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This lecture includes the slides that the doctor read and I added the doctors words right in the boxes.
The doctor started by making a correction, which is the additional slides on the website.

UreDers
Muscular Tube Measuring About 25 Cm. Begin
at Renal Pevis, then descend retroperitoneally and
anterior to psoas muscle to posterior surface of
Urinary bladder.

It is a muscular tube lined by

surface epithelium, then we have
connective tissue, then we have
the muscular layer, then the serosa
or adventitia.

Then cross pelvic inlet into minor (true) pelvis where they are still retroperitoneal
and cross anterior to Common Iliac Bifurcation And Anterior To Sacro-iliac Joint.
Then it follows the course of internal iliac artery (which goes to the pelvis).

Could Be Compromised By Aneurysm Of Common Iliac

End at ureterovesical and open into bladder and

The doctor said many times that
define upper border of urinary bladder trigone.
the ureDer end at the
3 Normal Constrictions (Kidney Stones Get
SUPERIOR POSTERIOR
Stuck):
(1) At Ureteropelvic( the beginning of the ureter aspects of the urinary bladder.
as it leaves the kidney)
(2) Where Ureters Cross Pelvic Inlet (Brim) (bending)
(3) And At Ureterovesical (Intramural) (the end of it)

Right Ureter Relations:

Anteriorly:
Duodenum, ileum right testicular/ovarian vessels, Right colic vessels, and mesentery of small
intestine.
Posteriorly:

Right Psoas muscle and bifurcation of common iliac artery.

Left Ureter Relations:

Anteriorly:

Sigmoid colon and mesocolon and left Colic vessels, Testicular/Ovarian artery.
Posteriorly: Left Psoas muscle and bifurcation of common iliac artery.
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Males: pass posterior to ductus deferens

Females: pass posterior & inferior to uterine artery.

***During hysterectomy (surgical removal of the uterus) ureter can be ligated with uterine artery.
(it is posterior to artery near cervix).

Blood Supply of the ureter:

Ovarian and Testicular Artery are

Upper Part: Renal Artery.

Mid-part: Ovarian/Testicular Artery. (branches
of aorta)
Lower/Pelvic Part: Superior Vesical artery.
Venous Blood Supply: Correspond to arteries.
Lymphatic drainage: Correspond to LN along
the course of arteries.
Nerve Supply:
Upper part: Renal nerve.
Mid-part: Ovarian/Testicular Nerve.
Lower/Pelvic Part: Hypogastric Plexus.
Afferent fibers enter spinal cord at L1-2 (thats
why the referred pain to that region during renal colic of
the ureter.)

branches from the aorta, because

during embryogenesis testicles
develop intra-abdominally (around
8th week), so testicles have to take
their blood supply form aorta and
after they develop they begin to
descend and exit through internal
ring of the inguinal canal then to the
external ring to the scrotal sac.
In a male infant you have to check
that both testicles are within the
scrotal sac and if there is
undescended testis , this mean it is
within higher a temperature than
the body because spermatogenesis
occur at lower temperature and this
will lead in the future to infertility

Clinical Points
Long = 25 cm, Narrower and 3 constrictions:
Hence susceptible to renal stones lodgment at constriction sites.
Renal Colic:
Severe pain experienced when renal stones are lodged.
Afferent fibers enter spinal cord at T 11-12 and L 1-2 (Skin of Flank loin and
Groin Areas).
Renal stone arrest at Lower Part referred pain felt at Tip of Penis/Testicles
or labia in case of females.

 Organ Of Urine Storage (500 Ml). Lies

behind Pubic symphysis and is Pelvic Organ

When Empty but rises into Hypogastric
region of abdominal cavity as it fills up.

It is Triangular and has an Apex, Base, A

Superior Surface And 2-inferiolateral

During pregnancy there will be more

pressure on Urinary Bladder, so as
long as pregnancy on the first 3
months within pelvic there will
pressure symptoms on the urinary
bladder this will result in frequency
of Micturition in the first 3 months

Surfaces.

Apex: Points Anteriorly and connected to

Umblicus by Median Umblical Ligament
(remnant of Urachus).

The Posterior Surface; has Two -lateral angles

where Ureters join the bladder and 2-Vasa
deferens run separating the Seminal Vesicles fro
each other.

Superior Surface: Is covered by peritoneum

and related to Ileum and Sigmoid Colon.

The problem here, as male age (>45)

Prostate undergo Hypertrophic
changes and because prostate have
very dense capsule present at very
constricted anatomical position ,this
hypertrophy it does not extend
outward but also it push inward
where the urethrae pass and this will
lead to different degree of urinary
retention (complete or partial ).

The Neck of Urinary bladder is Surrounded by

Prostate Lobes where Prostatic Urethra lies.

