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THE URINARY SYSTEM


Learning Objective

Describe the parts of the urinary system and their function(s).


The urinary system is the primary filtering system of the body (Fig. 6-84). This system is composed of two main organs, the kidneys and urinary bladder. The kidneys produce urine, which is drained from the kidneys by two tubes called ureters. Urine flows down both ureters to the bladder. The urinary bladder is a large reservoir where the urine is temporarily stored before excretion from the body. A tube called the urethra carries the urine from the bladder to the outside of the body. The length of the urethra differs in males and females, the female’s being shorter.

KIDNEYS

The bladder, ureters, and urethra store and pass the products of the kidneys.

The kidneys are two large, bean-shaped organs approximately 11cm by 7cm by 3cm, designed to filter waste materials from the blood (Figs. 6-85 and 6-86). They assist in controlling the rate of red blood cell formation and in the regulation of blood pressure; the absorption of calcium ions; and the volume, composition, and pH of body fluids. The kidneys are located in the upper posterior part of the abdominal cavity, one on each side of the spinal column. The upper end of each kidney reaches above the level of the 12th rib. The suprarenal (adrenal) gland sits like a cap on top of each kidney. The kidneys are protected by a considerable amount of fat and supported by connective tissue and the peritoneum. Attached to the hollow side of each kidney is the dilated upper end of the ureter, forming the renal pelvis.

 

Figure 6-84.—Location of urinary system organs. A, Anterior view of the urinary organs with the peritoneum and visceral organs removed. B, Surface markings of the kidneys, eleventh and twelfth ribs, spinous processes of L1 to L4, and lower edge of the pleura (posterior view). C, Horizontal (transverse) section of the abdomen showing the retroperitoneal position of the kidneys. (A: Barbara Cousins. B: From Abrahams P, Marks S, Hutchings R: McMinn's color atlas of human anatomy, ed 5, Philadelphia, 2003, Mosby.)

Image reprinted  from: Thibedeau, G. A., & Patton, K. T. (2006). Anatomy & Physiology (6th ed.). St. Louis: Elsevier Health Sciences.

 

Figure 6-85.—Internal structure of the kidney. A, Coronal section of the right kidney in an artist's rendering. B, Photo of a coronal section of a preserved human kidney. (A: Adapted from Brundage DJ: Renal disorders. Mosby's clinical nursing series, St Louis, 1992, Mosby. B: From Abrahams P, Marks S, Hutchings R: McMinn's color atlas of human anatomy, ed 5, Philadelphia, 2003, Mosby.)

Image reprinted  from: Thibedeau, G. A., & Patton, K. T. (2006). Anatomy & Physiology (6th ed.). St. Louis: Elsevier Health Sciences.

 

Figure 6-86.—Circulation of blood through the kidney. A, Diagram showing the major arteries and veins of the renal circulation. B, Renal arteriogram. Arcuate arteries (1) are seen near the junction of the cortex and medulla, interlobar arteries (2) are present between the medullary pyramids, and lobar arteries (3) and segmental arteries (4) are seen branching from the main renal artery (5). Note the tip of the catheter used to inject contrast material (6) into the proximal part of the main renal artery. (B: From Weir J, Abrahams P: Imaging atlas of the human anatomy, ed 2, Philadelphia, 1997, Mosby.)

Image reprinted  from: Thibedeau, G. A., & Patton, K. T. (2006). Anatomy &Physiology (6th ed.). St. Louis: Elsevier Health Sciences.

Structure

The lateral surface of the kidneys is convex in shape, and the medial side is deeply concave. The medial side of each kidney possesses a depression that leads to a hollow chamber called the renal sinus (Fig. 6-85). The entrance of the renal sinus is referred to as the hilum (Fig. 6-85). Blood vessels, nerves, lymphatic vessels, and the ureters pass through the hilum.

The superior end of the ureter forms a funnel-shaped sac called the renal pelvis (Fig. 6-85). The renal pelvis is divided into two or three tubes, called major calyces. The major calyces (sing. calyx) are further subdivided into minor calyces.

There are groups of elevated projections in the walls of the renal pelvis. These projections are called renal papillae. The renal papillae connect to the minor calyces through tiny openings in the minor calyces (Fig. 6-87).

