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Surgical Anatomy of the

surgical anatomy of the Retroperitoneum, Adrenals,Kidneys, and Ureters

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There is no greater aid to surgical expertise than an intimate knowledge of anatomy. For the urologist, the areas of greatest importance are the retroperitoneum and pelvis.

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l The lower ribs are in intimate contact with the kidneys andadrenal glands. Injury to the lower ribs suggests injury toretroperitoneal structures.

l The renal artery lies posterior to the renal vein, but thisrelationship is reversed when the aorta and inferior venacava divide into the common iliac vessels. Here, the commoniliac arteries are anterior to the common iliac veins.

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Psoas and Iliacus MusclesThe psoas major muscle originates on the 12th thoracic through

the 5th lumbar vertebrae . A smaller psoas minor isidentifiable in about one half of the population and resides medialto the psoas major. The psoas muscle(s) is covered by the psoasfascia.

In close proximity to the psoas muscle is the iliacus muscle,which attaches to the inner aspect of the iliac pelvic wing.

As theiliacus progresses caudally it joins with the psoas muscle to formthe iliopsoas muscle. This combined muscle then joins to thelesser trochanter of the femur and controls flexion of the hip.

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ExternalobliqueLower eight ribs Lateral lip ofiliac crest,

aponeurosisending inmidline rapheCompressabdominalcontents,

flexion ofthe trunkInternalobliqueLumbodorsalfascia, iliaccrestLower 4 ribs,

aponeurosisending inlinea albaCompressabdominalcontents,

flexion ofthe trunk

•Transversus•abdominis•Lumbodorsal•fascia, medial•lip of iliac crest•Aponeurosis•ending in•linea alba•Compress•abdominal•contents

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