In the name of God
Anatomy:
Genitourinary System
Moradian MD, MPH, PhD Candidate
Tehran University of Medical Sciences
2013Dr. Budgie
Hussain
Pearson, Inc.,
Pearson Benjamin
Cummings 2009
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عملکردهای اصلی دستگاه ادراری
:تسدایىذآنازرازیرمًادتاکىىذمیفیلترراخًنَاکلیٍزیادیآبساز،يسًختديرریختىیمحصًلات،سمًمتذنزیادییًوُایيتذنيايریکاسیذايرٌ،:مثلویتريشنحايیریختىیديرمًارد
کراتیىیهحفظراتذنتاز-اسیذسطحيتذنَایالکتريلیتآب،تعادل
(رویه)کىذمیاستاستخًانمغسدرسازیخًنمحرککٍرااریتريپًئتیه
.کىىذمیترشحرا
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Main Functions of Urinary SystemKidneys filter blood to keep it pure
Toxins
Metabolic wastes
Excess water
Excess ions
Dispose of nitrogenous wastes from blood Urea
Uric acid
Creatinine
Regulate the balance of water and electrolytes, acids and bases (Renin)
Secrete Erythtopoetine that stimulate BM RBC production
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The Urinary System
Paired kidneysکلیٍَا
A Ureter for each kidney
حالة-میسوای
Urinary bladder
مثاوٍ
Urethra پیشاتراٌ
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Kidneys are retroperitoneal organs خلف صفاق superior lumbar region of posterior abdominal wall
Hilus is cleft: vessels, ureters and nerves enter and leave واف
Adrenal glands lie superior to each kidney ًغدد فوق کلی
11 cm , 130-150 gr
*
*
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Kidneys layers
renal medulla منطقه مرکزی کلیه ها
renal cortex منطقه قشری کلیه ها
renal capsule کپسول لیفی
perinephric (perirenal) fat کپسول چربی
renal fascia نیام کلیه
paranephric (pararenal) fat چربی پارارنال
peritoneum (anteriorly), and transversalis
fascia (posteriorly)7
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Transverse sections show
retroperitoneal position of
kidneys
Note also: liver, aorta
muscles on CT
Note layers of adipose
(fat), capsule, fascia
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Kidney regionsCortex: outer
Columns of cortex divide medulla into “pyramids”
Medulla: innerDarker, cone-shaped medullary or renal pyramids
Parallel bundles of urine-collecting tubules
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The human kidney has lobesPyramid and cortical tissue surrounding it
5-11 per kidney
Renal pelvis (=basin)Expanded, funnel shaped, superior part ofureters
Branches to form two or three major calices
Each of these divides again, minor calices:collect urine from papillae of pyramids
Kidney Structure
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Kidney Structure
Nephron وفرون : واحد ساختماوی کلیً
Renal corpuscle (in cortex) ًجسمک کلی
Glomerulus (tuft of capillaries) گلومرول
Glomerular (Bowman’s) capsule کپسول بومه
Tubular sectionProximal convoluted tubule لولً پیچیدي وسدیک
Loop of Henle ًقوش ٌىل
Distal convoluted tubule لولً پیچیدي دور
Collecting duct مجرای جمع کىىدي
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Nephron
A. Renal Vein
B. Renal Artery
C. Ureter
D. Medulla
E. Renal Pelvis
F. Cortex
1. Ascending loop of
Henle
2. Descending loop of
Henle
3. Peritubular
capillaries
4. Proximal tubule
5. Glomerulus
6. Distal tubule
The Kidney and the Nephron
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More than a million of these tubules act
together to form the urine
Three main mechanisms
a. Glomerular filtration
b. Tubular reabsorption
c. Tubular secretion
Two major parts
1. A urine-forming nephron
2. A collecting duct which
concentrates urine by removing
water from it
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Scanning EM of podocytes clinging to
capillaries (left) and filtration membrane
diagram (right) The capillary pores (fenestrations)
restrict the passage of the largest
elements such as blood cells
The basement membrane and slit
diaphragm hold back all but the smallest
proteins while letting through small
molecules such as water, ions, glucose,
amino acids, and urea
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Classes of
nephrons
• Cortical nephrons– 85% of all
nephrons
– Almost entirely within cortex
• Juxtamedullarynephrons– Renal corpuscles
near cortex-medulla junction
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The collecting ducts
• The most important role is to conserve bodyfluids
• When the body must conserve water, theposterior pituitary gland secretes ADH(antidiuretic hormone)
• ADH increases the permeability of the collectingtubules and distal tubules to water so more isreabsorbed
• This decreases the total volume of urine
