THE RENAL SYSTEM

Dr. Justin V Sebastian

The urinary system contributes to homeostasis by altering blood
composition, pH, volume, and pressure; maintaining blood
osmolarity; excreting wastes and foreign substances; and
producing hormones.
The urinary system consists of two kidneys, two ureters, one
urinary bladder, and one urethra.
After the kidneys filter blood plasma, they return most of the
water and solutes to the bloodstream.
The remaining water and solutes constitute urine, which passes
through the ureters and is stored in the urinary bladder until it is
excreted from the body through the urethra.
Nephrology is the scientific study of the anatomy, physiology,
and pathology of the kidneys.
A physician who specializes in this branch of medicine is called a
OVERVIEW OF KIDNEY FUNCTIONS
Regulation of blood ionic composition. The kidneys
help regulate the blood levels of several ions.
Regulation of blood pH. The kidneys excrete a variable
amount of hydrogen ions (H+) into the urine and conserve
bicarbonate ions (HCO3-), which are an important buffer of

H+ in the blood. Both of these activities help regulate blood

pH.
Regulation of blood volume. The kidneys adjust blood
volume by conserving or eliminating water in the urine.
Regulation of blood pressure. The kidneys also help
regulate blood pressure by secreting the enzyme renin,
which activates the renin–angiotensin–aldosterone pathway.
Maintenance of blood osmolarity. By separately regulating loss
of water and loss of solutes in the urine, the kidneys maintain a
relatively constant blood osmolarity close to 300 milliosmoles per
liter (mOsm/liter).
Production of hormones. The kidneys produce two hormones.
Calcitriol, the active form of vitamin D, helps regulate calcium
homeostasis, and erythropoietin stimulates the production of red
blood cells.
Regulation of blood glucose level. Like the liver, the kidneys
can use the amino acid glutamine in gluconeogenesis, the
synthesis of new glucose molecules. They can then release glucose
into the blood to help maintain a normal blood glucose level.
Excretion of wastes and foreign substances. By forming
urine, the kidneys help excrete wastes—substances that have no
useful function in the body.
ANATOMY AND HISTOLOGY OF THE KIDNEYS
The paired kidneys are reddish, kidney-bean-shaped
organs located just above the waist between the
peritoneum and the posterior wall of the abdomen.
Because their position is posterior to the peritoneum of the
abdominal cavity, they are said to be retroperitoneal
organs.
The kidneys are located between the levels of the last
thoracic and third lumbar vertebrae, a position where they
are partially protected by the eleventh and twelfth pairs of
ribs.
The right kidney is slightly lower than the left because the
liver occupies considerable space on the right side superior
External Anatomy of the Kidneys
A typical adult kidney is 10–12 cm (4–5 in.)
long, 5–7 cm (2–3 in.) wide, and 3 cm (1 in.)
thick—and has a mass of 135–150 g.
The concave medial border of each kidney
faces the vertebral column.
Near the center of the concave border is an
indentation called the renal hilum, through
which the ureter emerges from the kidney
along with blood vessels, lymphatic vessels,
Three layers of tissue surround each kidney.
The deep layer, the renal capsule, is a smooth,
transparent sheet of dense irregular connective tissue that
is continuous with the outer coat of the ureter. It serves as a
barrier against trauma and helps maintain the shape of the
kidney.
The middle layer, the adipose capsule, is a mass of fatty
tissue surrounding the renal capsule. It also protects the
kidney from trauma and holds it firmly in place within the
abdominal cavity.
The superficial layer, the renal fascia, is another thin layer
of dense irregular connective tissue that anchors the kidney
to the surrounding structures and to the abdominal wall.
Internal Anatomy of the Kidneys
A frontal section through the kidney reveals two distinct regions: a
superficial, light red area called the renal cortex and a deep, darker
reddish-brown inner region called the renal medulla.
The renal medulla consists of several cone-shaped renal pyramids.
The base (wider end) of each pyramid faces the renal cortex, and its
apex (narrower end), called a renal papilla, points toward the renal
hilum.
