URINARY SYSTEM

Prepared by :Louela Quiao

 INTERNAL AND EXTERNAL ANATOMY

• The kidneys, ureters, bladder, and urethra are the

primary structures of the urinary system. They
filter blood and remove waste from the body in
the form of urine. The size and position of lower
urinary structures vary with male and female
anatomy.

• 1. Discuss comprehensively the external and

internal anatomy of male and female urinary
system.
 EXTERNAL ANATOMY
• Kidneys are located at about the T12 to L3
vertebrae, but the right is lower due to slight
displacement by the liver.
• Upper portions of the kidneys are somewhat
protected by the eleventh and twelfth ribs
• Each kidney weighs about 125–175 g in males
and 115–155 g in females.
• They are about 11–14 cm in length, 6 cm
wide, and 4 cm thick
• side of the spine in the retroperitoneal space
between the parietal peritoneum and the
posterior abdominal wall, well protected by
muscle, fat, and ribs
• The kidneys are well vascularized, receiving
about 25 percent of the cardiac output at rest.
• They are roughly the size of your fist,
• Male kidney is typically a bit larger than the
female kidney.
• covered by a fibrous capsule composed of
dense, irregular connective tissue that helps
to hold their shape and protect them.
• This capsule is covered by a shock-absorbing
layer of adipose tissue called the renal fat
pad, which in turn is encompassed by a tough
renal fascia. The fascia and, to a lesser extent,
the overlying peritoneum serve to firmly
anchor the kidneys to the posterior abdominal
wall in a retroperitoneal position.
• If we dissect kidneys by frontal section, we can
see three distinct regions:
• CORTEX, MEDULLA AND PELVIS

• most external region is the RENAL CORTEX

-Numerous tubes and blood vessels located in
the cortex make it appear light red and somewhat
granular.
-The cortex provides a space for arterioles
and venules from the renal artery and vein, as well
as the glomerular capillaries, to perfuse the
nephrons of the kidney
• Erythropotein, a hormone necessary for the
synthesis of new red blood cells, is also
produced in the renal cortex.

• The medulla is the inner region of the

parenchyma of the kidney.
• The medulla consists of multiple pyramidal
tissue masses, called the renal pyramids,
which are triangle structures that contain a
dense network of nephrons.
• At one end of each nephron, in the cortex of the
kidney, is a cup-shaped structure called the
Bowman’s capsule.
• It surrounds a tuft of capillaries called the
glomerulus that carries blood from the renal
arteries into the nephron, where plasma is
filtered through the capsule.
• After entering the capsule, the filtered fluid flows
along the proximal convoluted tubule to the loop
of Henle and then to the distal convoluted tubule
and the collecting ducts, which flow into the
ureter. Each of the different components of the
nephrons are selectively permeable to different
molecules, and enable the complex regulation of
water and ion concentrations in the body.
 • Renal Pelvis
• The renal pelvis contains the hilium. The hilum
is the concave part of the bean-shape where
blood vessels and nerves enter and exit the
kidney
• it is also the point of exit for the ureters—the
urine-bearing tubes that exit the kidney and
empty into the urinary bladder. The renal
pelvis connects the kidney to the rest of the
body.
 URETERS
• approximately 30 cm long
• The inner mucosa is lined with transitional
epithelium, and scattered goblet cells that
secrete protective mucus
• The muscular layer of the ureter consists of
longitudinal and circular smooth muscles that
create the peristaltic contractions to move the
urine into the bladder without the aid of
gravity. Fi
• a loose adventitial layer composed of collagen
and fat anchors the ureters between the
parietal peritoneum and the posterior
abdominal wall.

