Accessories to the Urinary Tract (Nursing)

00:01 Once all of that's been carried out, then, it can just be transported.

00:08 And the kidneys will connect to the bladder via these long, fairly narrow tubes of muscle called ureters.

00:16 And again, they're going to connect the relatively wider renal pelvis to the, again, relatively wider urinary bladder.

00:23 So, these ureters are actually fairly narrow compared to what they're receiving and where they're draining into.

00:32 And much like the kidneys, they're also going to be behind the peritoneal space.

00:37 So, they're going to be retroperitoneal.

00:42 And here, we see a cross-section of the bladder where the ureters are opening into the bladder somewhat posteriorly on either side.

00:52 We also see where the bladder is exiting out through the urethra and that gives us three openings in the bladder itself.

01:04 The right and left ureteral openings and the opening for the urethra.

01:09 And those three form a triangular spot called the trigone.

01:14 And that trigone is actually something you can see via endoscopy where it looks fairly smooth between those three little openings.

01:23 It has some unique embryological developments but that smoothness makes for a nice landmark when you're trying to locate the ureteral openings through a scope pass through the urethra.

01:37 The bladder is mostly made up of muscle in its wall.

01:42 And it's smooth muscle and therefore, it's under involuntary control and not a lot of smooth muscle gets its own name but it's a very special one in this case, a very large prominent one.

01:52 So, it's also called the detrusor muscle.

01:57 Now, there are some differences whether we're talking about male reproductive structures or female reproductive structures when it comes to the urinary bladder.

02:08 So, here, we see the bladder with some male reproductive structures, namely, the prostate.

02:14 The prostate is going to sit right at that urethral opening and it's going to be just posterior, very closely associated with the bladder itself here.

02:25 And then, distal to the prostate would be the penis and the urethra is going to run all the way through the prostate and through the penis to reach the opening or urethral meatus.

02:38 And that's going to be in very big contrast to the urinary bladder with female reproductive structures because here, you can see the urethra is going to be much shorter and much more direct.

02:50 There aren't these sort of turns after the prostate that the urethra takes in the male reproductive structures.

02:57 So, therefore, for example, doing a catheterization is going to be much shorter and much easier, relatively speaking compared to the urinary system in males.

03:13 Another clinical significance here is the thinness of the ureters.

03:19 So, when we talk about, for example, stones and where they might get lodged, they're not going to lodge in all places at equal frequencies.

03:30 There's going to be certain places where the ureters are a little more prone to becoming pinched or strictured.

03:38 So, we've already mentioned one where we go from the very wide renal pelvis to the narrow ureter.

03:44 That's the pelvicoureteric junction and that's a great spot for stones to get stuck.

03:50 Another one is where the ureter crosses over those large vessels after the aorta called the iliacs.

03:59 So, we have the iliac artery here and the ureter has to go right over it.

04:06 And so, that's a spot where the ureter can become compressed by this large vessel that is crossing over.

04:14 And then, finally, another junction where it forms a junction with the bladder or vesicoureteric junction.

04:21 Vesico is just another word for bladder.

04:25 So, again, kidney stones might be able to form pretty easily in the pelvis because there's room for them to float around without causing too much trouble.

04:35 But if it reaches this pelvicoureteric junction and may not be able to pass anymore.

04:42 And so, that's one of those three strictures where it might become lodged and create pain and other sorts of problems, for example, back up of that filtrate into the kidneys.

04:54 Similarly, where it crosses over the bifurcation or the iliac arteries, it can become compressed there.

05:02 So, say a stone is small enough to get into the ureters, passed that junction, and undergo peristalsis all the way down, well, it might get lodged here if it's just big enough that it can't pass.

05:16 And finally, same thing, it might be able to pass over the iliac artery but it might get lodged at its junction with the bladder.