The renal cortex is the smooth-textured area extending from the renal
capsule to the bases of the renal pyramids and into the spaces between
them.
It is divided into an outer cortical zone and an inner juxtamedullary zone.
Those portions of the renal cortex that extend between renal pyramids
are called renal columns.
A renal lobe consists of a renal pyramid, its overlying area of renal
cortex, and one-half of each adjacent renal column.
Together, the renal cortex and renal pyramids of the
renal medulla constitute the parenchyma (functional
portion) of the kidney.
Within the parenchyma are the functional units of the
kidney—about 1 million microscopic structures called
nephrons.
Urine formed by the nephrons drains into large
papillary ducts, which extend through the renal
papillae of the pyramids.
The papillary ducts drain into cup-like structures called
minor and major calyces.
Each kidney has 8 to 18 minor calyces and 2 or 3 major
A minor calyx receives urine from the papillary
ducts of one renal papilla and delivers it to a major
calyx.
From the major calyces, urine drains into a single
large cavity called the renal pelvis and then out
through the ureter to the urinary bladder.
The hilum expands into a cavity within the kidney
called the renal sinus, which contains part of the
renal pelvis, the calyces, and branches of the renal
blood vessels and nerves.
Adipose tissue helps stabilize the position of these
Blood and Nerve Supply of the Kidneys
Because the kidneys remove wastes from the
blood and regulate its volume and ionic
composition, it is not surprising that they are
abundantly supplied with blood vessels.
Although the kidneys constitute less than 0.5% of
total body mass, they receive 20–25% of the
resting cardiac output via the right and left renal
arteries.
In adults, renal blood flow, the blood flow
through both kidneys, is about 1200 mL per
Within the kidney, the renal artery divides into several
segmental arteries, which supply different segments
(areas) of the kidney.
Each segmental artery gives off several branches that enter
the parenchyma and pass through the renal columns
between the renal pyramids as the inter-lobar arteries.
At the bases of the renal pyramids, the inter-lobar arteries
arch between the renal medulla and cortex; here they are
known as the arcuate arteries.
Divisions of the arcuate arteries produce a series of
interlobular arteries.
These arteries are so named because they pass between
renal lobules. Interlobular arteries enter the renal cortex and
Each nephron receives one afferent arteriole,
which divides into a tangled, ball-shaped capillary
network called the glomerulus.
The glomerular capillaries then reunite to form an
efferent arteriole that carries blood out of the
glomerulus.
Glomerular capillaries are unique among capillaries
in the body because they are positioned between
two arterioles, rather than between an arteriole
and a venule.
Because they are capillary networks and they also
The efferent arterioles divide to form the peritubular
capillaries, which surround tubular parts of the nephron in
the renal cortex.
Extending from some efferent arterioles are long loop-shaped
capillaries called vasa recta that supply tubular portions of
the nephron in the renal medulla.
The peritubular capillaries eventually reunite to form
peritubular venules and then interlobular veins, which
also receive blood from the vasa recta.
Then the blood drains through the arcuate veins to the
inter-lobar veins running between the renal pyramids.
Blood leaves the kidney through a single renal vein that
exits at the renal hilum and carries venous blood to the
inferior vena cava.
Many renal nerves originate in the renal
ganglion and pass through the renal plexus
into the kidneys along with the renal arteries.
Renal nerves are part of the sympathetic
division of the autonomic nervous system.
Most are vasomotor nerves that regulate the
flow of blood through the kidney by causing
vasodilation or vasoconstriction of renal
arterioles.
The Nephron, Parts of a Nephron
Nephrons are the functional units of the kidneys.
Each nephron consists of two parts: a renal corpuscle, where blood
plasma is filtered, and a renal tubule into which the filtered fluid
passes.
The two components of a renal corpuscle are the glomerulus
(capillary network) and the glomerular (Bowman’s) capsule, a
double-walled epithelial cup that surrounds the glomerular capillaries.