• BLADDER
• Reservoir for urine
• In women, the bladder is located in front of
the vagina and below the uterus.
• In men, the bladder sits in front of the rectum
and above the prostate gland.
• The wall of the bladder contains folds called
rugae, and a layer of smooth muscle called the
detrusor muscle.
• As urine fills the bladder, the rugae contract to
accommodate the volume.
• The detrusor relaxes to hold the urine, then
contracts for urination.
• The typical healthy adult bladder can store up
to two cups of urine for two to five hours.
 URETHRA
• The urethra is the only urologic organ that
shows any significant anatomic difference
between males and females; all other urine
transport structures are identical.
• In females, the urethra is narrow and about 4
cm long, significantly shorter than in males.
• It extends from the bladder neck to the
external urethral orifice in the vestibule of the
vagina.
• The external urethral orifice is embedded in
the anterior vaginal wall inferior to the clitoris,
superior to the vaginal opening (introitus),
and medial to the labia minora.
• Its short length, about 4 cm, is less of a barrier
to fecal bacteria than the longer male urethra
and the best explanation for the greater
incidence of UTI in women.
• The urethra in both males and females begins
near the trigone of the bladder.
• In males, the urethra is about 17.5–20 cm,
four or five times as long as in females.
• The male urethra is divided into three
sections: the prostatic urethra (the widest
portion), the membranous urethra (the
narrowest portion), and the spongy urethra
(the longest portion).
• It extends from the bladder neck through the
prostate and the penis to the external urethral
orifice. In men, both urine and semen pass out
of the body through the urethra.
• the male urethra is a structure shared
between the urinary and reproductive
systems.
• The male urethra extends from the bladder,
passing through the prostate gland (of the
reproductive system) immediately inferior to
the bladder before passing below the pubic
symphysis
• The length of the male urethra averages 20 cm
in length. It is divided into three regions: the
prostatic urethra, the membranous urethra,
and the spongy or penile urethra.
• The prostatic urethra passes through the
prostate gland. During sexual intercourse, it
receives sperm via the ejaculatory ducts and
secretions from the seminal vesicles.
• Paired Cowper’s glands (bulbourethral glands)
produce and secrete mucus into the urethra to
buffer urethral pH during sexual stimulation.
• The membranous urethra passes through the
deep muscles of the perineum, where it is
invested by the overlying urethral sphincters.
• The spongy urethra exits at the tip (external
urethral orifice) of the penis after passing
through the corpus spongiosum.
 2.Discuss how the kidneys participate in
the removal of waste
• The nephron is the functional unit of the
kidney. It does the job of the urinary system.
The primary function of the nephron is to
remove waste products from the body before
they build up to toxic levels.
• The nephron does its job of getting rid of
metabolic wastes through filtration and
secretion. Useful substances are reabsorbed
back into the blood.
• During filtration, blood enters the afferent arteriole
and flows into the glomerulus where filterable blood
components, such as water and nitrogenous waste, will
move towards the inside of the glomerulus, and
nonfilterable components, such as cells and serum
albumins, will exit via the efferent arteriole.
• These filterable components accumulate in the
glomerulus to form the glomerular filtrate.
• Normally, about 20% of the total blood pumped by the
heart each minute will enter the kidneys to undergo
filtration; this is called the filtration fraction. The
remaining 80% of the blood flows through the rest of
the body to facilitate tissue perfusion and gas
exchange.
 FILTRATION
• Blood enters the glomerulus via the afferent
arteriole (branches from the renal artery), and
leaves via the efferent arteriole.
• The efferent arteriole is narrower than the
afferent arteriole which helps in building up a
hydrostatic pressure.
• The flow of blood in the glomerulus creates
hydrostatic pressure in the glomerulus which
forces molecules through the glomerular
filtration membrane.
 3.TRACE THE PHYSIOLOGIC PROCESSES
INVOLVED IN URINE FORMATION
• The anatomy of the nephron is important to understand the urine formation
process. Each nephron is made up of two parts:
• Renal Corpuscle
• Renal Tubule
• The renal corpuscle is divided into the glomerular capillaries or glomerulus and the
Bowman’s capsule. It is in the renal corpuscle that the blood is filtered at high
