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Urological Anatomy and Physiology. Mr Andrew Sinclair Consultant Urological Surgeon Stockport NHS Foundation Trust. Overview. Introduction Anatomy and clinical relevance Kidney Ureter Bladder Urethra Prostate Scrotum Physiology Renal Bladder Function Erection and Ejaculation.

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urological anatomy and physiology

Urological Anatomy and Physiology

Mr Andrew Sinclair

Consultant Urological Surgeon

Stockport NHS Foundation Trust

overview
Overview
  • Introduction
  • Anatomy and clinical relevance
    • Kidney
    • Ureter
    • Bladder
    • Urethra
    • Prostate
    • Scrotum
  • Physiology
    • Renal
    • Bladder Function
    • Erection and Ejaculation
introduction
Introduction
  • Need to know the BASICS only
  • Broad knowledge base
  • Identify life threatening problems
  • Don’t harm the patient
surface markings of the kidneys
Surface markings of the kidneys
  • 2 Kidneys
  • Retroperitoneal Organs
  • Each side of vertebral column
  • From T12 to L3
    • Right slightly lower because displaced inferiorly by the liver
  • Hilum at L1
anatomy of the kidneys
Anatomy of the Kidneys
  • Longer left renal vein crosses anterior to the Aorta
  • From Anterior to Posterior
    • Vein, Artery, Renal Pelvis
  • Left gonadal vein drains into Left renal vein
  • Right gonadal vein drains directly into IVC
microanatomy of the kidney
Microanatomy of the kidney

1.Renal Vein

2. Renal Artery

3. Renal Calyx

4.Medullary Pyramid

5.Renal Cortex

Vasculature

6.Segmental Artery

7.Interlobar Artery

8.Arcuate Artery

9.Arcuate Vein

10.Interlobar Vein

11. Segmental Vein

12.Renal Column

13.Renal Papillae

14.Renal Pelvis

15.Ureter

anatomy of the ureter
Anatomy of the Ureter

adrenal

  • Ureters continue from the renal pelvis at L1
  • 25 cm long
  • Run inferomedially along the transverse processes of lumbar vertebrae
  • Crosses pelvic brim at the SIJ anterior to the origins of the external iliac artery
  • Runs anterior to the internal iliac artery in the pelvis
  • Passes towards the ischial spine before turning towards the pubic tubercle and entering the bladder

kidney

ureter

bladder

urethra

anatomy of lower male gu tract
Anatomy of Lower Male GU Tract

Prostatic Urethra

Membranous Urethra

Bulbar Urethra

Penile urethra

relevance of anatomy1
Relevance of anatomy

Female catheterisation

Suprapubic catheterisation

Digital Rectal Examination

Male catheterisation

anatomy of the scrotum
Anatomy of the scrotum

Embryology

  • Important area for medical students
    • Chronic conditions
    • Easily palpable
    • Limited diagnoses
  • Therefore easy to bring to exams
spermatic cord
Runs through Inguinal canal

The coverings of the cord arise from the layers from the inguinal canal

Internal spermatic fascia from transversalis fascia

Cremasteric fascia and muscle from transversus abdominis & internal oblique

External spermatic fascia from external oblique aponeurosis

Contents of spermatic cord

Ductus deferens (45cm)

Testicular artery

Artery to the ductus deferens

Cremasteric artery

Pampiniform plexus

Sympathetic nerves

Parasympathetic nerves

Genital branch of genitofemoral nerve

Lymphatics

Spermatic cord
layers of the spermatic cord and scrotum
Layers of the spermatic cord and scrotum
  • Peritoneum
  • Transversalis fascia
  • Transversus abdominis & internal oblique
  • External oblique
  • Subcutaneous fat
  • Skin

CV Cavity of tunica vaginalis

T Testis

E Epididymis

scrotal contents
Scrotal Contents
  • Testis covered by visceral layer of tunica vaginalis except where the testis is attached to the epididymis and spermatic cord.
  • Parietal layer attached to internal spermatic fascia
  • Fluid between layers allows movement
relevance of anatomy identify origins of scrotal lumps
Relevance of Anatomy:Identify origins of scrotal lumps
  • Is it attached / part of the testicle
  • Is it separate from testicle
  • Is it transilluminable
  • Can you feel the testicle
  • Can you get above it
relevance of anatomy identify origins of scrotal lumps1
Relevance of Anatomy:Identify origins of scrotal lumps

Epididymal cyst

Inguinal Hernia

Hydrocele

Testicular cancer

renal physiology
Renal Physiology
  • General understanding
  • Complex physiology
  • General principles
loop of henle
Loop of Henle
  • Countercurrent multiplier
  • Relies on a concentration gradient between the 2 limbs of the loop
  • Requires energy
  • Relatively small gradient BETWEEN the 2 limbs is magnified by the countercurrent to a relatively large gradient ALONG the limb of the loop involved
  • Thick ascending limb
    • continuous active transport of NaCl into interstitium
    • Impermeable to H2O
  • Descending loop
    • Tonicity in equilibrium with the interstitium

Impermeable to H2O

physiology of micturition
Physiology of Micturition

Lateral corticospinal tract

Sympathetic

T10-L2

Parasympathetic

S2, 3, 4

Intermediolateral column – parasympathetic – Pelvic nerve

Onuf’s nucleus - rhabdosphincter

Anterior Horn Cell Nucleus – pudendal nerve – periurethral striated muscle

somatic

physiology of erections and ejaculation central erectile stimulation

Erectogenic stimuli– erotic imagery

– audiovisual

– tactile

– olfactory

Site of action – dopamine receptors in PVN

PRO-ERECTILEneural signalling

Physiology of erections and ejaculation.Central erectile stimulation

Inhibitory stimuli– anxiety

– fear

– depression

Cerebralcortex

PVN

Spinal cord

neural input to erections
Neural input to erections
  • In the flaccid state sympathetic dominance keeps arterioles and smooth muscle contracted
  • Erections are primarily vascular in nature BUT from parasympathetic stimulation
  • This leads to arteriolar dilation and trabecular smooth muscle relaxation.
  • Pudendal nerve also has an input causing ischiocavernosus muscle contraction further increasing intracavernosal pressure

NB Nervi erigentes now called pelvic splanchnic nerves

NB The 2 Inferior hypogastic plexuses make up the pelvic plexus

trabecular smooth muscle relaxation
Trabecular smooth muscle relaxation
  • Dominant mediator is Nitric oxide NO released from parasympathetic nerve terminals
  • Parasympathetic nerve terminal also releases Ach which stimulates vascular endothelium to also release NO
peripheral erectile stimulation
Peripheral erectile stimulation

Parasympathetic and Sympathetic nerves from the pelvic plexus pass within the cavernous nerve to the penis

PDE5 Inhibitors = Phosphodiesterase 5 Inhibitors

Examples of PDE5 inhibitors are Viagra, Cialis and Levitra

physiology and anatomy of erection
Physiology and anatomy of Erection

Erect State

Flaccid State

physiology of ejaculation
Physiology of Ejaculation
  • Ejaculation has 3 processes
    • Closure of bladder neck (sympathetic)
    • Emission (sympathetic)
      • 1stly prostatic secretions
      • Then seminal vesicle emptying
    • Antegrade ejaculation (sympathetic and somatic)
      • Somatic is the pudendal nerve causing contraction of the bulbocavernosus muscle.

Inferior mesenteric plexus

Superior hypogastric plexus

(sympathetic)