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
3
4
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
6
7
1: Colon ascendens2: Colon descendens3: M. psoas major4: Papilla renalis
5: Pelvis renalis6: Ren sinister, Extremitas inferior7: Ureter
8
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)
9
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
17
Pyramid:The base (fundus)
triangularThe two inferolateral
surface corpusApex
The bladder neck urethra
19
20
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)
22
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)
23
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
Selamat Belajar