Anatomy notes

Prostate:
Blood supply:
 Prostatic arteries are branches of inferior vesical arteries, internal pudendal and middle rectal
arteries, which are all branches from internal iliac.
 The prostatic venous plexus is continuous superiorly with the vesical venous plexus and
communicates posteriorly with the internal vertebral venous plexus.
Nerve supply: inferior hypogastric plexus.
Lymphatic drainage: internal iliac lymph nodes.

Urethra:
Blood supply:
- Pre-prostatic and prostatic urethra: arterial supply by
prostatic branches of inferior vesical and middle rectal
arteries. Venous drainage is by the prostatic venous plexus.
- The bulbourethral artery supplies the membranous and
bulbar urethra.
- The penile urethra is supplied by the deep penile artery, a branch of the internal pudendal artery. In
general, venous drainage mirrors the arterial supply.
- Female urethra: internal pudendal and vaginal arteries. Veins follow the arteries and have the same
names.
Nervous supply:
- Male urethra: nervous supply by prostatic nervous plexus, which is an extension of inferior
hypogastric plexus and pudendal nerve (external urethral sphincter). The internal sphincter is supplied
by greater cavernous sympathetic nerves.
- Female urethra: vesical nervous plexus and pudendal nerve (external urethral sphincter, no internal
sphincter in females).
Lymphatic drainage:
- The prostatic and membranous urethra drain to the obturator and internal iliac nodes.
- Lymphatic drainage from the spongy urethra (mostly the anterior part) drains to the deep and
superficial inguinal nodes.

Urethra parts

Pre-prostatic About 1 cm long.

urethra. Extends from the base of the bladder to the prostate.
Associated with the internal urethral sphincter.
Contraction of this sphincter prevents movement of semen into the bladder during ejaculation.

Prostatic 3-4 cm long and surrounded by the prostate.

urethra The lumen of the prostatic urethra contains a longitudinal fold of mucosa  urethral crest.
(widest). The depression on both sides of the urethral crest  prostatic sinuses.
The ducts of the prostate empty in the prostatic sinuses.
Midway along its length, the urethral crest is enlarged  seminal colliculus (also called
verumontanum).
2 structures open into the seminal colliculus (verumontanum):
 Prostatic utricle: remnant of uterus in males (during early fetal life everyone was female).
 Openings of the 2 ejaculatory ducts.
- Therefore the connection between urinary and reproductive tracts in males occurs in
prostatic urethra.
 Membranou Passes through the deep perineal pouch (between superior and inferior fascias of
s urethra urogenital/pelvic diaphragm)
(shortest and Surrounded by skeletal muscle of external urethral sphincter (sphincter urethrae muscle) in
most both males and females.
delicate).

Spongy  Bulbar (bulbous) portion of spongy urethra (prone to tear in straddle injury).
urethra: *** mechanism of straddle injury: occurs to the groin area between the thighs, in female 
injury to the vulva, in males  scrotum, penis, testes. An example is falling while riding a
bicycle and hitting the middle bar.
 Penile portion of spongy urethra (longest part).
Surrounded by erectile tissue of the penis (corpus spongiosum)  increased blood flow in this
tissue is what causes erection.
Both the external urinary and external anal sphincters are innervated by the pudendal nerve (S2, S3, S4).
Note: sympathetic innervation causes ejaculation, while parasympathetic innervation causes erection.

Ureter:
- Blood supply: branches divide into superior and inferior and anastomose together.
 Upper part: branches from renal artery.
 Middle part: branches from abdominal aorta, gonadal (testicular/ovarian) artery, common iliac
artery.
 Lower part: branches from internal iliac artery.
- The blood supply is very rich so anything causing damage to the ureter will cause severe bleeding.

- Blood supply: branches divide into superior and inferior and anastomose together.
 Upper part: branches from renal artery.
 Middle part: branches from abdominal aorta, gonadal (testicular/ovarian) artery, common iliac
artery.
 Lower part: branches from internal iliac artery.
- The blood supply is very rich so anything causing damage to the ureter will cause severe bleeding.

Constrictions of ureter:
1. ureteropelvic junction.
2. bifurcation of common iliacs = level of the pelvic brim, which separates the true pelvis from the false
pelvis
3. ureterovesical junction (as it enters the bladder).

