fossa navicularis,

and ends as external urethral meatus. Openings of bulbourethral glands just below urogenital

diaphragm. (vulnerable to catheter penetration)

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Females

- Courses through urogenital diaphragm and is surrounded by deep transverse perineal m. and

sphincter urethrae m. (later muscles doesnt completely surround urethra and is the reason for

high incidence of stress incontinence in women)

- Posterior surface fuses with anterior wall of vagina.

- External urethral orifice stratified Squamous epitheliumopens into vestibule of vagina between

labia minora.

! ! !

Done by:

Anagreh

Obiedat

Zoubi

Shatnawi