Blood plasma is filtered in the glomerular capsule, and then the filtered
fluid passes into the renal tubule, which has three main sections.
In the order that fluid passes through them, the renal tubule consists of
a (1) proximal convoluted tubule, (2) loop of Henle (nephron
loop), and (3) distal convoluted tubule.
The renal corpuscle and both convoluted tubules lie within the renal
cortex; the loop of Henle extends into the renal medulla, makes a
hairpin turn, and then returns to the renal cortex.
The distal convoluted tubules of several
nephrons empty into a single collecting duct.
Collecting ducts then unite and converge into
several hundred large papillary ducts, which
drain into the minor calyces.
The collecting ducts and papillary ducts extend
from the renal cortex through the renal medulla
to the renal pelvis.
So one kidney has about 1 million nephrons, but
a much smaller number of collecting ducts and
even fewer papillary ducts.
In a nephron, the loop of Henle connects the proximal
and distal convoluted tubules.
The first part of the loop of Henle dips into the renal
medulla, where it is called the descending limb of
the loop of Henle.
It then makes that hairpin turn and returns to the renal
cortex as the ascending limb of the loop of Henle.
About 80–85% of the nephrons are cortical
nephrons. Their renal corpuscles lie in the outer
portion of the renal cortex, and they have short loops
of Henle that lie mainly in the cortex and penetrate
only into the outer region of the renal medulla.
In The short loops of Henle receive their blood supply from
peritubular capillaries that arise from efferent arterioles.
The other 15–20% of the nephrons are juxtamedullary nephrons.
Their renal corpuscles lie deep in the cortex, close to the medulla,
and they have a long loop of Henle that extends into the deepest
region of the medulla.
Long loops of Henle receive their blood supply from peritubular
capillaries and from the vasa recta that arise from efferent
arterioles.
In addition, the ascending limb of the loop of Henle of
juxtamedullary nephrons consists of two portions: a thin ascending
limb followed by a thick ascending limb.
The lumen of the thin ascending limb is the same as in other areas
of the renal tubule; it is only the epithelium that is thinner. Nephrons
with long loops of Henle enable the kidneys to excrete very dilute or
Histology of the Nephron and Collecting
Duct
A single layer of epithelial cells forms the
entire wall of the glomerular capsule, renal
tubule, and ducts.
However, each part has distinctive histological
features that reflect its particular functions.
We will discuss them in the order that fluid
flows through them: glomerular capsule, renal
tubule, and collecting duct.
GLOMERULAR CAPSULE
The glomerular (Bowman’s) capsule consists of visceral and
parietal layers.
The visceral layer consists of modified simple squamous
epithelial cells called podocytes.
The many foot like projections of these cells (pedicels) wrap
around the single layer of endothelial cells of the glomerular
capillaries and form the inner wall of the capsule.
The parietal layer of the glomerular capsule consists of
simple squamous epithelium and forms the outer wall of the
capsule.
Fluid filtered from the glomerular capillaries enters the
capsular (Bowman’s) space, the space between the two
RENAL TUBULE AND COLLECTING DUCT
In the proximal convoluted tubule, the cells are simple
cuboidal epithelial cells with a prominent brush border of
microvilli on their apical surface (surface facing the lumen).
These microvilli, like those of the small intestine, increase
the surface area for reabsorption and secretion.
The descending limb of the loop of Henle and the first part
of the ascending limb of the loop of Henle (the thin
ascending limb) are composed of simple squamous
epithelium.
The thick ascending limb of the loop of Henle is composed
of simple cuboidal to low columnar epithelium.
In each nephron, the final part of the ascending limb of
the loop of Henle makes contact with the afferent
arteriole serving that renal corpuscle.
Because the columnar tubule cells in this region are
crowded together, they are known as the macula densa.
Alongside the macula densa, the wall of the afferent
arteriole (and sometimes the efferent arteriole) contains
modified smooth muscle fibers called juxtaglomerular
(JG) cells.
Together with the macula densa, they constitute the
juxtaglomerular apparatus (JGA).
