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22.4: Urinary Tract

  • Page ID
    22419
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    By the end of the section, you will be able to:

    • Identify the ureters, urinary bladder, and urethra, as well as their location, structure, histology, and function
    • Compare and contrast male and female urethras
    • Describe the micturition reflex

    Like the Digestive System with the digestive tract, the Urinary System also has a urinary tract, which includes the ureters, urinary bladder, and urethra. This section will start with urine excretion, tracing the flow of urine from the renal pelvis to ureter, urinary bladder, and urethra. Urine is a fluid of variable composition that requires specialized structures to remove it from the body safely and efficiently. Blood is filtered, and the filtrate is transformed into urine at a relatively constant rate throughout the day. This processed liquid is stored until a convenient time for excretion. All structures involved in the transport and storage of the urine are large enough to be visible to the naked eye. This transport and storage system not only stores the waste, but it protects the tissues from damage, prevents infection by foreign organisms, and for the male, provides reproductive functions.

    Ureters

    The kidneys and ureters are completely retroperitoneal, and the bladder has a peritoneal covering only over the dome. As urine is formed, it drains into the calyces of the kidney, which merge to form the funnel-shaped renal pelvis in the hilum of each kidney. The hilum narrows to become the ureter of each kidney. As urine passes through the ureter, it does not passively drain into the bladder but rather is propelled by waves of peristalsis. As the ureters enter the pelvis, they sweep laterally, hugging the pelvic walls. As they approach the bladder, they turn medially and pierce the bladder wall obliquely. This is important because it creates an one-way valve (a physiological sphincter rather than an anatomical sphincter) that allows urine into the bladder but prevents reflux of urine from the bladder back into the ureter. Children born lacking this oblique course of the ureter through the bladder wall are susceptible to “vesicoureteral reflux,” which dramatically increases their risk of serious UTI. Pregnancy also increases the likelihood of reflux and UTI.

    The ureters are approximately 30 cm long (Figure 22.4.1). The inner mucosa is lined with transitional epithelium and scattered goblet cells that secrete protective mucus. The muscular layer of the ureter consists of longitudinal and circular smooth muscles that create the peristaltic contractions to move the urine into the bladder without the aid of gravity. Finally, a loose adventitial layer composed of collagen and fat anchors the ureters between the parietal peritoneum and the posterior abdominal wall.

    Cross-section histology photo of ureter with major regions labeled.
    Figure 22.4.1: Ureter. Peristaltic contractions help to move urine through the lumen with contributions from fluid pressure and gravity. LM × 128; Micrograph provided by the Regents of the University of Michigan Medical School © 2012. (Image credit: "Ureter” by OpenStax is licensed under CC BY 3.0)

    Urinary Bladder

    The urinary bladder collects urine from both ureters (Figure 22.4.2). The bladder lies anterior to the uterus in females, posterior to the pubic bone and anterior to the rectum. During late pregnancy, its capacity is reduced due to compression by the enlarging uterus, resulting in increased frequency of urination. In males, the anatomy is similar, minus the uterus, and with the addition of the prostate inferior to the bladder. The bladder is partially retroperitoneal (outside the peritoneal cavity) with its peritoneal-covered “dome” projecting into the abdomen when the bladder is distended with urine.

    A, drawing of anterior view of lower urinary tract; B, histology photo of urinary bladder wall.
    Figure 22.4.2: Bladder. (a) Anterior cross section of the bladder. (b) The detrusor muscle of the bladder (source: monkey tissue) LM × 448; Micrograph provided by the Regents of the University of Michigan Medical School © 2012. (Image credit: “Bladder” by OpenStax is licensed under CC BY 3.0)

    Interactive Element

    The bladder is a highly distensible organ because the middle layer is comprised of irregular crisscrossing bands of smooth muscle collectively called the detrusor muscle. The interior surface is made of transitional cellular epithelium that is structurally suited for the large volume fluctuations of the bladder. When empty, it resembles columnar epithelia, but when stretched, it “transitions” (hence the name) to a squamous appearance (see Figure 22.4.2). Volumes in adults can range from nearly zero to 500–600 mL. The detrusor muscle contracts with significant force in the young. The bladder’s strength diminishes with age, but voluntary contractions of abdominal skeletal muscles can increase intra-abdominal pressure to promote more forceful bladder emptying. Such voluntary contraction is also used in forceful defecation and childbirth.

