How long is the ureter?
35 - 30 cm
How does the ureter propel urine towards the bladder?
Peristalsis
At what spinal level does the ureter arise?
Continuous with renal pelvis at L2
Is the ureter intra or retroperitoneal?
Retroperitoneal
How is the ureter located using the surface anatomy?
Ureter is a straight line 5 cm from the midsaggital plane extending from the L2 vertebra to the posterior superior iliac spine.
Where is the abdominal part of the ureter located?
From renal pelvis to bifurcation of common iliac artery
Where is the pelvic part of the ureter located?
Pelvic brim to posterior base of urinary bladder
What joint is located near the bifurcation of the common iliac artery?
The Sacroiliac joint
Ureter descends along medial border of the ________
Psoas major
What structures are located anteriorly to the right ureter?
Right testicular/ovarian vessels
Right colic/ileocolic vessels
Root of the mesentery
What structures are located posteriorly to the right ureter?
Tips of the transverse processes of the L2 - L5 vertebrae
Right genital femoral N
Right psoas muscle
Bifurcation of right common iliac artery
What structures lie anterior to the left ureter?
Left colic vessels
Left sigmoid vessels
Left testicular/ovarian vessels
Root of sigmoid mesocolon
Sigmoid colon
What structures lie posterior to the left ureter?
Tips of transverse processes
Left genital femoral nerve
Left psoas muscle
Bifurcation of left common iliac artery
Where do the ureters run at the pelvic brim?
Along the lateral pelvic wall parallel to the anterior margin of the greater sciatic notch.
Which direction do the ureters curve when they are opposite the ischial spine?
Anteromedially (they curve this direction superiorly to the levator ani)
How are the ductus deferans and the ureters positioned relative to each other?
Terminal part of the ureter enters the bladder anteriorly to the point where the ductus deferans enters the seminal vesicle
What structure does the ureter pass above before entering the urinary bladder?
The seminal vesicle
Which is more anterior the ureter or the ductus deferans?
The ureter
What is the path of the ductus deferens?
Passes through inguinal canal and attaches medially at the seminal vesicle
Where do the ovaries lie relative to the ureters?
Immediately anteriorly
How are the ovaries related to the ureters?
Ureter forms posterior wall of ovarian fossa in which the ovary lies
How do the ureters pass relative to the uterus?
The ureter passes laterally to the cervix before it attaches to the bladder then anteriorly to the anterior fornix of the vagina to attach to the nladder
What is the clinical significance of the pathway of the ureters relative to the uterus?
Damage to the ureters can occur during a hysterectomy
What structure lies posterior to the ureter at the entrance to the urinary bladder in males?
Rectovesical pouch
What structure lies posterior to the ureter at the entrance to the urinary bladder in females?
Anterior fornix of the vagina
What structures lie laterally to the ureter in males?
Anterior branches of the internal iliac artery (umbilical, superior and inferior vesical, and obturator artery)
Obturator Nerve
Obturator Fascia
What structures lie laterally to the ureter in females?
Anterior branches of the internal iliac artery
SUPERIOR VESICAL ARTERY
Obturator artery
Uterine artery
Obturator N
Obturator Fascia
What structures lie superior to the ureter in females?
Broad ligament
Uterine artery
What angle do ureters enter the urinary bladder?
Posterosuperior angle of its base
What direction do the ureters enter the bladder?
inferomedially
Where is the seminal vesicle located?
posterior to the bladder
Where do the ductus deferens run relative to the ureters?
Anteriorly and then superiorly to where the ureters meet the bladder
Where are the constrictions of the ureter located?
junction between renal pelvis and ureter at level L2/L3
At the pelvic brim near the bifurcation of the common iliac artery
At the entrance into urinary bladder wall
How many constrictions does the ureter have?
3
At what spinal level does the renal artery arise?
L1/L2 (like the hilum of the kidney)
Where does the right renal artery run relative to the IVC?
Posteriorly
What structure does the left renal vein pass behind?
The superior mesenteric artery
How much blood do the kidneys need?
They require 21% of CO
Do renal arteries have anastomoses?
No they are end arteries
What is the pathway of blood from heart to the glomerulus and back?