• Alcohol inhibits the release of ADH, so lesswater is reabsorbed producing copious amountsof dilute urine (can cause dehydration)
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Vessels• Afferent and efferent arterioles associated with glomerular capillaries
– Allows high pressure for forcing filtrate out of blood
– About 20% of renal plasma flow is filtered each minute (125 ml/min): this is the glomerular filtration rate (GFR), an important clinical measure of renal function
• This is about one liter every 8 minutes (only 1% ends up as urine)
• Peritubular capillaries arise from efferent arterioles– Absorb solutes and water from tubule cells
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Histology
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For studying
Parts of the kidney:
1. Renal pyramid
2. Efferent vessel
3. Renal artery
4. Renal vein
5. Renal hilum
6. Renal pelvis
7. Ureter
8. Minor calyx
9. Renal capsule
10. Inferior renal capsule
11. Superior renal capsule
12. Afferent vessel
13. Nephron
14. Minor calyx
15. Major calyx
16. Renal papilla
17. Renal column
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The UretersSlender tubes about 25 cm (10 “) long leaving each renal pelvis
One for each kidney carrying urine to the bladder
Descend retroperitonealy
خلف صفاقی
Enter posterolateralcorners of bladder
Run medially within posterior bladder wall before opening into interior
This oblique entry helps prevent backflow of urine
پس از لگنچه، روی عروق ایلیاک، : محل های تنگی حالب
انتهای حالب و ورود به مثانه
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Ureters play an active
role in transporting urine
(it’s not just by gravity)
layers of UretersTransitional epithelium of mucosa (مخاطی)
Muscularis (ماهیچه ای)– Inner longitudinal,
outer circular layers
– Inferior 3rd with extra longitudinal layer)
– Stimulated to contract when urine in ureter: peristaltic waves to propel urine to bladder
Adventitia (همبند)
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Urinary Bladder Collapsible muscular sac
Stores and expels urine: 250-300 cm3
Lies on pelvic floor posterior to pubic symphysis
Males: anterior to rectum
Females: just anterior to the vagina and uterus
See also brief atlas
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If full: bladder is spherical and extends into abdominal cavity (holds about 500 ml or 1 pt)
If empty: bladder lies entirely within pelvis with shape like upside-down pyramid
Urine exits via the urethra
Trigone is inside area between ureters and urethra: prone to infection (see slide 38)
Bladder wall layersMucosa with distensible transitional epithelium (can
stretch) مخاط قابل جمع شدن
Submucosa زیر مخاط
Thick muscularis called the detrusor muscleماهیچه صاف3 layers of highly intermingled smooth muscle
Fibrous adventitia سروز در سطح فوقانی
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UrethraSmooth muscle with inner mucosa
Drains urine out of the bladder and body
Male: about 20 cm (8”) long پروستاتیک، پرده ای، اسفنجی
Female: 3-4 cm (1.5”) long
Urethra____
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Urethral sphinctersInternal: involuntary sphincter of smooth muscle
External: skeletal muscle inhibits urination voluntarilyuntil proper time (levator anni muscle also helpsvoluntary constriction)
Males: urethra has
three regions (see
right)
1. Prostatic urethra__________
2. Membranous urethra____
3. Spongy or penile urethra_____
_________trigone
female
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Micturition (Voiding )
– Urinating
– Emptying the bladder
KNOW:
Micturition center of brain: pons
(but heavily influenced by higher centers)
Parasympathetic: to void
Sympathetic: inhibits micturition
Male Reproductive system
دستگاه تولید مثل مردانه
بیضه
اپیدیدم
مجرای منی بر
کیسه ی بیضی
آلت تناسلی خارجی
کیسه منی
غده پروستات
غده کوپفر38
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Gonads– testes (testosterone) = sex
characteristics
• muscle development and maturity
– ovaries (estrogen) = sex
characteristics
• maturity and coordination
Testis
Spermatogenesis
Oval organ, 4-5 cm x 2.5 cm in diameter
Tunica vaginalis احشایی و جداری
Tunica albuginea پردي سفید
Seminiferous tubulesلولً مىی ساز
Leydig cells ٌورمون : بیىابیىی
Sertoli cells (supportive)
Rete testis
Efferent ductules (لولً وابران) 40
Histology of the Testis
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Heat Exchange of Pampiniform Plexus
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Spermatic Ducts
Efferent ductules
12 small ciliated ducts collecting sperm from the rete testes