The Interior of Urinary bladder Presents Folds/Rugae when Empty. But A

triangular area joining the three openings; 2-ureters and one internal sphincter is
clear of Folds and called Trigone

The interior of urinary bladder

The 2 ureters enter the urinary bladder at the 2 lateral angels in the superior posterior region. The
area above the entrance of the 2 ureters is called the fundus.
And notice in the picture the internal urethral orifice (which is under the autonomic nervous
system) and the external (which is voluntary).

Now regarding the interior aspect of the urinary bladder, like any organ in the body that is subjected
to distension (the stomach for e.g.). You can see that it's folded to allow it to extend. These folds are
called "Rugae".
- still in the interior aspect we have a triangular area that extend between the 2 upper lateral points
(which represent the opening of the 2 ureters) and the internal urethral orifice. This area is called
the "trigon".
Trigone of the bladder is not folded, it smooth; the significant of this is Because if its folded this will
affect the potency of the tube (ureter), that means the urine will not pass easily from the ureter to
the bladder.

At the neck of urinary bladder we have the prostatic urethra and prostate (regarding males)
while in females related to urogenital diaphragm.

In females the UB and the urethra are

anterior to the uterus. There are 2 pouchs
(empty potential space) which are "Rectouterine" pouch behind the uterus
(between the uterus and the rectum) &
"viscero-uterine" pouch in front of the
uterus.

Regarding males as we said we have the prostate gland at the neck of the bladder. And in the
urethra there is an opening for the vas deference which passes within the substance of the prostate
gland carrying semen to the ejaculatory duct; this part of urethra is called prostatic urethra. Then
the urethra pass through the urogenital diaphragm.

The doctor scolded us for not

knowing what is the muscle tone -.-!

The blood supply and innervation of the Urinary

bladder:

Anyone want to know the content,

refer to the record!

- It's supplied by Superior and Inferior Vesical arteries which are branches of Internal Iliac Artery.
- Regarding the venous drainage it's correspond to the arteries and drain into the internal iliac vein.
- Nerve Supply via the Inferior Hypogastric Plexus from Sympathetic fibers of L 1-2

The urinary bladder relation:

Posterior surface (fundus/base):
- In males related to rectovesical pouch, rectum, seminal vesicles, and ampulla of ductus
deferens
- In females related to anterior wall of vagina
Anterior surface:
Related to pubic symphysis and retropubic space of Retzius
Superior surface:

In males - peritoneal cavity

In females vesicouterine pouch (peritoneal cavity)

Apex:
related to median umbilical lig. or urachus
Neck:
in males related to prostatic urethra and prostate while in females related to urogenital
diaphragm
Trigone of the bladder:
on posterior surface of bladder and defined superiorly by ureters and inferiorly by urethra
(internal urethral meatus)

Bladder clinical:
1- In infants the empty bladder lies within the false abdominal cavity. As it mature (in adults) it
shifts and move into the minor pelvis (true pelvis), but when full can rise above pelvic inlet.
2- Prostatic Hypertrophy: Affects Males above 45 yrs. Hence
Pressure over Prostatic Urethra and cause Residual volume
and Urgency to Micturation and Possible Retention.

# Prostatic Hypertrophy: Sildenafil

(Viagra) is used as a TT by increasing
cGMP that cause Smooth muscle
relaxation said the doctor.

3- Incontinence (total, stress, urge, overflow types):

Uncontrolled passage of urine, it affects female more than males, it happens due to the emotional
nature of the female (stress, anxiety, pregnancy . ) and due to some anatomical (structural)
variation in female.
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URETHRA :
Muscular Tube Carries urine from the Bladder to the outside of the body
Internal Sphincter prevents urine from emptying; composed of smooth muscle; involuntary
External Sphincter at the upper portion of the urethra allows you to resist the urge to urinate; composed
of skeletal muscle; voluntary
Female Short and Wide opens to the outside at the urethral meatus, subjected more to UTI
Male longer and narrow, passes through the prostate gland; carries urine and sperm.
Hence Males more prone for Renal Stone arrest But Females more susceptible to Urinary Tract Infection

Males (3 parts)
1. Prostatic post. wall has urethral crest that contains 2 openings of ejaculatory ducts. Prostatic
ducts are lateral to urethral crest.
2. Membranous the narrowest crosses urogenital diaphragm and surrounded by deep
transverse perineal m. and sphincter urethrae m. (external sphincter)
-Both musc. by pudendal n.
- the place where lodgment of renal stone occur
3. Penile (spongy/cavernous) surrounded by corpus spongiosum, enlarges into fossa navicularis,
and ends as external urethral meatus. Openings of bulbourethral glands just below urogenital
diaphragm. (vulnerable to catheter penetration)

Females
-

Courses through urogenital diaphragm and is surrounded by deep transverse perineal m. and
sphincter urethrae m. (later muscles doesnt completely surround urethra and is the reason for
high incidence of stress incontinence in women)
Posterior surface fuses with anterior wall of vagina.
External urethral orifice stratified Squamous epitheliumopens into vestibule of vagina between
labia minora.

!
! !
Done by:
Anagreh
Obiedat
Zoubi
Shatnawi
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