The distal convoluted tubule (DCT) begins a short
distance past the macula densa.
In the last part of the DCT and continuing into the
collecting ducts, two different types of cells are
present.
Most are principal cells, which have receptors for
both antidiuretic hormone (ADH) and aldosterone,
two hormones that regulate their functions.
A smaller number are intercalated cells, which
play a role in the homeostasis of blood pH.
The collecting ducts drain into large papillary
ducts, which are lined by simple columnar
epithelium.
The number of nephrons is constant from birth.
Any increase in kidney size is due solely to the growth of
individual nephrons.
If nephrons are injured or become diseased, new ones do
not form.
Signs of kidney dysfunction usually do not become
apparent until function declines to less than 25% of
normal because the remaining functional nephrons
adapt to handle a larger-than- normal load.
Surgical removal of one kidney, for example, stimulates
hypertrophy (enlargement) of the remaining kidney,
which eventually is able to filter blood at 80% of the rate
of two normal kidneys.
OVERVIEW OF RENAL PHYSIOLOGY
To produce urine, nephrons and collecting
ducts perform three basic processes—
glomerular filtration, tubular reabsorption,
and tubular secretion:
GLOMERULAR FILTRATION
The fluid that enters the capsular space is called the
glomerular filtrate.
The fraction of blood plasma in the afferent arterioles of the
kidneys that becomes glomerular filtrate is the filtration
fraction.
Although a filtration fraction of 0.16–0.20 (16–20%) is
typical, the value varies considerably in both health and
disease.
On average, the daily volume of glomerular filtrate in adults
is 150 liters in females and 180 liters in males.
More than 99% of the glomerular filtrate returns to the
bloodstream via tubular reabsorption, so only 1–2 liters are
The Filtration Membrane
Together, the endothelial cells of glomerular
capillaries and the podocytes, which completely
encircle the capillaries, form a leaky barrier known
as the filtration membrane.
This sandwich-like assembly permits filtration of
water and small solutes but prevents filtration of
most plasma proteins, blood cells, and platelets.
Substances filtered from the blood cross three
barriers—a glomerular endothelial cell, the basal
lamina, and a filtration slit formed by a podocytes.
1 Glomerular endothelial cells are quite
leaky because they have large fenestrations
(pores) that measure 0.07–0.1 um in diameter.
This size permits all solutes in blood plasma to
exit glomerular capillaries but prevents filtration
of blood cells and platelets.
Located among the glomerular capillaries and in
the cleft between afferent and efferent
arterioles are mesangial cells
These contractile cells help regulate glomerular
filtration.
2 The basal lamina, a layer of acellular
material between the endothelium and the
podocytes, consists of minute collagen fibers
and proteoglycans in a glycoprotein matrix; it
prevents filtration of larger plasma proteins.
3 Extending from each podocytes are thousands of
foot-like processes termed pedicels that wrap around
glomerular capillaries.
The spaces between pedicels are the filtration slits.
A thin membrane, the slit membrane, extends across
each filtration slit; it permits the passage of molecules
having a diameter smaller than 0.006–0.007 um,
including water, glucose, vitamins, amino acids, very
small plasma proteins, ammonia, urea, and ions.
Less than 1% of albumin, the most plentiful plasma
protein, passes the slit membrane because, with a
diameter of 0.007um, it is slightly too big to get
Formation of urine
The kidneys form urine which passes through the
ureters to the bladder for storage prior to excretion.
The composition of urine reflects the activities of the
nephrons in the maintenance of homeostasis.
Waste products of protein metabolism are excreted,
electrolyte balance is maintained and the pH (acid-
base balance) is maintained by the excretion of
hydrogen ions.
There are three processes involved in the formation
of urine: simple filtration, selective
reabsorption & secretion.
Simple filtration
Filtration takes place through the semipermeable
walls of the glomerulus and glomerular capsule.
Water and a large number of small molecules pass
through, although some are reabsorbed later.
