Blood supply and Nerve supply of the Kidneys, ureters, bladder and urethra

Blood supply of the kidneys

• The renal arteries arise at the level of the IV disc between the L1 and the L2 vertebrae

• The longer right renal artery passes posterior to the IVC,

Divides into segmental arteries…………..etc.• Supernumerary or aberrant renal arteries.

• The renal veins lie anterior to the renal arteries, and the longer left renal vein passes anterior to the aorta.

• The renal vein emerges from the hilum of the kidney and drains into the inferior vena cava

• Blood supply of the ureter• The abdominal part OF THE URETER:

• The arteries to the ureters arise mainly from three sources:

1-The renal artery,

2- Gonadal artery (testicular or ovarian arteries), and

3- Abdominal aorta.

• The veins of the ureters drain into the IVC

• The pelvic part of the ureter:

Branches of the common and internal iliac arteries supply the pelvic part of the ureters • Females:

Uterine artery is the most fixed• Males:

Inferior vesical arteries

Veins from the ureters accompany the arteries and have corresponding names.

• Blood supply of the urinary bladder• Arterial supply:• Mainly from branches of the internal iliac arteries• 1- Superior vesical arteries (sup.)• 2- Inferior vesical arteries ( = vaginal arteries in females)• 3- Obturator and inferior gluteal arteries

• Venous supply:

• veins draining the bladder correspond to the arteries and are tributaries of the internal iliac veins.

• Venous supply contd.:• In Males:

Vesical venous plexus and prostatic venous plexus, drain mainly through the inferior vesical veins into the internal iliac veins

• In females:

The vesical venous plexus communicates with the vaginal or uterovaginal plexus

• Blood supply of the urethra:• Male urethra:

• 1- The urethra in the bladder neck and the prostatic urethra are supplied by the prostatic branches of the inferior vesical and middle rectal arteries• 2- The intermediate and spongy parts of

the urethra are supplied by the internal pudendal artery.

• The veins accompany the arteries and have similar names

• Female urethra:

Arterial supply by the internal pudendal and vaginal arteries • The veins follow the arteries and have similar names.

Nerve Supply

• Nerve supply of the kidneys:

• The nerve supply is the renal sympathetic plexus. • The afferent fibers that travel through the

renal plexus enter the spinal cord in the 10th, 11th, and 12th thoracic nerves.

• Nerve supply of the Ureters:

• From:

1- Renal plexus

2- Aortic plexus

3- Superior hypogastric plexus

4- Inferior hypogasrtic plexus

5- Testicular (or ovarian ) plexus

Through nerves that follow the blood vessels

Afferent fibers travel with the sympathetic nerves and enter the spinal cord in the first and second lumbar segments

• Nerve supply of the Urinary bladder:• 1- Sympathetic:From T11 to L3 spinal cord levels, through the hypogastric plexuses and nerves, to the vesical plexus (pelvic)

• 2- Parasympathetic:• from the sacral spinal cord levels are

conveyed by the pelvic splanchnic nerves and the inferior hypogastric plexuses

• Nerve supply of the Male urethra:

• From the prostatic nerve plexus (mixed sympathetic, parasympathetic and visceral afferent fibers)

• Nerve supply of the Female urethra:

• The nerves to the urethra arise from the vesical (nerve) plexus and the pudendal nerve

Lymphatic drainage

• Lymphatic drainage of the kidneys:Follow the renal veins ,and drain into the Lumbar lymph nodes (Aortic and renal)

Lymphatic drainage of the Ureters:1- Lymphatic vessels from the Superior part of the ureter: either:

a-join those from the kidney or

b- pass directly to the lumbar (caval and aortic) nodes

2- Lymphatic vessels from the Middle part of the ureter

Drain into common iliac lymph nodes

• 3- Lymphatic vessels from the Lower part of the ureter:

drain into the common, external, or internal iliac lymph nodes.

• Lymphatic drainage of the urinary bladder:• In both sexes, lymphatic vessels leave the

superior surface of the bladder and pass to the external iliac lymph nodes .

• Those from the fundus pass to the internal iliac lymph nodes. • Some vessels from the neck of the bladder

drain into the sacral to common iliac lymph nodes.

Lymphatic drainage of the Male urethra• The lymphatic vessels drain mainly into the internal

iliac lymph nodes , but some lymph passes to the external iliac lymph nodes. • Lymphatic vessels from the spongy urethra pass to the

deep inguinal lymph nodes.

Lymphatic drainage of the female urethra• Most lymphatic vessels from the urethra pass to the

sacral and internal iliac lymph nodes . • A few vessels drain into the inguinal lymph nodes.

Thank You