pressure. The arteriole that brings blood into the glomerulus is called the afferent
arteriole whereas the artery that takes blood away from the glomerulus is known
as the efferent arteriole.
• Between these arterioles forms, a network of capillaries called the glomerular
capillaries of the glomerulus. The Bowman’s capsule is a cup-shaped structure in
which this glomerulus is located. The glomerulus along with the Bowman’s capsule
achieve the filtration of blood to form urine. The renal tubule consists of :
• The proximal convoluted Tubule(PCT)
• The U-shaped Loop Of Henle
• The Distal Convoluted Tubule(DCT)
• Once the blood is filtered in the renal corpuscle,
the resultant fluid is called the glomerular filtrate.
This glomerular filtrate now passes into the PCT.
In the PCT, substances like NaCl, K+, water,
glucose, and bicarbonate are reabsorbed into the
filtrate whereas urea, creatinine, uric acid are
added to the filtrate.
• From the PCT, the filtrate enters the U-shaped
Loop of Henle where reabsorption and secretion
of water and various metabolites occurs. The
filtrate then passes into the DCT. From the DCT,
the filtrate passes into the collecting tubules, into
the renal pelvis and the ureters as urine to be
stored int he urinary bladder.
• Glomerular Filtration
• This process occurs in the glomerular capillaries.
The process of filtration leads to the formation of
an ultrafiltrate. The blood gushes into these
capillaries with high pressure and gets filtered
across the thin capillary walls. Everything except
the blood cells and proteins are pushed into the
capsular space of the Bowman’s capsule to form
the ultrafiltrate. The glomerular filtration rate
(GFR) is 125ml/min or 180 Litres/day.
• Tubular Reabsorption
• During glomerular filtration, all substances except
blood cells and proteins are pushed through the
capillaries at high pressure. At the level of the Proximal
Convoluted Tubule(PCT), some of the substances from
the filtrate are reabsorbed. These include sodium
chloride, potassium, glucose, amino acids, bicarbonate,
and 75% of water.
• Absorption of some substances is passive, some
substances are actively transported while others are
co-transported. The absorption depends upon the
permeability of different parts of the nephron. The
distal convoluted tubule shows selective absorption.
The substances and water which is reabsorbed are
taken up by the peritubular capillaries to be returned
to the blood.
• Tubular Secretion
• The peritubular capillaries that help in
transporting the reabsorbed substances into
the bloodstream, also help in actively
secreting substances like H+ ions, K+ ions.
Whenever excess K+ is secreted into the
filtrate, Na+ ions are actively reabsorbed to
maintain the Na-K balance. Some drugs are
not filtered in the glomerulus and so are
actively secreted into the filtrate during the
tubular secretion phase.
4.Describe the routes and mechanisms of
tubular reabsorption and secretion.
• The process by which glomerular filtration
occurs is called renal ultrafiltration. The force
of hydrostatic pressure in the glomerulus (the
force of pressure exerted from the pressure of
the blood vessel itself) is the driving force that
pushes filtrate out of the capillaries and into
the slits in the nephron.
• Osmotic pressure (the pulling force exerted by
the albumins) works against the greater force
of hydrostatic pressure, and the difference
between the two determines the effective
pressure of the glomerulus that determines
the force by which molecules are filtered.
These factors will influence the glomeruluar
filtration rate, along with a few other factors
5. Discuss hormonal regulation of tubular
reabsorption and tubular secretion.
 6.Describe the normal characteristics of
urine, ...
• Physical Characteristics
• Physical characteristics that can be applied to
urine include color, turbidity (transparency),
smell (odor), pH (acidity – alkalinity) and
density. Many of these characteristics are
notable and identifiable by by vision alone,
but some require laboratory testing.
• Color: Typically yellow-amber, but varies
according to recent diet and the concentration
of the urine. Drinking more water generally
tends to reduce the concentration of urine,
and therefore causes it to have a lighter color.
Dark urine may indicate dehydration. Red
urine indicates red blood cells within the
urine, a sign of kidney damage and disease.
• Smell: The smell of urine may provide health
information. For example, urine of diabetics may
have a sweet or fruity odor due to the presence
of ketones (organic molecules of a particular
structure) or glucose. Generally fresh urine has a