Blood cells, plasma proteins and other large
molecules are unable to filter through and remain
in the capillaries.
The filtrate in the glomerulus is very similar in
composition to plasma with the important
exception of plasma proteins.
Filtration is assisted by the difference between the
blood pressure in the glomerulus and the pressure of
the filtrate in the glomerular capsule.
Because the diameter of the efferent arteriole is less
than that of the afferent arteriole, a capillary
hydrostatic pressure of about (55mmHg) builds up in
the glomerulus. This pressure is opposed by the
osmotic pressure of the blood, about (30 mmHg), and
by filtrate hydrostatic pressure of about (15 mmHg)
filtration pressure is, therefore:

55- (30+15)=10mmHg.
The volume of filtrate formed by both kidneys
each minute is called the glomerular filtration
rate (GFR).
In a healthy adult the GFRis about 125ml/min; i.e.
180litres of dilute filtrate are formed each day by
the two kidneys.
Most of the filtrate is reabsorbed with less than
1%, i.e. 1 to 1.5 litres, excreted as urine.
The difference in volume and concentration is due
to selective reabsorption of some constituents of
the filtrate and tubular secretion of others.
Auto-regulation of filtration.
Renal blood flow is protected by a mechanism called auto
regulation whereby renal blood flow is maintained at a constant
pressure across a wide range of systolic blood pressures (from
80 to 200 mmHg).
Autoregulation operates independently of nervous control; i.e. if
the nerve supply to the renal blood vessels is interrupted,
autoregulation continues to operate.
It is therefore a property inherent in renal blood vessels; it may
be stimulated by changes in blood pressure in the renal arteries
or by fluctuating levels of certain metabolites.
In severe shock when the systolic blood pressure falls below
80mmHg, autoregulation fails and renal blood flow and the
hydrostatic pressure decrease, impairing filtration within the
Selective reabsorption
Selective reabsorption is the process by which the
composition and volume of the glomerular filtrate are
altered during its passage through the convoluted
tubules, the medullary loop and the collecting tubule.
The general purpose of this process is to reabsorb into
the blood those filtrate constituents needed by the
body to maintain fluid and electrolyte balance and the
pH of the blood.
Active transport is carried out at carrier sites in the
epithelial membrane using chemical energy to
transport substances against their concentration
Some constituents of glomerular filtrate (e.g. glucose, amino
acids) do not normally appear in urine because they are
completely reabsorbed unless they are present in blood in
excessive quantities.
The kidneys' maximum capacity for reabsorption of a substance
is the transport maximum, or renal threshold, e.g. normal blood
glucose level is 2.5 to 5.3mmol/l (45 to 95mg/100ml).
If the level rises above the transport maximum of about 9
mmol/1 (160 mg/100 ml) glucose appears in the urine because
all the carrier sites are occupied and the mechanism for active
transfer out of the tubules is overloaded.
Other substances reabsorbed by active transport include amino
acids and sodium, calcium, potassium, phosphate and chloride.
Some ions, e.g. sodium and chloride, can be absorbed by both
active and passive mechanisms depending on the site in the
nephron.
The transport maximum, or renal threshold, of some substances
varies according to the body's need for them at the time, and in
some cases reabsorption is regulated by hormones.
Parathyroid hormone from the parathyroid glands and calcitonin
from the thyroid gland together regulate reabsorption of calcium
and phosphate.
Antidiuretic hormone (ADH) from the posterior lobe of the pituitary
gland increases the permeability of the distal convoluted tubules
and collecting tubules, increasing water reabsorption.
Aldosterone, secreted by the adrenal cortex, increases the
reabsorption of sodium and excretion of potassium.
Nitrogenous waste products, such as urea and uric acid, are
Secretion
Filtration occurs as the blood flows through the
glomerulus.
Substances not required and foreign materials, e.g.
drugs including penicillin and aspirin, 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 into the
convoluted tubules and excreted from the body in
the urine.
Tubular secretion of hydrogen (H+) ions is important
in maintaining homeostasis of blood pH.