The principal portion of the kidney is divided into two distinct regions: an inner medulla and outer cortex (Fig. 6-85). The renal medulla is composed of pyramid-shaped masses of tubes and tubules called renal pyramids. Renal pyramids drain the urine to the renal pelvis. The renal cortex forms a shell over the renal medulla. Renal cortex tissue dips down, like fingers, between the renal pyramids, and forms renal columns. The cortex possesses very small tubes associated with nephrons. Nephrons are the functional units of the kidneys.

RENAL BLOOD VESSELS.—The renal artery supplies blood to the kidneys. The renal artery enters the kidneys through the hilum and sends off branches to the renal pyramids. These arterial branches are called interlobar arteries. At the border between the medulla and cortex, the interlobar arteries branch to form the arcuate arteries. The arcuate arteries branch and form the interlobular arteries.

The venous system of the kidneys generally follows the same paths as the arteries. Venous blood passes through the interlobular, arcuate, interlobar, and renal veins.

NEPHRONS.—The functional units of the kidneys are called nephrons. There are about 1 million nephrons in each kidney. Each nephron consists of a renal corpuscle and a renal tubule.

The renal corpuscle (Malpighian corpuscle) is composed of a tangled cluster of blood capillaries called a glomerulus. The glomerulus is surrounded by a sac-like structure referred to as the glomerulus capsule or Bowman's capsule (Fig. 6-88).

Leading away from the glomerulus is the renal tubule. The initial portion of the renal tubule is coiled and called the proximal convoluted (meaning coiled or twisted) tubule. The proximal convoluted tubule dips down to become the descending loop of Henle. The tubule then curves upward toward the renal corpuscle and forms the ascending loop of Henle.

 

Figure 6-87.—Renal papilla. Collecting ducts (CD) can be seen opening into a calyx (C) at the papillary tip. The interstitial tissue (I) includes some Henle loops and vasa recta vessels. (From Stevens A, Lowe J: Human histology, ed 3, Philadelphia, 2005, Mosby.)

Image reprinted  from: Thibedeau, G. A., & Patton, K. T. (2006). Anatomy & Physiology (6th ed.). St. Louis: Elsevier Health Sciences.


Once the ascending limb reaches the region of the renal corpuscle, it is called the distal convoluted tubule. Several distal convoluted tubules merge in the renal cortex to form a collecting duct. The collecting duct begins to merge within the renal medulla. The collecting ducts become increasingly larger as they are joined by other collecting ducts. The resulting tube is called the papillary duct. The papillary duct empties into the minor calyx through an opening in the renal papilla.

Function

The kidneys are effective blood purifiers and fluid balance regulators. In addition to maintaining a normal pH of the blood (acidbase balance), the kidneys keep the blood slightly alkaline by removing excess substances from it. The end product of these functions is the formation of urine, which is excreted from the body.

Urine is formed through a series of processes in the nephron. These processes are filtration, reabsorption, and secretion.

FILTRATION.—Urine formation begins when water and various dissolved substances are filtered out of blood plasma from a glomerular capillary into the glomerular capsule. The filtered substance (glomerular filtrate) leaves the glomerular capsule and enters the renal tubule.

REABSORPTION.—As glomerular filtrate passes through the renal tubule, some of the filtrate is reabsorbed into the blood of the peritubular capillary. The filtrate entering the peritubular capillary will repeat the filtration cycle. This process of reabsorption changes the composition of urine. For instance, the filtrate entering the renal tubule is high in sugar content, but because of the reabsorption process, urine secreted from the body does not contain sugar.

 

Figure 6-88.—Nephron. The nephron is the basic functional unit of the kidney. Arrows show the direction of flow within the nephron. (Adapted from Brundage DJ: Renal disorders. Mosby's clinical nursing series, St Louis, 1992, Mosby.)

Image reprinted  from: Thibedeau, G. A., & Patton, K. T. (2006). Anatomy & Physiology (6th ed.). St. Louis: Elsevier Health Sciences.

