sistem urinarius- anatomi klinis- bl 16 2009

Siti Aminah TSEBagian Anatomi

Fakultas Kedokteran UMY

SISTEM URINARIAANATOMI KLINIS

Tujuan pembelajaranSistem Urinaria

Tujuan pembelajaranSistem Urinaria

Menyebutkan fungsi setiap organ yang terlibat pada sistem urinarius

Menjelaskan vaskularisasi yang berhubungan dengan filtrasi glomerulus

Menjelaskan struktur makroanatomi renMenjelaskan struktur nefron pada cortex dan

medulla renalis Mejelaskan letak, struktur dan fungsi ureterMejelaskan letak, struktur dan inervasi vesicae

urinariaMenjelaskan perbedaan struktur anatomi

urethrae laki-laki dan wanitaMenjelaskan berbagai kepentingan klinis pada organ

sistem urinaria

Menyebutkan fungsi setiap organ yang terlibat pada sistem urinarius

Menjelaskan vaskularisasi yang berhubungan dengan filtrasi glomerulus

Menjelaskan struktur makroanatomi renMenjelaskan struktur nefron pada cortex dan

medulla renalis Mejelaskan letak, struktur dan fungsi ureterMejelaskan letak, struktur dan inervasi vesicae

urinariaMenjelaskan perbedaan struktur anatomi

urethrae laki-laki dan wanitaMenjelaskan berbagai kepentingan klinis pada organ

sistem urinaria

Organ Penyusun Sistema Urinaria

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Sistem Urinaria•Ren•Tractus urinarius (pelvis renalis, ureter, vesicae urnaria, urethra)

REN

Letak pada dinding posterior abdomenRen sinister terletak setinggi costae 11-12, atau VT 12-VL1Ren dexter terletak setinggi costae 12 atau VL 1-2Ukuran 5x10x4 cm, 120-300 g

Struktur Ren

Hilus A . Renalis (A.

Abdominalis- VL2) V. Renalis (V. Cava inferior) Ureter

Cortex : tubulus contortus proximal & distal

Medulla : piramis renalis; ansa Henle, ductus colectivus papilla renalis

3-4 calyx minor calix major

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1: Colon ascendens2: Colon descendens3: M. psoas major4: Papilla renalis

5: Pelvis renalis6: Ren sinister, Extremitas inferior7: Ureter

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Inervasi Ren Inervasi Ren

Saraf simpatis dari MS T11 – L2 n. Splancnicus lumbalis & thoracalis serabut saraf postganglion menuju ke A. renalis (aliran darah arteri ke glomerulus)

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Anatomi klinis : RENAnatomi klinis : REN

Kelainan embrional :“Horseshoe kidney” the

two developing kidneys make contact & fuse united at their lower poles prevents normal ascent unable to pass the origin of inferior mesenteric artery

Persistance of fetal lobulation of the kidney surface into adult rare

Agenesis of the ren, aplasiaRen ectopic

Horseshoe kidney

Lobulated kidney

Anatomi klinis : RENAnatomi klinis : REN

Damage to the kidneyKidneys: lie deeply on

the posterior abdominal wall not easily damaged

Fractures of the lower ribs, penetrating wounds in the lumbar region produce kidney damage

Fig. 41 Projection of the internal organs onto the surface of the body;

dorsal view

UreterMengalirkan urin dari

pelvis renalis vesicae urinaria,

Peristaltik, 3-5 kali/menit, 1-4 ml/menit.

Pipa muskuler, d 3-5 mm, p 25-30 cm

3 penyempitan (pembentukan batu ureter) :Ureteropelvina

junctionMenyilang a. iliaca

communisMelewati dinding

vesicae urinaria13

Vaskularisasi Dan InervasiVaskularisasi Dan InervasiDarah arteri :

A. renalis, cabang aorta abdominalis, A. gonade, A.iliaca communis, a. iliaca interna, A. vesicalis inferior

Darah vena : menuju ke v. renalis, v. iliaca interna, v. vesicalis inferior

Nerve supply:Simpatis VT11 – VL1Parasimpatis VS 2-4Sebagai serabut sensoris:

Peregangan dinding ureterPenuh kontraksi spasme

Nyeri / akut abdomen(kolik ureter)

The Ureters: Clinical NotesThe Ureters: Clinical NotesEmbryological abnormalities

Reduplication of the uretersPresence of an ectopic or acessory renal

artery compress the ureter dilatation of the pelvis of ureter and the calyces hydronephrosis

Enlargement of the prostate glandEnlargement of the prostate gland in

ageing males increases pressure of urine within the bladder dilatation of the ureters difficulty in emptying

Infection From the bladder to ureters

Embryological abnormalitiesReduplication of the uretersPresence of an ectopic or acessory renal

artery compress the ureter dilatation of the pelvis of ureter and the calyces hydronephrosis