    Urethra

    The urethra transports urine from the bladder to the outside of the body for disposal. The urethra is the only urologic organ that shows any significant anatomic difference between males and females; all other urine transport structures are identical (Figure 22.4.3) The reproductive organs will be discussed in the next chapter for both male and female. The urinary structures are discussed in this chapter with more details to in the following paragraphs.

    Two drawings of midsagittal views of lower urinary tract of female in A and male in B.
    Figure 22.4.3: Female and Male Urethras. Urethra transports urine from the bladder to the outside of the body. This image shows (a) a female urethra and (b) a male urethra. (Image credit: “Female and Male Urethras” by OpenStax is licensed under CC BY 3.0)

    The urethra in both males and females begins inferior and central to the two ureteral openings forming the three points of a triangular-shaped area at the base of the bladder called the trigone (Greek tri- = “triangle” and the root of the word “trigonometry”). The urethra tracks posterior and inferior to the pubic symphysis (see Figure 22.4.3). In both males and females, the proximal urethra is lined by transitional epithelium, whereas the terminal portion is a nonkeratinized, stratified squamous epithelium. In the male, pseudostratified columnar epithelium lines the urethra between these two cell types. Voiding is regulated by an involuntary autonomic nervous system-controlled internal urinary sphincter, consisting of smooth muscle and voluntary skeletal muscle that forms the external urinary sphincter below it.

    Female Urethra

    The external urethral orifice is embedded in the anterior vaginal wall inferior to the clitoris, superior to the vaginal opening (introitus), and medial to the labia minora. Its short length, about 4 cm, is less of a barrier to fecal bacteria than the longer male urethra and the best explanation for the greater incidence of UTI in women. Voluntary control of the external urethral sphincter is a function of the pudendal nerve. It arises in the sacral region of the spinal cord, traveling via the S2–S4 nerves of the sacral plexus.

    Male Urethra

    The male urethra passes through the prostate gland immediately inferior to the bladder before passing below the pubic symphysis (see Figure 22.4.3b). The length of the male urethra varies between men but averages 20 cm in length. It is divided into four regions: the preprostatic urethra, the prostatic urethra, the membranous urethra, and the spongy or penile urethra. The preprostatic urethra is very short and incorporated into the bladder wall. The prostatic urethra passes through the prostate gland. During sexual intercourse, it receives sperm via the ejaculatory ducts and secretions from the seminal vesicles. Paired Cowper’s glands (bulbourethral glands) produce and secrete mucus into the urethra to buffer urethral pH during sexual stimulation. The mucus neutralizes the usually acidic environment and lubricates the urethra, decreasing the resistance to ejaculation. The membranous urethra passes through the deep muscles of the perineum, where it is invested by the overlying urethral sphincters. The spongy urethra exits at the tip (external urethral orifice) of the penis after passing through the corpus spongiosum. Mucous glands are found along much of the length of the urethra and protect the urethra from extremes of urine pH. Innervation is the same in both males and females.

    Micturition Reflex

    Micturition is a less-often used, but proper term for urination or voiding. It results from an interplay of involuntary and voluntary actions by the internal and external urethral sphincters. When bladder volume reaches about 150 mL, an urge to void is sensed but is easily overridden. Voluntary control of urination relies on consciously preventing relaxation of the external urethral sphincter to maintain urinary continence. As the bladder fills, subsequent urges become harder to ignore. Ultimately, voluntary constraint fails with resulting incontinence, which will occur as bladder volume approaches 300 to 400 mL.

    Nerves involved in the control of urination include the hypogastric, pelvic, and pudendal. Normal micturition is a result of stretch receptors in the bladder wall that transmit nerve impulses to the sacral region of the spinal cord to generate a spinal reflex. The resulting parasympathetic neural outflow causes contraction of the detrusor muscle and relaxation of the involuntary internal urethral sphincter. At the same time, the spinal cord inhibits somatic motor neurons, resulting in the relaxation of the skeletal muscle of the external urethral sphincter. The micturition reflex is active in infants but with maturity, children learn to override the reflex by asserting external sphincter control, thereby delaying voiding (potty training). This reflex may be preserved even in the face of spinal cord injury that results in paraplegia or quadriplegia. However, relaxation of the external sphincter may not be possible in all cases, and therefore, periodic catheterization may be necessary for bladder emptying.

