Anatomy and Physiology Urinary System

1. Kidneys- The kidneys receive blood from the renal arteries, left and right, which branch directly from the abdominal aorta. Despite their relatively small size, the kidneys receive approximately 20% of the cardiac output. Each renal artery branches into segmental arteries, dividing further into interlobar arteries which penetrate the renal capsule and extend through the renal columns between the renal pyramids. The interlobar arteries then supply blood to the arcuate arteries that run through the boundary of the cortex and the medulla. Each arcuate artery supplies several interlobular arteries that feed into the afferent arterioles that supply the glomeruli. 2. Ureters- The ureters are paired muscular ducts with narrow lumina that carry urine from the kidneys to the bladder. ureters arise from the renal pelvis on the medial aspect of each kidney before descending towards the bladder on the front

of the psoas major muscle. The ureters cross the pelvic brim near the bifurcation of the iliac arteries (which they cross anteriorly). 3. Bladder- The urinary bladder is a muscular sac in the pelvis, just above and behind the pubic bone. When empty, the bladder is about the size and shape of a pear. In males, the base of the bladder lies between the rectum and the pubic symphysis. It is superior to the prostate, and separated from the rectum by the rectovesical excavation. In females, the bladder sits inferior to the uterus and anterior to the vagina; thus, its maximum capacity is lower than in males. It is separated from the uterus by the vesicouterine excavation. In infants and young children, the urinary bladder is in the abdomen even when empty. A completely full bladder is capable of holding approximately 1 liter of fluid Ordinarily the urge to urinate occurs when the bladder contains about 200 ml of urine. 4. Urethra- the urethra is a tube that connects the urinary bladder to the outside of the body. In males, the urethra is the conduit for semen during sexual intercourse. It also serves as a passage for urine to flow. In females, the urethra is shorter and emerges above the vaginal opening. The external urethral sphincter is a striated muscle that allows voluntary control over urination. The female urethra is about 4 cm in length. There is inadequate data for the typical length of the male urethra, however a study of 109 men showed an average length of 22.3 cm (SD = 2.4 cm), ranging from 15 cm to 29 cm.

Pathophysiology Urothelial Bladder Cancer Stage IV

Precipitating Factors -Smoking -Family driver -Construction worker

Predisposing Factors: -Gender

-decrease chance to urinate -decrease chance to drink water

Men are three times likely to be diagnosed with bladder cancer

Increased urine dwell-times

Increased nicotine consumption

Change in normal lining of Urothileal cells

Uncontrolled abnormal cell growth (dyplasia)

Clumping of abnormal cells

Tumor formation

Advanced localized tumor growth

Metastasis

Obstruction of urine flow from the bladder

Bladder tenderness

Dysuria

Hematuria

Change in bladder habits

Hypogastric Pain

Anemia

Loss of Appetite

Body Malaise

Weight Loss