Heart -> Aorta -> renal artery -> Segmental artery -> Interlobular artery -> Arcuate artery -> Afferent arteriole -> Glomerulus -> Efferent arteriole -> peritubular artery and vasa recta -> Interlobular vein +arcuate vein ->arcuate vein ->Interlobular vein -> Renal vein -> IVC -> Heart
What are the divisions of the renal artery?
Divides into anterior and posterior divisions just before the hilum.
Anterior division divides into 4 segments
Posterior division continues to a segment on its own.
What are the anterior division’s segments?
Superior
Anterior superior
Anterior inferior
Inferior
What are the posterior divisions?
Posterior segment
What does the blood supply of the abdominal ureter consist of?
Renal artery
Gonadal artery
Suprarenal artery
Vessels from posterior abdominal wall
What supplies the pelvic part of the ureter?
Common iliac vessels
Internal iliac vessels
Inferior vesical vessels
What lymphatics drain kidneys?
Lymphatics from kidneys follow renal veins and drain into:
Right and Left lumbar lymph nodes
Caval lymph nodes
Aortic lymph nodes
What lymphatics do ureters drain into?
Para aortic lymph nodes
What lymph nodes drain superior portion of pelvic part of ureters?
external iliac lymph nodes
What lymph nodes drain superior portion of pelvic part of ureters?
internal iliac lymph nodes
Where do kidneys get their nerve supply?
Efferent fibres from renal nerve plexus
What is the renal nerve plexus composed of?
Sympathetic and parasympathetic nerve fibers
Where are the sympathetic nerve fibers that innervate the kidneys from?
T10 - L1 via abdominopelvic splanchnic nerve
Where are parasympathetic nerve fibers derived from?
Both vagus nerves
Where do visceral afferents from the kidneys go?
Visceral afferents follow sympathetic fibers retrograde to dorsal root ganglia and spinal cord segments (T11 - L2)
Where do visceral afferents from the ureters go?
Ureter sympathetic innervation follows pelvic splanchnic nerves to dorsal root ganglia and spinal cord segments (T10 - L2)
Ureters are primarily above pelvic pain line
Where is the visceral efferent innervation beneath the pelvic pain line from?
S2 - S4 and they follow parasympathetic pelvic nerve
Where do kidneys get their parasympathetic innervation?
Vagus nerves
Where do ureters get their parasympathetic innervation?
S2 - S4 splanchnic nerves
What are stones that accumulate in calices or ureters?
calculi
What do calculi do that causes pain to people?
They can block passages and cause swelling and hydronephrosis which results in what is known as ureteric colic
Where is ureteric colic referred to?
Can be referred to lumbar or inguinal region
What is the functional unit of kidney called?
Uriniferous tubule which consists of nephron, collecting tubule and collecting duct
What are the contents of the renal corpuscle?
Glomerulus capillaries
Visceral epithelium (podocytes)
Parietal epithelium (bowman’s capsule)
How many nephrons does the typical kidney have?
1.25 million
What percentage of nephrons are cortical nephrons?
85%
Where are cortical nephrons located?
Right beneath renal capsule
What percentage of nephrons are medullary nephrons?
15% of nephrons
Where are juxtamedullary nephrons located?
Close to renal medulla and have long loops of henle.
What do juxtamedullary nephrons do?
Contribute to kidney’s ability to concentrate urine
Which nephrons have longer loops of henle?
Juxtamedullary nephrons
What are the components of the renal tubule?
Proximal and distal convoluted tubule
Loop of henle
What is the role of the nephron?
Filter blood
Concentrate urine
Reabsorb nutrients and water
What are the 2 poles of the renal corpuscle?
Vascular pole
Urinary pole
What are the 2 layers of the bowman’s capsule?
Parietal layer
Visceral layer
What epithelium does the parietal layer of the bowman’s capsule contain?
Simple squamous epithelium
What cells constitute the visceral layer of the bowman’s capsule?
Podocytes envelope capillary tuft
What is the capsular space and what is its function?
Capsular space is the space between bowman’s capsule and glomerulus which receives filtered liquid filtered through capillary wall and visceral layer.
What are the 3 layers of filtration membrane in the renal glomerulus?
