Urinary system

Introduction
• One of the excretory systems of body.
• Maintaining homeostasis of water and
electrolyte concentrations within the body.
• It consists of the following structures

• 2 kidneys,
• 2 ureters,
• urinary bladder
 The kidneys
Position
• Lie on posterior abdominal wall,
• One on each side of vertebral column,
• Behind peritoneum and below diaphragm.
• Level of t12th to l3rd ,
• Measure ~12x6x3cm (left often slightly longer
than right)
• Weigh ~130g each
• Bean-shaped appearance
 Left right

Posterior Diaphragm Muscle of posterior abdominal wall

· Subcostal nerve and vessuls
12 th ribs

Anterior Stomach · Spleen · Pancreas Duodenum,hepatic

(tail) Flexure Peritoneum
· Jejunum·, Peritoneum

superior R- Adrenal gland L-adrenal gland

medial IVC IVC
Organs associated with the kidneys
 structure of the kidney
• Fibrous capsule,- surrounding the kidney
• Cortex, - reddish-brown layer immediately below
the capsule and outside pyramids
• Medulla,- innermost layer, consisting of pale
conical-shaped incisions, the renal pyramids.
• Hilum - concave ,-renal blood and lymph vessels,
the ureter and nerves enter.
Renal pelvis
• Funnel-shaped
• Lined with transitional epithelium with a smooth
muscle and connective tissue wall
• Continuous inferiorly with ureter
• Divides into major and minor calyces
• Urine - collecting duct -minor calyx - major calyx -
renal pelvis - ureters - bladder
• Peristalsis –calyxes- originating in pacemaker cells
• Not under nerve control
 Microscopic structure of the kidney

• The kidney functional units,- the nephrons, and

collecting tubules.
• Collecting tubules transport urine through
pyramids to the renal pelvis
• Tubules are supported by a small amount of
connective tissue, containing blood vessels,
nerves and lymph vessels.
The nephron
• Functional unit of the kidney (1,000,000)
• Responsible for urine formation: filtration,
secretion ,reabsorption
• Closed end form glomerular capsule- complete
arterial capillaries,
• Glomerular capsule is described in three parts:
• Proximal convoluted tubule
• Medullary loop (loop of henle)
• Distal convoluted tubule,
• Larger ducts that empty into minor calyces.

• Blood - Renal artery- divides into smaller

arteries and arterioles.
• Afferent arteriole, enters each glomerular
capsule then subdivides into a bunch of
capillaries in glomerular
• Efferent arteriole -leading away from the
glomerulus
• Efferent arteriole; - supply oxygen and nutrients
to remainder of nephron.
• Venous blood drained from renal vein
• BP in the glomerulus is higher than in other
capillaries
• walls of the glomerulus and the glomerular
capsule - single layer of flattened epithelial cells
• Glomerular walls are more permeable than
those of other capillaries
• The remainder of the nephron and the
collecting tubule are formed by a single layer
of highly specialised cells
• Connective tissue phagocytic mesangial cells ,
as part of the reticuloendothelial system
• Lymphatic drainage- para-aortic nodes ,

posterior mediastinum nods

• Nerve supply- consists of sympathetic and
parasympathetic nerves.

- Control of renal blood vessel diameter

-Renal blood flow independently of auto
regulation
 Functions of the kidney
Formation of urine
• The kidneys form urine, which passes to the
bladder for storage prior to excretion
• The composition of urine returns exchange of
substances between nephron and blood in
renal capillaries.
• Waste products of protein metabolism are
excreted, water and electrolyte levels are
controlled and pH (acid–base balance) is
maintained by excretion of hydrogen ions.
Cont..
• There are three processes involved in the
formation of urine:.
• Simple filtration
• Selective reabsorption
• Secretion.
Simple filtration
• Takes place-glomerulus and glomerular
capsule.
• Water and a large number of small molecules
pass through,
• Blood cells, plasma protein, other large
molecules are unable to filter through
• Filtration is assisted by the difference between

- capillary hydrostatic pressure of about (55

mmhg)

- Osmotic pressure of the blood, (30 mmhg)

-f iltrate hydrostatic pressure of about (15

mmhg) in the glomerular capsule.
• Filtration pressure= 55 - (30 + 15) = 10 mmhg
Glomerular filtration rate (GFR).