Ureters
Each of the two ureters transports urine from the renal pelvis of one
kidney to the urinary bladder.
Peristaltic contractions of the muscular walls of the ureters push
urine toward the urinary bladder, but hydrostatic pressure and
gravity also contribute.
Peristaltic waves that pass from the renal pelvis to the urinary
bladder vary in frequency from one to five per minute, depending on
how fast urine is being formed.
The ureters are 25–30 cm (10–12 in.) long and are thick- walled,
narrow tubes that vary in diameter from 1 mm to 10 mm along their
course between the renal pelvis and the urinary bladder.
Like the kidneys, the ureters are retroperitoneal.
At the base of the urinary bladder, the ureters curve medially and
pass obliquely through the wall of the posterior aspect of the urinary
Even though there is no anatomical valve at
the opening of each ureter into the urinary
bladder, a physiological one is quite effective.
As the urinary bladder fills with urine, pressure
within it compresses the oblique openings into
the ureters and prevents the back flow of
urine.
When this physiological valve is not operating
properly, it is possible for microbes to travel up
the ureters from the urinary bladder to infect
Structure
Three layers of tissue form the wall of the ureters. The deepest
coat, the mucosa, is a mucous membrane with transitional
epithelium.
Transitional epithelium is able to stretch—a marked advantage for
any organ that must accommodate a variable volume of fluid.
Throughout most of the length of the ureters, the intermediate
coat, the muscularis, is composed of inner longitudinal and outer
circular layers of smooth muscle fibers.
Peristalsis is the major function of the muscularis.
The superficial coat of the ureters is the adventitia, a layer of
areolar connective tissue containing blood vessels, lymphatic
vessels, and nerves that serve the muscularis and mucosa.
The adventitia blends in with surrounding connective tissue and
anchors the ureters in place.
Urinary Bladder
The urinary bladder is a hollow, distensible muscular organ
situated in the pelvic cavity posterior to the pubic symphysis.
In males, it is directly anterior to the rectum; in females, it is
anterior to the vagina and inferior to the uterus.
Folds of the peritoneum hold the urinary bladder in position.
When slightly distended due to the accumulation of urine, the
urinary bladder is spherical. When it is empty, it collapses.
As urine volume increases, it becomes pear-shaped and rises
into the abdominal cavity.
Urinary bladder capacity averages 700–800 mL.
It is smaller in females because the uterus occupies the space
just superior to the urinary bladder.
Anatomy and Histology of the Urinary
Bladder
In the floor of the urinary bladder is a small
triangular area called the trigone.
The two posterior corners of the trigone
contain the two ureteral openings; the opening
into the urethra, the internal urethral
orifice, lies in the anterior corner.
Because its mucosa is firmly bound to the
muscularis, the trigone has a smooth
Three coats make up the wall of the urinary bladder.
The deepest is the mucosa, a mucous membrane composed of
transitional epithelium similar to that of the ureters.
Rugae (the folds in the mucosa) are also present to permit expansion of
the urinary bladder.
Surrounding the mucosa is the intermediate muscularis, also called the
detrusor muscle, which consists of three layers of smooth muscle fibers:
the inner longitudinal, middle circular, and outer longitudinal layers.
Around the opening to the urethra the circular fibers form an internal
urethral sphincter; inferior to it is the external urethral sphincter,
which is composed of skeletal muscle and is a modification of the deep
muscles of the perineum.
The most superficial coat of the urinary bladder on the posterior and
inferior surfaces is the adventitia, a layer of areolar connective tissue
that is continuous with that of the ureters.
Over the superior surface of the urinary bladder is the serosa, a layer of
The Micturition Reflex
Discharge of urine from the urinary bladder, called micturition, is
also known as urination or voiding.
Micturition occurs via a combination of involuntary and voluntary
muscle contractions.
When the volume of urine in the urinary bladder exceeds 200–400
mL, pressure within the bladder increases considerably, and stretch
receptors in its wall transmit nerve impulses into the spinal cord.