and transporting it to the epididymis
Epididymis (head, body & tail)
6 m long coiled duct adhering to the posterior of testis
site of sperm maturation & storage (fertile for 40 to 60 days)
Ductus (vas) deferens مجرای منی بر
muscular tube 45 cm long passing up from scrotum through
inguinal canal to posterior surface of bladder
Ejaculatory duct مجرای انزالی
2 cm duct formed from ductus deferens & seminal vesicle &
passing through prostate to empty into urethra
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Male Duct System
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Accessory Glands
Seminal vesicles کیسً ی مىی
posterior to bladder
empty into ejaculatory duct
Prostate gland
below bladder, surrounds urethra and ejaculatory duct
empty through pores in urethral wall
Bulbourethral (Cowper) glands
near bulb of penis
empty into penile urethra
lubricating fluid45
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Anatomy of the Penis
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Spermatozoon
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Semen (Seminal Fluid)
2-5 ml of fluid expelled during orgasm60% seminal vesicle fluid, 30% prostatic & 10% sperm and trace of bulbourethral fluid
normal sperm count is 50-120 million/ml (< 25 million/ml is associated with infertility)
sperm serve to digest path through cervical mucus and to fertilize egg
Other components of semen
fructose provide energy for sperm motility
fibrinogen
clotting enzymes convert fibrinogen to fibrin causing semen to clot
fibrinolysin liquefies semen within 30 minutes
prostaglandins stimulate female peristaltic contractions
spermine is a base stabilizing sperm pH at 7.2 to 7.6
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Female External Genitalia
Vulva: everything that is externally visible (mons pubis,
labia majora, labia minora, clitoris, urethral orifice,
vaginal vestibule, perineal body)
mons pubis: mound of fatty tissue above the pubic bone
labia majora: large, outer fatty folds of skin tissue
labia minora: inner folds of skin and erectile tissue
clitoris: small, highly sensitive organ
glans: tip of the clitoris
prepuce (clitoral hood): loose-fitting fold of skin covering
the clitoral glans
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Female External Genitalia
vaginal vestibule: the cleft containing the vaginal and urethral openings
Skene’s glands: group of small mucous glands that open into vaginal
vestibule (near urethra)
Bartholin’s glands: two glands that open into vaginal vestibule (on either
side of the vaginal opening) - thought to provide some lubrication, may
emit a pheromone
hymen: thin mucous membrane partially covering the vaginal opening
perineum: tissue between the genital and anus.
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External Female Genitalia
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Female Internal Genitalia
Vagina: tubular organ connecting external genitals with uterus
Grafenberg spot (g-spot):
mass of erectile and glandular tissue surrounding the urethra just below the
bladder
some women report that simulation to g-spot produces sexual arousal and
orgasm
uterus: hollow muscular organ - purpose to nurture developing
fetus
cervix: small lower portion of the uterus that projects into the vagina
Perimetrium: پوشش صفاقی
myometrium: layers of smooth muscle comprising the uterus
endometrium: inner lining of the uterus that builds a rich blood supply
and sloughs off the lining each month
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Female Internal Genitalia
ovaries: female gonads - containing the immature
female reproductive cells
ovum: female reproduce cell
fallopian tubes: thin flexible muscular structures
connecting the ovaries with the uterus - passageway
for the ovum to travel to the uterus
cilia: tiny hairlike projections that line the fallopian tubes
and propel the ovum towards the uterus
fimbriae: fringelike projections that reach out to the ovary
to draw a released ovum into the fallopian tube.
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Uterine tube
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Ovaries
The female gonads or sex glands
They develop and expel an ovum each month
A woman is born with approximately 400,000
immature eggs called follicles
During a lifetime a woman release 400 to 500
fully matured eggs for fertilization
The follicles in the ovaries produce the female
sex hormones, progesterone and estrogen
These hormones prepare the uterus for
implantation of the fertilized egg