• The volume of filtrate formed by both kidneys

each minute
• Healthy adult the GFR is about 125 ml/min;

• 180 litres of filtrate are formed each day

• Most of the filtrate is reabsorbed

• 1 to 1.5 litres, excreted as urine.

Selective reabsorption
• Purpose of reabsorb -to maintain fluid and
electrolyte balance and PH of the blood.
• Some are reabsorbed by active transport ( AA
and Na, Ca, K, Po and chloride.)some are
passive(Cl-) H2O
• Some parts do not normally appear in urine
because completely reabsorbed
• Except they are present in blood in excessive
quantities.
• The kidneys' maximum capacity for reabsorption
of a substance is the transport maximum, or renal
threshold,
• Some substances - transport maximum, or renal
threshold, of varies ( body's need , hormones.)
• Parathyroid hormone and thyroid gland together
regulate reabsorption of calcium and phosphate.
• Antidiuretic hormone (ADH) increasing water
reabsorption
• Aldosterone, - increases the reabsorption of
sodium and excretion of potassium
 PCT-65% Loop of DCT- CD-2%
henle- 8%
25%
Reabso Ca+ Na+ Na+ Na+. Nacl,
ption Cl-, PO4, H20 ,Nac HCO3 Ca2
HCO, l, Ca2 -
75-90% of Nacl, H20
H20. Ca2
Glucose,, H+
amino acids
Secretion
• Substances not required and foreign materials,
e.G. Drugs
• May not be cleared from the blood by
filtration because of the short time it remains
in the glomerulus.
• Such substances are cleared by secretion
from the peritubular capillaries into the
filtrate within the convoluted tubules
 PCT Loop of DCT CT
henle
Secretion uric acid, - organic -
acids, K+,
bile salts H+, drugs,

some
drugs,
creatinine
Composition of urine
• Urine is clear and
• Water 96%
• Urea 2% amber in colour
• Uric acid urobilin,
• Creatinine
• Ammonia
• specific gravity is 1020-
• Sodium 1030,
• Potassium 2%
• PH around 4.5 to 8
• Chlorides
• Phosphates • Healthy adult passes
• Sulphates 1000 to 1500 ml per
• Oxalates
day.
Substance Blood Plasma Urine
(total amount) (amount per day)
Urea 4.8 g 25 g
Uric acid 0.15 g 0.8 g
Creatinine 0.03 g 1.6 g
Potassium 0.5 g 2.0 g
Chloride 10.7 g 6.3 g
Sodium 9.7 g 4.6 g
Protein 200 g 0.1 g
HCO3- 4.6 g 0g
Glucose 3g 0g
Water balance and urine output
• Water is taken through the GI tract and metabolic
processes.
• Excreted in expired air, faeces, skin as sweat, main
component of urine
• Balance intake and output is controlled by the
kidneys.
• The minimum urinary output, about 500 ml per
day.
• Excess of urine produce is controlled mainly
by antidiuretic hormone (Adh) ( pituitary
gland).
• There is a close link pituitary and the
hypothalamus
• Osmoreceptors (thalamus) detect changes in
the osmotic pressure
• Stimulate the posterior lobe of pituitary to
release ADH.
• Water reabsorption by the cells dct and ct
• Reducing osmotic pressure - ADH output.
• Osmotic pressure within normal limits
Electrolyte balance
Sodium and potassium concentration
• Sodium is intake is typically in extra of body's
needs.
• It is excreted mainly in urine and sweat.