Fenestrations of endothelial cells of glomerular capillaries
Combined basement membrane
Filtration slits between foot processes of podocytes
What structural aspect of podocytes makes them so important?
They have foot processes which embrace the capillaries and create small sieve like openings
What are the types of processes that podocytes have?
Primary processes which are not in contact with basement membrane
Secondary processes that embrace the capillaries
Filtration slits which are spaces within interdigitation of secondary processes
What is the juxtaglomerular apparatus?
Area of specialized contact between afferent arteriole and the distal straight tubule
What are the 3 types of cells in the juxtaglomerular apparatus?
Juxtaglomerular granular cells
Macula densa cells
Extraglomerular mesangial cells
What are juxtaglomerular granular cells?
Modiifed smooth muscle cells in afferent arteriole that are responsible for renin release
What are macula densa cells?
Modified epithelial cells of distal straight tubule which contacts the vascular end of renal corpuscle and these cells signal renin release.
What are extraglomerular mesangial cells?
Cells located at vascular pole that clear excess debris and trapped residue from basement membrane and they are both phagocytic and contractile.
What are the 2 capillary beds associated with nephrons?
Glomeruli and vasa recta
Where does the afferent arteriole come from?
Interlobular artery
Where does the efferent arteriole go to?
The peritubular capillaries (or vasa recta)
Where do peritubular capillaries drain into?
Interlobular veins
Where do the vasa recta occur?
juxtamedullary nephrons
Do cortical nephrons have vasa recta?
Nope
What kind of exchange is there between ascending and descending loop of henle?
Countercurrent exchange of water and solutes
What are the alternating regions of the renal cortex?
Cortical labrynth which consists of glomeruli and convoluted tubules
Medullary rays which consist of radially directed straight tubules of nephrons and collecting ducts
What lines the proximal convoluted tubule?
Cuboid epithelium
How many cells on proximal convoluted cross section?
3 - 4 cells
What is a feature of the cytoplasm of proximal convoluted tubules? Why?
It is strongly acidophilic because they have lots of mitochondria
What structures are unique to the proximal tubules?
The brush border surface with lots of microvilli
What type of epithelium does the distal convoluted tubule have?
Cuboidal epithelium
How are cells of the DCT different to the PCT?
DCT cells have less microvilli and a flatter surface.
Wider lumen
5 - 8 nuclei in cross section instead of 3 - 4
What are the 2 parts of the loop of henle?
Descending thick & thin limb
Ascending thick & thin limb
What is the difference between thick and thin limbs?
Thick epithelium is cuboidal
Thin epithelium is squamous
What is the collecting/connecting tubule?
Tubular structure that is continuous with the nephron
What is the function of the collecting/connecting tubule?
Remaining filtrated is moved through to the collecting duct
What is the collecting duct?
Duct that collects urine from several nephrons and filters it through to the minor calyx
What tissue type do collecting ducts have?
In the cortex they are lined by simple cuboidal epithelium and at the apex by simple columnar epithelium
What are the types of cells in collecting ducts?
Principal cells with sparse short microvilli
Intercalated cells with abundant microvilli
What happens to principal cells as they approach the renal papillae?
They lengthen
What happens to intercalated cells as they approach the renal papillae?
They diminish in numbers
What are renal papillae?
The location where the pyramids meet the minor calices
Are intercalated discs dark or light staining?
Dark staining
What shape is the lumen of the ureter?
Star shaped
What are the layers of the ureter?
Lumen
Mucosa
Muscularis propria
Adventitia
What are the parts of the mucosa of the ureter made up of?
Epithelium: transitional epithelium (aka urothelium)
Lamina propria
What layers are not present in the ureter?
Muscularis mucosa
Submucosa
What are the 2 layers of smooth muscles in ureters and where are they located?
Inner longitudinal and outer circular layer
They are located in the muscularis propria
How is the lower third of the ureter different to the rest of the ureter?
Lower third contains an additional longitudinal smooth muscle layer
What are the components of the adventitia of the ureter?
Dense irregular connective tissue containing blood vessels, lymphatic vessels and nerves
What is special about transitional epithelium?
It can contract and expand according to what is required