mild smell but aged urine has a stronger odor
similar to that of ammonia.
• The pH of normal urine is generally in the range
4.6 – 8, with a typical average being around 6.0.
Much of the variation occurs due to diet. For
example, high protein diets result in more acidic
urine, but vegetarian diets generally result in
more alkaline urine (both within the typical range
of 4.6 – 8).
• Density: Density is also known as “specific gravity.” This is
the ratio of the weight of a volume of a substance
compared with the weight of the same volume of distilled
water. The density of normal urine ranges from 0.001 to
0.035.
• Turbidity: The turbidity of the urine sample is gauged
subjectively and reported as clear, slightly cloudy, cloudy,
opaque or flocculent. Normally, fresh urine is either clear
or very slightly cloudy. Excess turbidity results from the
presence of suspended particles in the urine, the cause of
which can usually be determined by the results of the
microscopic urine sediment examination. Common causes
of abnormal turbidity include: increased cells, urinary tract
infections or obstructions.
 Chemical composition of a urine
• Normal urine consists of water, urea, salts, and pigments.
• Urine is an aqueous solution of greater than 95% water, with a minimum
of these remaining constituents, in order of decreasing concentration:
• Urea 9.3 g/L.
• Chloride 1.87 g/L.
• Sodium 1.17 g/L.
• Potassium 0.750 g/L.
• Creatinine 0.670 g/L.
• Other dissolved ions, inorganic and organic compounds (proteins,
hormones, metabolites).
• Urine is sterile until it reaches the urethra, where epithelial cells lining the
urethra are colonized by facultatively anaerobic gram-negative rods and
cocci. Urea is essentially a processed form of ammonia that is non-toxic to
mammals, unlike ammonia, which can be highly toxic. It is processed from
ammonia and carbon dioxide in the liver.
• Abnormal Types of Urine
• There are several conditions that can cause abnormal components
to be excreted in urine or present as abnormal characteristics of
urine. They are mostly referred to by the suffix -uria. Some of the
more common types of abnormal urine include:
• Proteinuria—Protein content in urine, often due to leaky or
damaged glomeruli.
• Oliguria—An abnormally small amount of urine, often due to shock
or kidney damage.
• Polyuria—An abnormally large amount of urine, often caused by
diabetes.
• Dysuria—Painful or uncomfortable urination, often from urinary
tract infections.
• Hematuria—Red blood cells in urine, from infection or injury.
• Glycosuria— Glucose in urine, due to excess plasma glucose in
diabetes, beyond the amount able to be reabsorbed in the proximal
convoluted tubule.
 7. Trace the physiological processes
involved in urine formation
• There are three stages involved in the process of
urine formation. They are-
1. Glomerular filtration or ultra-filtration
• 2. Selective reabsorption
• 3. Tubular secretion
• Glomerular filtration
• The afferent arterioles supplying blood to glomerular
capsule carries useful as well as harmful substances.
The useful substances are glucose, aminoacids,
vitamins, hormones, electrolytes, ions etc and the
harmful substances are metabolic wastes such as urea,
uric acids, creatinine, ions, etc.
• The diameter of efferent arterioles is narrower than
afferent arterioles. Due to this difference in diameter
of arteries, blood leaving the glomerulus creates the
pressure known as hydrostatic pressure.
• The glomerular hydrostatic pressure forces the blood
to leaves the glomerulus resulting in filtration of blood.
A capillary hydrostatic pressure of about 7.3 kPa (55
mmHg) builds up in the glomerulus. However this
pressure is opposed by the osmotic pressure of the
blood, provided mainly by plasma proteins, about 4
kPa (30 mmHg), and by filtrate hydrostatic pressure of
about 2 kPa (15 mmHg in the glomerular capsule
• the net filtration pressure is Therefore: 55-(30 +15) =
10mmHg.
• By the net filtration pressure of 10mmHg, blood is
filtered in the glomerular capsule.
• Water and other small molecules readily pass through
the filtration slits but Blood cells, plasma proteins and
other large molecules are too large to filter through
and therefore remain in the capillaries. The filtrate
containing large amount of water, glucose, aminoacids,
uric acid, urea, electrolytes etc in the glomerular
capsule is known as nephric filtrate of glomerular
filtrate. The volume of filtrate formed by both kidneys
each minute is called the glomerular filtration rate
(GFR). In a healthy adult the GFR is about 125 mL/min,
i.e. 180 litres of filtrate are formed each day by the two
kidney
 Selective reabsorption