• Na excreted is regulated by hormone aldosterone,

• Afferent arteriole stimulated to produce renin by
low blood volume or pressure.
• Renin converts angiotensin 1 by
angiotensinogen (liver),
• Angiotensin 1convoluted to angiotensin 2 by ACE
(PCT,lungs)
• Strong vasoconstrictor and increases blood
pressure.
• Raised renin and K levels also Stimulate secrete
aldosterone
• Water is reabsorbed with sodium

• Increase blood volume,leading to reduced

renin secretion
• Reducing intracellular potassium

Maintain the normal ph

• Cells of the proximal convoluted tubules
secrete hydrogen ions.
• Filtrate they combine with buffers
• Carbonic acid is converted to carbon dioxide
(CO2) and water (H2O), and CO2 is reabsorbed,
maintaining buffering capacity of the blood
• Hydrogen ions are excreted in the urine as
ammonium salts and hydrogen phosphate
 URETERS
• It’s tubes that convey urine from the kidneys
to the urinary bladder
• About 25 to 30 cm long , diameter about 3 mm

• Continuous with renal pelvis.

• It passes downwards behind the peritoneum in
front of psoas muscle into pelvic cavity,
• passes obliquely through posterior wall of the
bladder
• Because of prevents reflux of urine into ureters
•  females, the ureters pass through the 
mesometrium and under the uterine arteries on
the way to the urinary bladder
Structure
Consist of three layers of tissue:
• Outer covering of fibrous tissue,- continuous
with the fibrous capsule of the kidney
• Middle muscular layer
- smooth muscle fibers - longitudinal &
spiraling round the ureter,
• Inner layer,- mucosa, lined with transitional
epithelium
BLOOD SUPPLY
• Upper part –renal artery testicular or ovarian
arteries
• Middle part-branch of aorta
• Pelvic part- rectal or uterine vessels

Venus return-renal ,gonadal vain ovarian veins

NERVE SUPPLY
• Sympathetic- T10-L1
• Parasympathetic- S2-S4
Function
• Force to urine from kidneys into bladder by
peristaltic contraction of smooth muscle layer.
• Not under autonomic nerve control.

• The waves of contraction originate in a

pacemaker in the minor calyces.
• Peristaltic waves occur several times per
minute,
URINARY BLADDER
• it is a reservoir for urine.

• lies in the pelvic cavity

• size and position vary, depending on the
amount of urine it contains.
Structure
• The bladder is roughly pear-shaped, but
becomes more oval as it fills with urine.
• It has anterior, superior and posterior surfaces.
( base).
• Neck of bladder opens into the urethra
• The superior surface cover by peritoneum .
• Posteriorly it surrounds uterus in female and
rectum in male
• Bladder wall is composed of three layers:

- Outer layer - loose connective tissue

-Middle layer, - smooth muscle fibres and

elastic tissue .(detrusor)

- Mucosa, - transitional epithelium

• Capacity of the bladder
• 20–50 mL at birth,
• 200 mL at 1 year,
• 600 mL in young adult males
• The three orifices in the bladder wall form a
triangle or trigone
• Thickening of the smooth muscle layer
forming the internal urethrul sphincter.
• This sphincter is not under voluntary control
Urethra
male
• tube that connects urinary bladder to  
urinary meatus   (20 cm)
• travels through the penis and also carries
urine & semen.([ejaculation )
• external urethral sphincter is a striated muscle
 that allows voluntary control
• male there an additional 
internal urethral sphincter muscle
•  Urethra is divided into four parts in men,

1 pre-prostatic urethra-(p u)
internal part of urethra and varies between
0.5 and 1.5 cm in length depending on the
fullness
• Linig- transitional epithelium
2 prostatic urethra (pu)
• Crosses through the prostate gland
There are several openings:
(1) the ejaculatory duct -sperm from seminal
vesicle,
(2) prostatic ducts fluid from prostate enters
(3) prostatic utricle, is merely called the ve
rumontanum.
• linig-Transitional epithelium
3 Membranous urethra
•  small (1-2 cm) portion(narrowest part)
• Passing through the external urethral sphincter.
• It is located in the deep perineal pouch.  
• Bulbourethral glands (cowper's gland) are found
posterior to this region but open in the 
spongy urethra.
• Linig-  pseudostratified epithelium
4 spongy urethra ( penile urethra)
– Runs along the penis - it is 15–16 cm
– Travels through the corpus spongiosum.
– Urethral gland , bulbourethral glands
are also found here
– Produces a spiral stream of urine
– Lining-pseudostratified epithelium
• Arterial Arterial