Enlargement of the prostate glandEnlargement of the prostate gland in

ageing males increases pressure of urine within the bladder dilatation of the ureters difficulty in emptying

Infection From the bladder to ureters

Vesicae Urinaria

Organ retroperitoneal pada cavum pelvis,

Di belakang symphisis pubis

Ukuran tergantung isi urine (300-500 ml miksi)

Dinding : tunica mukosa, tunica muscularis (otot polos), tunica serosa

Trigonum vesicae : tunica mukosa melekat erat pada lapisan otot

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Pyramid:The base (fundus)

triangularThe two inferolateral

surface corpusApex

The bladder neck urethra

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Urethrae Urethrae • Pipa muskuler dari vesicae urinaria • Laki-laki & wanita, berbeda dalam panjang dan fungsi

• 20-25 cm : 3-5 cm• Saluran urogenital ; saluran urin

Urethrae laki-laki :Pars prostatica (3 cm) (str. kolumner berlapis)Pars membranacae (str. kolumner berlapis)Pars spongiosa (str. kolumner berlapis str, skuamosa pada gland penis)

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Inervasi Vesicae Urinaria

• MS S2-4 cornu lateralis Saraf parasimpatis (n. splancnichus pelvicum) kontraksi m. detrusor vesicae (saraf sensoris dari dinding vesicae urinaria berjalan bersama serabut saraf parasimpatis ini) dan relaksasi m. sphincter vesicae interna

• MS T10 - L2 Saraf simpatis (plexus hypogastricus) relaksasi m. detrusor vesicae dan kontraksi m. sphincter vesicae interna

• MS S1-2 cornu anterior saraf motoris (n. Pudendus) m. sphincter urethrae (m. sphincter vesicae externa)

• MS S2-4 cornu lateralis Saraf parasimpatis (n. splancnichus pelvicum) kontraksi m. detrusor vesicae (saraf sensoris dari dinding vesicae urinaria berjalan bersama serabut saraf parasimpatis ini) dan relaksasi m. sphincter vesicae interna

• MS T10 - L2 Saraf simpatis (plexus hypogastricus) relaksasi m. detrusor vesicae dan kontraksi m. sphincter vesicae interna

• MS S1-2 cornu anterior saraf motoris (n. Pudendus) m. sphincter urethrae (m. sphincter vesicae externa)

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Vaskularisasi dan Inervasi

Arterial supply: a. vesicalis inferior, a. profunda penis, a. urethralis

MICTURITIONPressure within the bladder rise afferent

impulses n. splanchnicus pelvicus S2-4 parasympathetic motor: contraction of m.

detrussor, relaxation of m. sphincter vesicaeSomatic fibre relaxation of m. sphincter

urethraRelaxation of the pelvic floor musclesFull contraction of the detrussor assisted by the

muscle of the anterior wall and diaphragmaThe ability to stop the flow of urine

voluntary in midstream:Contraction of the intrinsic striated sphincterContraction of the pelvic floor

Obstruction to urine flow in the male

After the age of 45-50 years the prostate gland very frequently enlarges

Consequence:The tissue pressure on the walls of the prostatic urethra rises the detrussor muscle has to raise pressure to force urine out detrussor muscle hypertrophies:Fail to empty the bladder completelyThe urine stream has less force

Residual urine after micturition:

Obstruction to urine flow in the maleObstruction to urine flow in the male

Residual urine after micturition:The time that elapses before the desire to pass

urine again becomes shorterInfection of the bladder: cystitis

Enlarged bladder & persistently high intraluminal pressures difficult for the ureters to empty: hydroureter hydronephrosisInfection ascend from the bladder

The final stage of prostatic enlargement complete inability to pass urine: acute retention of urine

Residual urine after micturition:The time that elapses before the desire to pass

urine again becomes shorterInfection of the bladder: cystitis

Enlarged bladder & persistently high intraluminal pressures difficult for the ureters to empty: hydroureter hydronephrosisInfection ascend from the bladder

The final stage of prostatic enlargement complete inability to pass urine: acute retention of urine

Stress incontinence in the femaleStress incontinence in the femaleChildbirth perineal tears weakening

the pelvic floor fails to support the mechanism that normally maintain continence stress incontinenceLaughing, coughing, sneezing

produce a dribble of urineBy contrast: retention of urine (relatively

common in males after middle age) not a problem in females

Childbirth perineal tears weakening the pelvic floor fails to support the mechanism that normally maintain continence stress incontinenceLaughing, coughing, sneezing

produce a dribble of urineBy contrast: retention of urine (relatively

common in males after middle age) not a problem in females

Injury to the spinal cordInjury to the spinal cordInjuries to the spinal cord (V L-S)