SECRETION.—Secretion is the process by which the peritubular capillary transports certain substances directly into the fluid of the renal tubule. These substances are transported by similar mechanisms as used in the reabsorption process, but done in reverse. For example, certain organic compounds, such as penicillin and histamine, are secreted directly from the proximal convoluted tubule to the renal tubule. Large quantities of hydrogen ions are secreted in this same manner. The secretion of hydrogen ions plays an important role in regulating pH of body fluids.

The glomerulus filters an estimated 1,200 ml of blood through the kidneys each minute (or 2,500 gallons in 24 hours) and about 80 gallons of glomerular filtrate in 24 hours. All the water from this filtrate is reabsorbed in the renal tubules except those containing the concentrated waste products.

The function of the ureters is to carry urine from each kidney to the urinary bladder. The ureters are two membranous tubes 1 mm to 1 cm in diameter and about 25 cm in length. Urine is transported through the ureters by peristaltic waves (produced by the ureter's muscular walls).

URINARY BLADDER

The urinary bladder functions as a temporary reservoir for urine. The bladder possesses features that enable urine to enter, be stored, and later be evacuated from the body.

Structure

The bladder is a hollow, expandable, muscular organ located in the pelvic girdle. Although the shape of the bladder is spherical, its shape is altered by the pressures of surrounding organs. When it is empty, the inner walls of the bladder form folds. As the bladder fills with urine, the walls become smoother.

The internal floor of the bladder includes a triangular area called the trigone (Fig. 6-89). The trigone has three openings at each of its angles. The ureters are attached to the two posterior openings. The anterior opening, at the apex of the trigone, contains a funnel-like continuation called the neck of the bladder. The neck leads to the urethra.

 

Figure 6-89.— Structure of the urinary bladder. Frontal view of a dissected urinary bladder (male) in a fully distended state. Inset shows a cross section of the bladder wall, which has layers similar to those in other hollow abdominopelvic organs (compare to Figure 25-2)

Image reprinted  from: Thibedeau, G. A., & Patton, K. T. (2006). Anatomy & Physiology (6th ed.). St. Louis: Elsevier Health Sciences.

The wall of the bladder consists of four bundles of smooth muscle fibers. These interlaced muscle fibers form the detrusor muscle (which surrounds the bladder neck) and comprise what is called the internal urethral sphincter. The internal urethral sphincter prevents urine from escaping the bladder until the pressure inside the bladder reaches a certain level. Parasympathetic nerve fibers in the detrusor muscle function in the micturition (urination) process. The outer layer (serous coat) of the bladder wall consists of two types of tissue, parietal peritoneum and fibrous connective tissue.

Micturition (Urination)

Micturition is the process by which urine is expelled from the bladder. It involves the contraction of the detrusor muscle and pressure from surrounding structures to expel the urine. Urination also involves the relaxation of the external urethral sphincter. The external urethral sphincter surrounds the urethra about 3 centimeters from the bladder, and is composed of voluntary muscular tissue.

Urination is usually stimulated by the distention of the bladder as it fills with urine. When the walls of the bladder contract, nerve receptors are stimulated and the urination reflex is triggered. The urination reflex causes the internal urethral sphincter to open and the external urethral sphincter to relax. This relaxation allows the bladder to empty. The bladder can hold up to 600 ml of urine. The desire to urinate may not occur until the bladder contains 250-300 ml.

URETHRA

The urethra is the tube that carries urine from the bladder to the outside of the body. The urinary meatus is the external urethral orifice. In the male, the urethra is common to the urinary and reproductive systems; in the female, it belongs only to the urinary system.

Female Urethra

The female urethra is about 4 cm long, extending from the bladder to the external orifice.

Male Urethra

The male urethra is about 20 cm long and is divided into three parts: the prostatic, membranous, and penile portions.

PROSTATIC URETHRA—The prostatic urethra is surrounded by the prostate gland; it contains the orifices of the prostatic and ejaculatory ducts. This portion of the male urethra is about 2.5 cm long.

MEMBRANOUS URETHRA.—The membranous urethra is about 2 cm in length and is surrounded by the external urethral sphincter.

PENILE URETHRA.—The penile urethra, the longest portion, is about 15 cm long. It lies in the ventral portion of the penis. The urethra terminates with the external orifice at the tip of the penis.


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David L. Heiserman, Editor

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Revised: June 06, 2015