These impulses propagate to the micturition center in sacral
spinal cord segments S2 and S3 and trigger a spinal reflex called the
micturition reflex.
In this reflex arc, parasympathetic impulses from the micturition
center propagate to the urinary bladder wall and internal urethral
sphincter.
The nerve impulses cause contraction of the detrusor muscle and
Simultaneously, the micturition center inhibits somatic motor
neurons that innervate skeletal muscle in the external
urethral sphincter.
Upon contraction of the urinary bladder wall and relaxation of
the sphincters, urination takes place.
Urinary bladder filling causes a sensation of fullness that
initiates a conscious desire to urinate before the micturition
reflex actually occurs.
Although emptying of the urinary bladder is a reflex, in early
childhood we learn to initiate it and stop it voluntarily.
Through learned control of the external urethral sphincter
muscle and certain muscles of the pelvic floor, the cerebral
cortex can initiate micturition or delay its occurrence for a
limited period.
Urethra
The urethra is a small tube leading from the
internal urethral orifice in the floor of the
urinary bladder to the exterior of the body.
In both males and females, the urethra is the
terminal portion of the urinary system and
the passageway for discharging urine from
the body.
In males, it discharges semen (fluid that
contains sperm) as well.
In females, the urethra lies directly posterior to the pubic symphysis, is
directed obliquely, inferiorly, and anteriorly, and has a length of 4 cm
(1.5 in.).
The opening of the urethra to the exterior, the external urethral
orifice, is located between the clitoris and the vaginal opening.
The wall of the female urethra consists of a deep mucosa and a
superficial muscularis.
The mucosa is a mucous membrane composed of epithelium and
lamina propria.
The muscularis consists of circularly arranged smooth muscle fibers and
is continuous with that of the urinary bladder.
Near the urinary bladder, the mucosa contains transitional epithelium
that is continuous with that of the urinary bladder; near the external
urethral orifice, the epithelium is nonkeratinized stratified squamous
epithelium.
Between these areas, the mucosa contains stratified columnar or
In males, the urethra also extends from the internal urethral
orifice to the exterior, but its length and passage through
the body are considerably different than in females.
The male urethra first passes through the prostate, then
through the deep muscles of the perineum, and finally
through the penis, a distance of about 20 cm (8 in.).
The male urethra, which also consists of a deep mucosa
and a superficial muscularis, is subdivided into three
anatomical regions: (1) The prostatic urethra passes
through the prostate. (2) The membranous
(intermediate) urethra, the shortest portion, passes
through the deep muscles of the perineum. (3) The spongy
urethra, the longest portion, passes through the penis.
The epithelium of the prostatic urethra is continuous with
that of the urinary bladder and consists of transitional
epithelium that becomes stratified columnar or pseudo-
stratified columnar epithelium more distally.
The mucosa of the membranous urethra contains stratified
columnar or pseudo-stratified columnar epithelium.
The epithelium of the spongy urethra is stratified columnar
or pseudo-stratified columnar epithelium, except near the
external urethral orifice. There it is nonkeratinized
stratified squamous epithelium.
The lamina propria of the male urethra is areolar
connective tissue with elastic fibers and a plexus of veins.
The muscularis of the prostatic urethra is composed of mostly circular
smooth muscle fibers superficial to the lamina propria; these circular
fibers help form the internal urethral sphincter of the urinary bladder.
The muscularis of the membranous urethra consists of circularly
arranged skeletal muscle fibers of the deep muscles of the perineum
that help form the external urethral sphincter of the urinary bladder.
Several glands and other structures associated with reproduction
deliver their contents into the male urethra.
The prostatic urethra receives secretions that contain sperm, neutralize
the acidity of the female reproductive tract, and contribute to sperm
motility and viability.
The spongy urethra receives an alkaline substance before ejaculation
that neutralizes the acidity of the urethra, and mucus, which lubricates
the end of the penis during sexual arousal.
The entire urethra, but especially the spongy urethra, receives mucus
during sexual arousal or ejaculation.