Arbaminch College of Health Sciences

Department of Clinical Nursing

UNIT TEN
URINARY SYSTEM

10.1. Introduction to the Urinary System

The urinary system is a regulatory system which maintains the purity and constancy
of internal fluids. The urinary system bears the major responsibility for the
elimination of nitrogenous wastes, toxins, and drugs from the body. It also regulates
the volume and chemical make up of blood. Besides, kidneys produce enzyme
(rennin) which help regulate BP, and hormone (erythropoietin) which stimulates RBC
production. Kidney cells also convert vitamin D to its active form.

The urinary system consists of:

 Two kidneys
 Two ureters
 One urinary bladder

By: Mesfin Beyene(HO), 2003EC 97

 Arbaminch College of Health Sciences
Department of Clinical Nursing
 One urethra
The majority of the activities of the urinary system are performed by the kidneys. The
other organs of the urinary system provide temporary storage reservoirs for urine or
serve as transportation channels to carry it from one region to another.
The scientific study of the anatomy, physiology, and pathology of the kidneys is called
nephrology.
The branch of medicine that deals with the male and the female urinary system and
the male reproductive system is urology.
10.2. The Kidneys
Location and structure
The kidneys are small, dark, red organs with kidney bean shape. They lie against the
dorsal body wall in a retroperitoneal position (beneath the parietal peritoneum) in the
superior lumbar region, and extend from T-12 to L-3 thus receiving some protection
from the lower part of the rib cage. Because it is crowded by the liver, the right
kidney is positioned slightly lower than the left kidney.
An adult kidney is about:
 12 cm (5 inches) long
 6 cm (2.5 inches) wide, and
 3 cm (1 inch) thick
They are convex laterally and had a medial indentation called the renal hilus. Several
structures including the ureters, the renal blood vessels, and nerves enter and exit the
kidneys at the hilus. Atop each kidney is an adrenal gland which is part of the endocrine
system and is a distinct separate organ functionally. The kidney is protected by three
layers of connective tissue;
(1) A fibrous renal fascia, immediately deep to the parietal peritoneum which binds the
kidney and associated organs to the abdominal wall.
(2) The adipose capsule, a layer of fat that cushions the kidney and holds it in place, and
(3) The renal capsule, a fibrous sac that is anchored at the hilum and encloses the rest of
the kidney. a fibrous transparent renal capsule encloses each kidney and gives a fresh
kidney a glistening appearance. In a living person, a fatty mass, the adipose capsule,
surrounds each kidney and helps hold it in place against the muscles of the trunk wall and
cushions the kidneys.
Internal Anatomy
The outer part of the kidney is a reddish area called the renal cortex. The inner, striated
(striped) part is known as the renal medulla. Within the renal medulla are 8 to 18
striated, triangular structures –renal pyramids (medullary pyramids). The bases of the
renal pyramids face the renal cortex and their tips called renal papillae, face the centre
of kidney. The pyramids are separated by extensions of cortical tissue called renal
columns. Medial to the hilus is a large, funnel-shaped basin called renal pelvis. The
pelvis is continuous with the ureter leaving the hilus. Extensions of the pelvis, called
calyces (singular: calyx), form cup-shaped areas that enclose the tips of the pyramids.
The functional parts of each kidney are approximately 1 million microscopic units
called nephrons.

 Urine formed by the nephrons drains into collecting ducts  then to large papillary
ducts  then to minor calyx  then to major calyx  then to renal pelvis which
connects to a ureter.