• dorsal and bulbar arteries of penis, which are

branches from the internal pudendal arteries.
Veins- internal pudendal and internal iliac veins
Lymphatic –internal/external iliacly, inguinal
lymph nodes.
• Nurve- sympathetic, parasympathetic, and
visceral afferent fiber
Female urethra
– About 4.8 cm to 5.1 cm long

– Exits the body between clitoris and the vagina,

– Extending - internal to external urethral

orifice.
– The meatus (open) is located below the clitoris.
• Embedded in the anterior wall of vagina, and
its direction is obliquely downward and
forward;
• proximal 2/3rds - transitional epithelium -
distal 1/3rd - stratified squamous epithelium
• The urethra consists of three coats:
– Muscular, - being a continuation of of

bladder
– Erectile,

– Mucous,

• voluntary - external urethral sphincter

• Arterial - internal pudendal , vaginal arteries
• Vain- internal pudendal , vaginal vain
• Lymph-sacral and internal iliac lymph nodes,
deep inguinal lymph nodes.
• Nerve- sympathetic, parasympathetic, and
visceral afferent fibers(pudendal nerve-
somatic)
• Function of urethra
• Discharge urine from the body
• Ejaculation of sperm
 Micturition
• Is a process by which urinary bladder empties
when it become filled

• Normal voiding is a spinal reflex

• Controlled by CNS( brain and spinal cord)
• Coordinates the function of bladder and
urethra
Reflex center for micturition

1 sacral micturition center

- Spinal center for micturition

- Sacral pudental nucleus: relaxation of

external sphincter
- Sacral detrusor nucleus : contraction of
detrusor muscle
2. Pontine micturition center
– - Reticulospinal tract(control volentary
movment)
– - Use control terminated sacral micturition
centre reflex
3. Cerebral cortex
- Detrusor area is located in the medial
frontal lobe
- Stimulate detrusor nucleus
4. Basal Ganglia:
- Inhibits sacral detrusor nucleus
• during storage - afferents in pelvic nerves
detect bladder filling and send signals to
lumbosacral spinal cord and brain
• These signals motivation the efferent
pathways in hypogastric nerves to inhibit
bladder contraction and close the bladder
neck ,
• and also motivation the efferent pathways in
pudendal nerves to contract the external
• The sphincter afferents in pudendal
nerves detect the sphincter contractions
• send signals back to lumbosacral spinal
cord, which force on efferents in
hypogastric nerves to inhibit bladder
contraction and close the bladder neck
• Afferents in the pelvic nerves send bladder

fullness signals to brain

• brain sends signals via efferents in pelvic nerves
to stimulate the bladder and also inhibitory
input to sphincter pudendal nerves to relax
EUS .
• urine flow in urethra additional facilitates
voiding by activating
Clinical conditions
• Many clinical conditions can cause
disturbances to normal urination, including:
• Urinary incontinence, the inability to hold
urine
– Stress incontinence, incontinence as a result of
external mechanical disturbances
– Urge incontinence, incontinence that occurs as a
result of the uncontrollable need to urinate
– Mixed incontinence, a combination of the two
types of incontinence
• Urinary retention, the inability to initiate
urination
• Overactive bladder, a strong need to urinate,
usually accompanied by detrusor overactivity
• Interstitial cystitis, a condition characterized
by urinary frequency, urgency, and pain
• Prostatitis, an inflammation of the prostate
gland that can cause urinary frequency,
urgency, and pain
• Benign prostatic hyperplasia, an enlargement
of the prostate that can cause urinary
frequency, urgency, retention, and the
dribbling of urine
• Urinary tract infection, which can cause urinary
frequency and dysuria
• Polyuria, abnormally large production of urine,
associated with, in particular, diabetes mellitus
 (types 1 and 2), and diabetes insipidus
• Oliguria, low urine output, usually due to a
problem with the upper urinary tract
• Anuria mentions to absent or almost absent
urine output.
• Micturition syncope, a vasovagal response which
may cause fainting.
• Paruresis, the inability to urinate in the presence
of others, such as in a public toilet.
• Bladder sphincter dyssynergia, a discoordination
between the bladder and external urethral
sphincter as a result of brain or spinal cord injury