SISTEM URINARIA ANATOMI KLINIS

Siti Aminah TSE Bagian Anatomi Fakultas Kedokteran UMY

Tujuan pembelajaran Sistem Urinaria

Menyebutkan fungsi setiap organ yang terlibat pada

sistem urinarius Menjelaskan vaskularisasi yang berhubungan dengan filtrasi glomerulus Menjelaskan struktur makroanatomi ren Menjelaskan struktur nefron pada cortex dan medulla renalis Mejelaskan letak, struktur dan fungsi ureter Mejelaskan letak, struktur dan inervasi vesicae urinaria Menjelaskan perbedaan struktur anatomi urethrae laki-laki dan wanita Menjelaskan berbagai kepentingan klinis pada organ sistem urinaria

Organ Penyusun Sistema Urinaria

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

REN
Letak pada dinding posterior abdomen Ren sinister terletak setinggi costae 11-12, atau VT 12-VL1 Ren dexter terletak setinggi costae 12 atau VL 1-2 Ukuran 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 6 3-4 calyx minor

1: Colon ascendens 2: Colon descendens 3: M. psoas major 4: Papilla renalis

5: Pelvis renalis 6: Ren sinister, Extremitas inferior 7: Ureter

Inervasi Ren
Saraf simpatis dari

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

Anatomi 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, aplasia Ren ectopic

Horseshoe kidney

Lobulated kidney

Anatomi klinis : REN

Damage to the

kidney
Kidneys: 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

Ureter
Mengalirkan 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 junction Menyilang a. iliaca communis Melewati dinding vesicae urinaria
13

Vaskularisasi Dan Inervasi

Darah 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 VL1 Parasimpatis VS 2-4 Sebagai serabut sensoris: Peregangan dinding ureter Nyeri / akut abdomen Penuh kontraksi spasme (kolik ureter)

The Ureters: Clinical Notes

Embryological abnormalities Reduplication of the ureters Presence of an ectopic or acessory renal artery compress the ureter dilatation of the pelvis of ureter and the calyces hydronephrosis Enlargement of the prostate gland Enlargement of the prostate gland in ageing males increases pressure of urine within the bladder dilatation of the ureters difficulty in emptying Infection

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

17

mukosa melekat erat pada lapisan otot

 Pyramid: The base (fundus) triangular The two inferolateral surface corpus Apex The bladder neck

urethra

19

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)
20

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)

22

23

Vaskularisasi dan Inervasi

Arterial

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

MICTURITION
Pressure within the bladder rise afferent

impulses n. splanchnicus pelvicus S2-4

parasympathetic motor: contraction of m. detrussor,

relaxation of m. sphincter vesicae Somatic fibre relaxation of m. sphincter urethra Relaxation of the pelvic floor muscles Full contraction of the detrussor assisted by the muscle of the anterior wall and diaphragma
The ability to stop the flow of urine voluntary

in midstream:
Contraction of the intrinsic striated sphincter Contraction 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 completely The urine stream has less force

Residual urine after micturition:

Obstruction to urine flow in the male

Residual urine after micturition: The time that elapses before the desire to pass urine again becomes shorter Infection of the bladder: cystitis

Enlarged bladder & persistently high

intraluminal pressures difficult for the ureters to empty:

hydroureter hydronephrosis Infection ascend from the bladder

The final stage of prostatic enlargement

complete inability to pass urine: acute

Stress incontinence in the female

Childbirth perineal tears weakening the

pelvic floor fails to support the mechanism that normally maintain continence stress incontinence Laughing, coughing, sneezing produce a dribble of urine By contrast: retention of urine (relatively common in males after middle age) not a problem in females

Injury to the spinal cord

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 MASCULINA

Organa Genitalia Masculina Externa: Scrotum Penis Organa Genitalia Masculina Interna: Testis Epididymis Ductus deferens Ductus ejaculatorius Urethra Glandula seminalis Glandula prostat

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.

Scrotum
Soft & mobile pouch: Testis Epidydimis Funiculus spermaticus

Scrotum
Scrotal subcutaneous tissue: Almost completely devoid of fat heat loss Smooth muscle fibres tunica dartos Nerves: Anterior part L1 Posterior part S2, S3, S4 Vessels: A. pudenda interna, branch from a. femoralis, a. epigastrica inf Lymphatic drainage: nll. Inguinalis

superficialis

The scrotum: clinical notes

Indirect inguinal hernia hernia

scrotalis Referred pain from ureter

Penis
Pars fixa = radix penis

pelvis (ischiopubic rami) Pars libera Corpus penis:

2 corpora cavernosa penis

crus penis 1 corpus spongiosa penis bulbus penis glans penis

Penis
The skin: Praeputium cover the glans attached to the groove (proximal limit of the glans): sulcus coronarius Frenulum preputii Circumcision remove the praeputium Fascia & ligaments: Ligamentum fundiforme line alba Ligamentum suspensorium symphysis pubis

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 tissue Venous drainage: v. dorsalis penis Lymphatic drainage: nll. Inguinalis

superficialis

Penis

Testis and Epididymis

Within the scrotum
Ovoid: 4x3x2,5cm Mesorchium

Inferior of the testis

(remain of the gubernaculum)

Testis and its ducts

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

Epidydimidis
Storing and maturation of

the sperms Parts: caput, corpus, cauda Cauda epidydimidis ductus deferens

Nerves & vessels

Nerve supply: Mainly sympathetic T10 blood

vessels Arterial supply: a. testicularis Venous drainage: plexus pampiniformis Lymphatic drainage: nll. paraaorta

Funiculus spermaticus
Structures: A. testicularis Plexus pampiniformis Ductus deferens Lymphatics from the testis The autonomic nerves to the testis The genital branch of n. genitofemoralis Anulus inguinalis

profundus canalis inguinalis anulus

Testis: clinical notes

Congenital disorders: undescensus testicularum Retain of complete peritoneal pouch

congenital inguinal hernia Exposed position liable to damage Hydrocele (serous fluid in the tunica vaginalis) fluctuation

Ductus deferens
Cauda epidydimis

ductus ejaculatorius 45 cm long

Ductus ejaculatorius
The uniting of the

ductus deferens + ductus excretorius vesicula seminalis urethrae pars prostata

Glandula 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

Glandula Prostata
Cone-shape, 4x3x2,5cm

Inferior vesica urinaria

urethrae pars prostatica Secret alkalis 5 Lobes: anterior, posterior, lateralis (2), medialis Internal structure:
Colliculus seminalis

Sinus prostaticus

Nerves & vessels

Nerve supply: secretion of the glands Sympathetic L1 Parasympathetic S2-4 Arterial supply: a. vesicalis inf, a. rectalis

med, a. pudenda interna Venous drainage:

Plexus vesicoprostaticus v. iliaca interna V. 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 60 Symptoms compression of the urethra: Urinary stream weaker Pressure within bladder to force urine past the obstruction vesical muscles hypertrophies still fails to empty the bladder completely: Infections Terminal dribbling Frekuensi Acute retention of urine Carcinoma of the prostate

Selamat Belajar