By: Mesfin Beyene(HO), 2003EC 98

 Arbaminch College of Health Sciences
Department of Clinical Nursing

Blood supply
Approximately one-fourth of the total blood supply of the body passes through the
kidneys each minute.
The arterial supply of each kidney is the renal artery.
As the renal artery approaches the hilus, it divides into segmental arteries, which
themselves, in the kidney, divide into smaller and smaller vessels (lobar, interlobar,
arcuate, interlobular arteries). They eventually terminate as the afferent arterioles. One
afferent arteriole is distributed to each nephron, where the arteriole divides into a tangled
capillary network called the glomelurus (plural: glomeruli).
The capillaries of the glomerulus permit the passage of some substances and restrict the
passage of others. The resulting fluid, called glomerular filtrate, consists of water and
smaller solutes such as glucose, vitamins, amino acids, very small proteins, nitrogenous
wastes and ions.
Once blood is filtered by the glomeruli, the glomeruli unite to form an efferent
arteriole that drains blood out of the glomerulus. Upon leaving the glomerulus, each
efferent arteriole divides to form a network of capillaries called peritubular capillaries,
which reclaim useful substances from the glomerular filtrate and eliminate other
substances into it. These capillaries eventually reunite to form peritubular veins which
merge into interlobular, arcuate, interlobar veins. Ultimately, all the veins deliver their
blood to the renal vein.
Nephrons
Each kidney contains over a million tiny structures called nephrons. Nephrons are the
structural and functional units of the kidney. Each nephron consists of two main
structures: a glomerulus, which is a tangled capillary network, and a renal tubule. About
85% of all nephrons are located almost entirely in the renal cortex, and are called cotical
nephrons. The remainder is called juxtamedullary nephron.
The closed end of the renal tubule is enlarged and cup-shaped and completely surrounds
the glomerulus. This portion of the glomerulus is called the glomerular, or Bowman’s,
capsule. The rest of the tubule is about 3 cm (1.25 inches) long. As it extends from the
glomerular capsule, it coils and twists before forming a hairpin loop, and then again
becomes coiled and twisted before entering a collecting tubule called the collecting duct.
These different regions of the tubule have specific names; in order from the glomelular
capsule they are the proximal convoluted tubule, the loop of Henle, and the distal
convoluted tubule.
Bowman’s capsule is the cap shaped mouth of a nephron. It enclosed in a two
layered glomerular capsule (parietal and visceral).
Proximal convoluted tubule
It arises from the glomerular capsule. It is the longest and most coiled of the four regions.

Loop of Henle
The loop of henle is the segment of renal tubule just beyond the proximal tubule. It
consists of a descending limb, a sharp turn and an ascending limb.

By: Mesfin Beyene(HO), 2003EC 99

 Arbaminch College of Health Sciences
Department of Clinical Nursing
Distal tubule
It is a convoluted portion of the tubule beyond (distal) to the loop of henle. It is the end of
the nephron.
The collecting ducts, each of which receives urine from many nephrons, run downward
through the medullary pyramids. They deliver the final urine product into the calyces and
renal pelvis. It is a straight tubule joined by the distal tubules of several nephrons.
Collecting duct join larger duct, and all the larger collecting ducts of one renal pyramid
converge to form one tube that open at a renal papilla into one of the small
calyces .bowman’s capsule and both convoluted tubule lie in the cortex of the kidney,
where as the loops of henle and collecting ducts extend into the medulla.
Each and every nephron is associated with two capillary beds—the glomerulus and
the peritubular capillary beds. The glomerulus is both fed and drained by arterioles. The
afferent arteriole, which arises from the interlobular artery, is the “feeder vessel”, and the
efferent arteriole receives blood that has passed through the glomerulus. The glomerulus,
specialized for filtration, is unlike any other capillary bed in the entire body, because it is
both fed and drained by arterioles.
Arterioles are high-resistance vessels, and the afferent arteriole has a larger
diameter than the efferent. Hence, blood pressure in the glomerulus is extraordinarily
high. This extremely high pressure forces fluid and solutes (smaller than proteins) out of
the blood into the glomerular capsule. Most of this filtrate (99%) is eventually reclaimed
by the renal tubule cells and returned to the blood in the peritubular capillary beds.
The peritubular capillaries arise from the efferent arteriole that drains the
glomerulus. Unlike the high pressure glomerulus, these capillaries are low pressure,
porous vessels that are adapted for absorption instead of filtration. They cling closely to
the whole length of the renal tubule, where they are in an ideal position to receive solutes
and water from the tubule cells.