Bladder:
- Arterial supply:
 Males: superior vesical arteries + inferior vesical arteries.
 Females: superior vesical arteries + vaginal arteries.
 There is also a contribution from obturator and inferior gluteal arteries.
- Venous drainage:
 In males the vesical venous plexus is enveloping the base of the bladder, it is connected to the
prostatic venous plexus and drains into the inferior vesical veins  internal iliac veins, or it can
drain directly into the internal vertebral venous plexuses.
 In females the vesical venous plexus envelops the neck of the bladder and the pelvic part of the
urethra and communicates with the vaginal or uterovaginal venous plexus.
- Nerve supply:
 Sympathetic: T11-L2 or L3  inferior mesenteric ganglion  hypogastric plexuses  vesical
plexus.
 Parasympathetic: S2-S4  inferior hypogastric plexus  vesical plexus.
  Sympathetic causes ejaculation, while parasympathetic causes erection (discussed in next
lecture).
 Sympathetic innervation contracts (closes) the internal urethral sphincter in males, and relaxes
the detrusor muscle to inhibit excretion of urine.
 Parasympathetic innervation on the other hand relaxes (opens) the internal urethral sphincter,
and contracts the detrusor muscle to cause excretion of urine.
 Sensory fibers for pain sensation follow parasympathetic nerves, except the superior surface of
the bladder = sympathetic.

Lymphatics: Lateral vesical lymph nodes  internal/external iliac lymph nodes  common iliac lymph nodes.

Kidneys:
Blood supply:
- The right renal artery is longer than the left and passes posterior to the vena cava.
- Left renal artery is a little more superior than the left, both of them emerge at level L1/L2.
- The renal veins are anterior to the renal arteries.
- The left renal vein is longer and can be compressed by superior mesenteric artery, which crosses over it.

Nerves/ lymphatics:
- Drained by lateral aortic (lumbar) nodes around the origin of the renal artery.
- Efferent (motor) innervation: sympathetic branches T10-L2.
- Afferent (sensory) innervation/pain: least splanchnic nerve (sympathetic T12), referred pain: flanks (in the
back between the last rib and the iliac crest).

Coverings of the kidney:

- Deep to superficial:
 Fibrous capsule: directly covering the kidney.
 Perinephric/perirenal fat, around kidneys and suprarenal/adrenal glands.
 Extraperitoneal fascia/ renal fascia (Gerota’s fascia): encloses kidneys as well as suprarenal/
adrenal glands and hilum, a membranous layer. Fuses with transversalis fascia, fascia covering
the diaphragm, quadratus lamborum fascia, and psoas major fascia.
 Paranephric/pararenal fat: not a continuous layer, posterior and posterolateral to each kidney.
- Ptosis of the kidney: happens in conditions such as (starvation, diabetes, cancer) when the paranephric &
perinephric layers of fat covering the kidney go away, so the kidney drops = ptosis.

Calculations:
1. Filtration rate (mg/min) = glomerular filtration rate (ml/min) x plasma concentration (mg/mL) .
2. Urinary excretion rate= Us (urine concentration) (mg/mL) x V (urine flow rate) (mL/min)
3. Urinary Excretion Rate of Substance = Filtration Rate + Secretion Rate – Reabsorption Rate.
o Urinary excretion rate of substance= Filtration Rate (creatinine)
o Urinary excretion rate of substance= Filtration Rate- Reabsorption Rate (sodium)
o Urinary excretion rate of substance= Filtration Rate- Reabsorption completely (glucose)
o Urinary excretion rate of substance= Filtration Rate + secretion (Organic acids and bases)
4. Renal Plasma Flow RPF= Us (urine concentration) (mg/mL) x V (urine flow rate) (mL/min)/ Ps (plasma
concentration) (mg/mL)
 PAH: RPF= 5.85 x 1 / 0.01 = 585 ml/min
 Correction factor is 0.9
 ∴ RPF=585/0.9 = 650 ml/min
5. Filtration Fraction = GFR/ RPF
6. Henderson-Hasselbalch equation: pH = 6.1 + log [HCO3- / 0.03 x PCO2]
7. Plasma anion gap (mEq/L ) = [Na+] – [HCO3 –] – [Cl-]
8. Q = ∆ P /R
∆ P = difference in hydrostatic pressure between artery and vein, R= resistance.
9. GFR (ml/min) = net filtration pressure x filtration coefficient K f