• As the filtrate passes to the renal tubules, useful

substances including some water, electrolytes
and organic nutrients such as glucose,
aminoacids, vitamins hormones etc are
selectively reabsorbed from the filtrate back into
the blood in the proximal convoluted tubule.
• Reabsorption of some substance is passive, while
some substances are actively transported. Major
portion of water is reabsorbed by Osmosis
• Only 60–70% of filtrate reaches the Henle loop. Much
of this, especially water, sodium and chloride, is
reabsorbed in the loop, so that only 15–20% of the
original filtrate reaches the distal convoluted tubule,
More electrolytes are reabsorbed here, especially
sodium, so the filtrate entering the collecting ducts is
actually quite dilute.
• The main function of the collecting ducts is to reabsorb
as much water as the body needs. Nutrients such as
glucose, amino acids, and vitamins are reabsorbed by
active transport.
• Positive charged ions ions are also reabsorbed by
active transport while negative charged ions are
reabsorbed most often by passive transport. Water is
reabsorbed by osmosis, and small proteins are
reabsorbed by pinocytosis.
 Tubular secretion

• Tubular secretion takes place from the blood

in the peritubular capillaries to the filtrate in
the renal tubules and can ensure that wastes
such as creatinine or excess H+ or excess K+
ions are actively secreted into the filtrate to be
excreted.
• Excess K+ ion is secreted in the tubules and in
exchange Na+ ion is reabsorbed otherwise it
causes a clinical condition called Hyperkalemia
• Tubular secretion of hydrogen ions (H+) is very
important in maintaining normal blood pH.
Substances such as , e.g. drugs including
penicillin and aspirin, may not be entirely
filtered out of the blood 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.
• The tubular filtrate is finally known as urine.
Human urine is usually hypertonic
• Composition of human urine
• Water – 96%
• Urea – 2%
• Uric acids, creatinine, pigments- 0.3%
• Inorganic salts – 2%
• Bad smell is due to Urinoid
• Pale yellow color due to urochrome or urobillin
(which is a breakdown product of haemoglobin)
 8.Micturition REFLEX
• It results from an interplay of involuntary and
voluntary actions by the internal and external
urethral sphincters
• When bladder volume reaches about 150 mL, an
urge to void is sensed but is easily overridden,
• Voluntary control of urination relies on
consciously preventing relaxation of the external
urethral sphincter to maintain urinary
continence.
• As the bladder fills, subsequent urges become
harder to ignore. Ultimately, voluntary
constraint fails with resulting incontinence,
which will occur as bladder volume
approaches 300 to 400 mL
• Normal micturition is a result of stretch
receptors in the bladder wall that transmit
nerve impulses to the sacral region of the
spinal cord to generate a spinal reflex.
• The resulting parasympathetic response
causes contraction of the detrusor muscle and
relaxation of the involuntary internal urethral
sphincter, allowing a small volume of urine to
reach the external urethral sphincter.
• At the same time, the spinal cord inhibits
somatic motor neurons, resulting in the
relaxation of the skeletal muscle of the
external urethral sphincter.
• The micturition reflex is active in infants but with
maturity, children learn to override the reflex by
asserting external sphincter control, thereby
delaying voiding (potty training).
• This reflex may be preserved even in the face of
spinal cord injury that results in paraplegia or
quadriplegia. However, relaxation of the external
sphincter may not be possible in all cases, and
therefore, periodic catheterization may be
necessary for bladder emptying.
• Nerves involved in the control of urination include
the hypogastric, pelvic, and pudendal.
• Voluntary micturition requires an intact spinal cord
and functional pudendal nerve arising from the
sacral micturition center. Since the external urinary
sphincter is voluntary skeletal muscle, actions by
cholinergic neurons maintain contraction (and
thereby continence) during filling of the bladder.
• At the same time, sympathetic nervous activity via
the hypogastric nerves suppresses contraction of the
detrusor muscle. With further bladder stretch,
afferent signals traveling over sacral pelvic nerves
activate parasympathetic neurons.
• This activates efferent neurons to release
acetylcholine at the neuromuscular junctions,
producing detrusor contraction and bladder
emptying.
9. Explain how a lesion in the urinary
system affects other organ systems
10. Discuss the development of urinary system
and the effects of aging on the urinary system
• Kidneys
• After the age of 40 there is a decrease in the
number of cells within the kidney. As this is
happening there is a thickening of the connective
tissue capsule surrounding the organ and a
decrease in the thickness of the cortical region.
• The loss of kidney cells is explained mostly by a
loss of glomeruli. As glomeruli are responsible for
filtration, the loss of cells is associated with a loss
of kidney functioning.
• Bladder and Urethra
• The walls of the bladder and urethra are made of
smooth muscle. With age this muscle tissue
weakens and is less elastic. This means that the
bladder is less able to expand and contract in
older people. As a result, the bladders of elderly
people have a capacity of approximately one-half
of young adults and the bladders are unable to
fully evacuate during urination.
• Bladder control can be affected by muscle
changes and changes in the reproductive system.
As the kidneys age, a number of events occur. The
number of units that filter waste from the blood
(nephrons) decreases, as does the overall amount
of kidney tissue. The blood vessels supplying the
kidney can harden, slowing filtration of blood.
Additionally, the bladder wall changes with age.
The elastic tissue becomes tough, and the
bladder becomes less stretchy. Muscles weaken,
and the organ may not empty completely when
urinating.
• Kidney function usually remains normal in the elderly,
albeit sometimes working more slowly than in a
younger individual. However, illness, medications, and
other conditions can affect a kidney’s ability to function
properly. Changes in the kidneys may affect an elderly
person’s ability to concentrate urine. Dehydration can
occur if fluid intake is reduced in an attempt to reduce
bladder control problems. Aging also increases the risk
for urinary disorders such as acute and chronic kidney
failure, urinary incontinence, leakage, or retention, and
bladder and other urinary tract infections.
• Urinary system cancers are associated with
advanced age and are more common in the
elderly, especially prostate cancer (men) and
bladder cancer.
11. Pathophysiology of each signs and
symptoms
• infection of kidney pelvis-Bacteria may infect
the kidney, usually causing back pain and
fever.
• If blood glucose levels become too high, the
body will try to remedy the situation by
removing glucose from the blood through the
kidneys. When this happens, the kidneys will
also filter out more water and you will need to
urinate more than usual as a result.