10.3. Ureters
Ureters are slender tubes 25 to 30 cm long (10 to 12 inches) long and 6mm (1/4 inch) in
diameter. Each ureter runs behind the peritoneum from the hilus of a kidney to the

By: Mesfin Beyene(HO), 2003EC 100

 Arbaminch College of Health Sciences
Department of Clinical Nursing
posterior aspect of the bladder, which it enters at slight angle. The superior end of each
ureter is continuous with the pelvis of the kidney, and its mucosal lining continuous with
that lining the renal pelvis and the bladder below. The ureter has three layers an
adventitia, muscularis, and mucosa. The adventitia is a connective tissue layer that binds
it to the surrounding tissues. The muscularis consists of two layers of smooth muscle. The
mucosa has a transitional epithelium continuous with that of the renal pelvis above and
urinary bladder below.
Essentially, the ureters are passageways that carry urine from the kidneys to the bladder.
Once urine has entered the bladder, it is prevented from flowing back into the ureters by
small valve-like folds of the bladder mucosa that flap over the ureter openings.
10.4. Urinary Bladder
The urinary bladder is a smooth, collapsible muscular sac that stores urine temporarily. It
is located retroperitoneally in the pelvis just posterior to the pubic symphisis. It has three
openings: the two ureter openings and the single opening of the urethra, which drains the
bladder. In males, the prostate gland surrounds the neck of the bladder where it empties
into the urethra. In women it sits on the anterior of vagina and in front of the uterus,
where as in men it rest on the prostate.
The bladder wall contains three layers of smooth muscle, collectively referred to as the
detrusor muscle, , and its mucosa is a special type of epithelium, transitional epithelium.
When the bladder is empty, it is collapsed, 5 to 7.5 cm at most, and its walls are thick and
thrown into folds. A moderately full bladder is about 12.5cm long and holds about 500ml
of urine, but is capable of holding more than twice that amount. When the bladder is
really distended or stretched by urine, it becomes firm and may be felt just above the
pubic symphysis.
Although urine is formed continuously by the kidneys, it is usually stored in the bladder
until its release is convenient.
10.5. Urethra
The urethra is a thin-walled tube that carries urine by peristalsis from the bladder to the
outside of the body.
At the bladder-urethra junction, a thickening of smooth muscle forms the internal urethral
sphincter, an involuntary sphincter that keeps the urethra closed when urine is not being
passed. A second sphincter, the external urethral sphincter, is fashioned by skeletal
muscles as the urethra passes through the pelvic floor. This sphincter is voluntarily
controlled.
The length and relative function of the urethra differ in the two sexes.
 In females it is about 3 to 4 cm long and its external orifice, or opening, lies
anterior to the vaginal opening. Its function is to conduct urine to the body
exterior.
 In males, the urethra is approximately 20 cm long, and has three regions: the
prostatic, begin at the urinary bladder and passes for about 2.5cm through the
prostate gland membranous is a short portion where the urethra passes through the
muscular floor of the pelvic cavity, and spongy (or penile) the largest pass as
through the penis to the external urethral orifice urethrae. It opens at the tip of the
penis after travelling down its length.
The urethra of the male has a double function:
1. it carries urine out of the body, and
2. It provides the passageway through which sperm is ejected from the body.
Thus, in males, the urethra is part of both the urinary and reproductive systems.

By: Mesfin Beyene(HO), 2003EC 101

 Arbaminch College of Health Sciences
Department of Clinical Nursing

Note the following terminologies:

 Micturation (voiding) is the act of emptying the bladder two sphincters or valves –
the internal urethral sphincter – control the flow of urine from the bladder.
 Urinary incontinence occurs when we are unable to voluntarily control the external
sphincter. Incontinence is normal in children 2 years old or younger, because they
have not yet gained control over their voluntary sphincter.
 Urinary retention is essentially the opposite of incontinence. It is a condition in
which the bladder is unable to expel its contained urine.
 Oliguria is an abnormally low urinary output [100 to 400 ml per day].
 Anuria is a urinary output of less than 100ml per day.

By: Mesfin Beyene(HO), 2003EC 102