    Drawing of a midsagittal view of the female pelvis showing the pudendal nerve exiting the sacrum and innervating the clitoris and vulva region.
    Figure 22.4.4: Female Pelvis with Nerves: Pudendal nerve is one nerve that innvervates this region. (Image credit: “Nerves Innervating the Urinary System” by OpenStax is licensed under CC BY 3.0).

    Concept Review

    The ureters are retroperitoneal and lead from the renal pelvis of the kidney to the trigone area at the base of the bladder. A thick muscular wall consisting of longitudinal and circular smooth muscle helps move urine toward the bladder by way of peristaltic contractions.The bladder is largely retroperitoneal and can hold up to 500–600 mL urine. The urethra is the only urinary structure that differs significantly between males and females. This is due to the dual role of the male urethra in transporting both urine and semen. The urethra arises from the trigone area at the base of the bladder. Urination is controlled by an involuntary internal sphincter of smooth muscle and a voluntary external sphincter of skeletal muscle. The shorter female urethra contributes to the higher incidence of bladder infections in females. The male urethra receives secretions from the prostate gland, Cowper’s gland, and seminal vesicles as well as sperm. Micturition is the process of voiding the urine and involves both involuntary and voluntary actions. Voluntary control of micturition requires a mature and intact sacral micturition center. It also requires an intact spinal cord. Loss of control of micturition is called incontinence and results in voiding when the bladder contains about 250 mL urine.

    Review Questions

    Q. Peristaltic contractions occur in the ________.

    A. urethra

    B. bladder

    C. ureters

    D. urethra, bladder, and ureters

    Answer

    Answer: C

    Q. What is the epithelium of the urinary bladder?

    A. stratified squamous

    B. transitional

    C. stratified cuboidal

    D. simple columnar

    Answer

    Answer: B

    Q. Which part of the urinary system is not completely retroperitoneal?

    A. kidneys

    B. ureters

    C. bladder

    D. nephrons

    Answer

    Answer: C

    Critical Thinking Questions

    Q. Why are females more likely to contract bladder infections than males?

    Answer

    A. The longer urethra of males means bacteria must travel farther to the bladder to cause an infection.

    Q. How can the bladder fill with urine while we sleep? Gravity is not helping this process.

    Answer

    A. Peristalsis will move the urine to the bladder, without the effect of gravity. The one-way valve allows the urine to enter the bladder but prevents reflux back into the ureter. Thus, the bladder fills up with urine over night.

    Glossary

    anatomical sphincter
    smooth or skeletal muscle surrounding the lumen of a vessel or hollow organ that can restrict flow when contracted
    detrusor muscle
    smooth muscle in the bladder wall; fibers run in all directions to reduce the size of the organ when emptying it of urine
    external urinary sphincter
    skeletal muscle; must be relaxed consciously to void urine
    internal urinary sphincter
    smooth muscle at the juncture of the bladder and urethra; relaxes as the bladder fills to allow urine into the urethra
    incontinence
    loss of ability to control micturition
    micturition
    also called urination or voiding
    physiological sphincter
    sphincter consisting of circular smooth muscle indistinguishable from adjacent muscle but possessing differential innervations, permitting its function as a sphincter; structurally weak
    retroperitoneal
    outside the peritoneal cavity; in the case of the kidney and ureters, between the parietal peritoneum and the abdominal wall
    sacral micturition center
    group of neurons in the sacral region of the spinal cord that controls urination; acts reflexively unless its action is modified by higher brain centers to allow voluntary urination
    trigone
    area at the base of the bladder marked by the two ureters in the posterior–lateral aspect and the urethral orifice in the anterior aspect oriented like points on a triangle
    urethra
    transports urine from the bladder to the outside environment

    Contributors and Attributions


    This page titled 22.4: Urinary Tract is shared under a CC BY license and was authored, remixed, and/or curated by Whitney Menefee, Julie Jenks, Chiara Mazzasette, & Kim-Leiloni Nguyen (ASCCC Open Educational Resources Initiative) .