Anatomy of the Urinary System

Question 1

Give the bony landmarks of the upper and lower poles of the kidneys

Answer 1

Left Kidney: T11-T12 → L2-L3

Right Kidney: T12 → L3-L4

Question 2

At what vertebral level would you find the hilum of the kindeys?

Answer 2

L1

Question 3

Where are the kidneys postioned in relation to the peritoneum?

Answer 3

They are retroperitoneal

Question 4

What is the normal width and legnth of the kidney?

Answer 4

6-7 cm wide

9-14 cm long

Question 5

With regards to legnth and width, under what circumstances might you want to investigate the kidney?

Answer 5

• >2 cm difference between Left and Right
• Renal legnth <8cm

Question 6

What is the renal angle?

Answer 6

The angle between the 12th rib and Erector Spinae muscle where the kidney can be palpated

Question 7

Describe the layers of fat and fascia that surround the kidney

Answer 7

• Kidney surrounded by capsule
• Surrounded by Perirenal fat
• Surrounded by renal fascia (Garota’s fascia)
• Surrounded by Pararenal fat

Question 8

What is the function of the renal fat and fascia layers?

Answer 8

Keep the kidneys in anatomical postion as there are no ligaments keep them in place

Question 9

What is the typical legnth and diameter of a ureter?

Answer 9

• 25-30cm long
• 1.5mm diameter

Question 10

How can the ureter be divided into 3 segments?

Answer 10

• Abdominal (proximal)
• Pelvic (middle)
• Intramural (distal)

Question 11

What is the most common area for the ureter to be injured?

Answer 11

at the pelvic brim or between L4 and L5

Question 12

What is the Vesicular Uretal Junction

Answer 12

The Junction where the ureter enters the bladder and coalesces with the detrusor muscles

Question 13

How is urine reflux prevented in the bladder?

Answer 13

• Ureter passes diagonally though bladder wall
• destrusor muscle forms a flap to stop reflux
• this has nothing to do with sphnicters

Question 14

What kind of epithelium is the lumen of ureter, bladder and pelvis of the kidney lined with?

Answer 14

Urothelium

Question 15

What is the trigone of the bladder?

Answer 15

• Triangular area of smooth muscle in the bladder
• Formed between the 2 ureteric openings and the internal urethral orifice

Question 16

What is the difference in legnth between male and female urethras?

Answer 16

• Female: ~4 cm
• Male: ~ 15 cm

Question 17

Label the strucutures of the male urethra

Answer 17

Question 18

Label 1-5 on the female urethra

Answer 18

Question 19

Identify 1-7 on this cross section of the kidney

Answer 19

1. Renal Pelvis
2. Medulla
3. Cortex
4. Renal Pyramid
5. Renal lobe
6. Minor Calyx
7. Major Calyx

Question 20

What are the 2 broad categories of nephron and what are the main differences betweent them?

Answer 20

1. Cortical (90% of nephrons)- short loop of Henle
2. Juxtamedullary (10% of nephrons)- longer loops of Henle

Question 21

Describe the landmarks for the renal vessels

Answer 21

• Renal artery arises directly from abdominal aorta
• Renal vein has to pass over the aorta and under the superior mesenteric artery to reach the IVC

Question 22

Name the different types of artery found in the kidney and their anatomical postion

Answer 22

• Renal artery - enters via hilum
• Segmental artery (x5)- branch off renal artery
• Interlobar artery- between the pyramids
• Arcuate artery- between cortex and medulla
• Interlobular- within the cortex of lobe

Question 23

From the hilum describe the course of the ureter until it enters the bladder

Answer 23

1. From hilum, enter abdomen through anterior surface of psoas major
2. Crosses brim of pelvis at sacro-iliac join and enters the pelvic cavity
3. Crosses the bifurcation of the common iliac
4. Moves transversely towards bladder at level is ischial spine

Question 24

List 3 common sites where renal stones can lodge due to non-uniformity of ureter lumen diameter

Answer 24

1. Pelvic uteric junction
2. Vesico-uteric junction
3. where Ureter passes iliac joint