(paraplegia, complete transection of the cord) awareness of bladder filling: (-) bladder empties itself automatically (without warning)

Injuries to the spinal cord (V L-S) (paraplegia, complete transection of the cord) awareness of bladder filling: (-) bladder empties itself automatically (without warning)

ORGANA GENITALIA MASCULINAOrgana Genitalia Masculina Externa:

ScrotumPenis

Organa Genitalia Masculina Interna:TestisEpididymisDuctus deferensDuctus ejaculatoriusUrethraGlandula seminalisGlandula prostat

Tujuan pembelajaran Organa Genitalia Masculina

Tujuan pembelajaran Organa Genitalia Masculina

Menyebutkan letak dan fungsi setiap organ yang terlibat pada sistem genitalia masculina

Menjelaskan struktur anatomi, vaskularisasi dan inervasi scrotum

Menjelaskan struktur dan fungsi ductus defferens dan ductus ejaculatorius

Menjelaskan struktur dan fungsi vesicula seminalis dan glandula prostata

Menjelaskan struktur, vaskularisasi dan inervasi urethrae laki-laki

Menjelaskan berbagai kepentingan klinis pada organ genitalia masculina.

Menyebutkan letak dan fungsi setiap organ yang terlibat pada sistem genitalia masculina

Menjelaskan struktur anatomi, vaskularisasi dan inervasi scrotum

Menjelaskan struktur dan fungsi ductus defferens dan ductus ejaculatorius

Menjelaskan struktur dan fungsi vesicula seminalis dan glandula prostata

Menjelaskan struktur, vaskularisasi dan inervasi urethrae laki-laki

Menjelaskan berbagai kepentingan klinis pada organ genitalia masculina.

Scrotum Soft & mobile pouch:

TestisEpidydimisFuniculus spermaticus

Scrotum Scrotum Scrotal subcutaneous tissue:

Almost completely devoid of fat heat lossSmooth muscle fibres tunica dartos

Nerves:Anterior part L1Posterior part S2, S3, S4

Vessels:A. pudenda interna, branch from a.

femoralis, a. epigastrica infLymphatic drainage: nll. Inguinalis

superficialis

Scrotal subcutaneous tissue:Almost completely devoid of fat heat lossSmooth muscle fibres tunica dartos

Nerves:Anterior part L1Posterior part S2, S3, S4

Vessels:A. pudenda interna, branch from a.

femoralis, a. epigastrica infLymphatic drainage: nll. Inguinalis

superficialis

The scrotum: clinical notesThe scrotum: clinical notesIndirect inguinal hernia hernia

scrotalisReferred pain from ureter

Indirect inguinal hernia hernia scrotalis

Referred pain from ureter

Penis Penis Pars fixa = radix penis

pelvis (ischiopubic rami)Pars libera Corpus

penis:2 corpora cavernosa penis

– crus penis1 corpus spongiosa penis –

bulbus penis – glans penis

Pars fixa = radix penis pelvis (ischiopubic rami)

Pars libera Corpus penis:2 corpora cavernosa penis

– crus penis1 corpus spongiosa penis –

bulbus penis – glans penis

Penis Penis The skin:

Praeputium cover the glans attached to the groove (proximal limit of the glans): sulcus coronarius

Frenulum preputiiCircumcision remove the praeputium

Fascia & ligaments:Ligamentum fundiforme line albaLigamentum suspensorium symphysis

pubis

The skin:Praeputium cover the glans

attached to the groove (proximal limit of the glans): sulcus coronarius

Frenulum preputiiCircumcision remove the praeputium

Fascia & ligaments:Ligamentum fundiforme line albaLigamentum suspensorium symphysis

pubis

Penis Penis Nerves:

Sympathetic fibres pelvic plexus vasoconstriction

Parasympathetic fibres (S2-4) vasodilatation erection

N. pudendus m. ischiocavernosus & m. bulbospongiosus, the skin

Vessels:Arterial supply: A. pudenda interna

supply the erectile tissueVenous drainage: v. dorsalis penis

Lymphatic drainage: nll. Inguinalis superficialis

Nerves:Sympathetic fibres pelvic plexus

vasoconstrictionParasympathetic fibres (S2-4)

vasodilatation erectionN. pudendus m. ischiocavernosus &

m. bulbospongiosus, the skinVessels:

Arterial supply: A. pudenda interna supply the erectile tissue

Venous drainage: v. dorsalis penisLymphatic drainage: nll. Inguinalis

superficialis

Penis

Testis and EpididymisTestis and Epididymis

Within the scrotumOvoid: 4x3x2,5cmMesorchium Inferior of the testis (remain of the gubernaculum)

Within the scrotumOvoid: 4x3x2,5cmMesorchium Inferior of the testis (remain of the gubernaculum)

Testis and its ductsTestis and its ductsTunica albuginea

fibrous septa lobes – tubulus seminiferus mediastinum straight tubules efferent tubules epididymis

The covering of the testis:Tunica vaginalis – internal

spermatic fascia – fascia cremasterica (m. cremaster) – exernal spermatic fascia

Tunica albuginea fibrous septa lobes – tubulus seminiferus mediastinum straight tubules efferent tubules epididymis

The covering of the testis:Tunica vaginalis – internal

spermatic fascia – fascia cremasterica (m. cremaster) – exernal spermatic fascia

Epidydimidis Epidydimidis Storing and maturation

of the sperms Parts: caput, corpus,

caudaCauda epidydimidis

ductus deferens

Storing and maturation of the sperms

Parts: caput, corpus, cauda

Cauda epidydimidis ductus deferens

Nerves & vessels Nerves & vessels Nerve supply:

Mainly sympathetic T10 blood vessels

Arterial supply: a. testicularisVenous drainage: plexus

pampiniformisLymphatic drainage: nll. paraaorta

Nerve supply:Mainly sympathetic T10 blood vessels

Arterial supply: a. testicularisVenous drainage: plexus

pampiniformisLymphatic drainage: nll. paraaorta

Funiculus spermaticusFuniculus spermaticusStructures:

A. testicularisPlexus pampiniformisDuctus deferensLymphatics from the

testisThe autonomic nerves to

the testisThe genital branch of n.

genitofemoralisAnulus inguinalis

profundus canalis inguinalis anulus inguinalis superficialis

Structures:A. testicularisPlexus pampiniformisDuctus deferensLymphatics from the

testisThe autonomic nerves to

the testisThe genital branch of n.

genitofemoralisAnulus inguinalis

profundus canalis inguinalis anulus inguinalis superficialis

Testis: clinical notesTestis: clinical notesCongenital disorders:

undescensus testicularumRetain of complete peritoneal pouch congenital inguinal hernia

Exposed position liable to damage

Hydrocele (serous fluid in the tunica vaginalis) fluctuation

Congenital disorders: undescensus testicularumRetain of complete peritoneal pouch congenital inguinal hernia

Exposed position liable to damage

Hydrocele (serous fluid in the tunica vaginalis) fluctuation

Ductus deferens Ductus deferens Cauda

epidydimis – ductus ejaculatorius

45 cm long

Cauda epidydimis – ductus ejaculatorius

45 cm long

Ductus ejaculatoriusDuctus ejaculatoriusThe uniting of the

ductus deferens + ductus excretorius vesicula seminalis

urethrae pars prostata

The uniting of the ductus deferens + ductus excretorius vesicula seminalis

urethrae pars prostata

Glandula SeminalisGlandula Seminalis

Lie in the interval between the base of the bladder anteriorly and the rectum posteriorly

Secrete a sticky, yellowish fluid which rich in fruktose

Lie in the interval between the base of the bladder anteriorly and the rectum posteriorly

Secrete a sticky, yellowish fluid which rich in fruktose

Glandula ProstataGlandula Prostata

Cone-shape, 4x3x2,5cmInferior vesica urinaria

urethrae pars prostaticaSecret alkalis5 Lobes: anterior,

posterior, lateralis (2), medialis

Internal structure:Colliculus seminalisSinus prostaticus

Cone-shape, 4x3x2,5cmInferior vesica urinaria

urethrae pars prostaticaSecret alkalis5 Lobes: anterior,

posterior, lateralis (2), medialis

Internal structure:Colliculus seminalisSinus prostaticus

Nerves & vesselsNerves & vesselsNerve supply: secretion of the

glandsSympathetic – L1Parasympathetic – S2-4

Arterial supply: a. vesicalis inf, a. rectalis med, a. pudenda interna

Venous drainage:Plexus vesicoprostaticus v. iliaca internaV. sacralis

Lymphatic drainage: nll. Iliaca interna, nll. sacralis

Nerve supply: secretion of the glandsSympathetic – L1Parasympathetic – S2-4

Arterial supply: a. vesicalis inf, a. rectalis med, a. pudenda interna

Venous drainage:Plexus vesicoprostaticus v. iliaca internaV. sacralis

Lymphatic drainage: nll. Iliaca interna, nll. sacralis

The prostate: clinical notes

Benign enlargement of the prostate:Extremely common in men after the age

of 60Symptoms compression of the

urethra:Urinary stream weakerPressure within bladder to force urine past the

obstruction vesical muscles hypertrophies still fails to empty the bladder completely:InfectionsTerminal dribblingFrekuensi Acute retention of urine

Carcinoma of the prostate

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