GENITOURINARY ANATOMY AND PHYSIOLOGY

GU ANATOMY AND PHYSIOLOGY

and HISTORY & PHYSICAL EXAM

KIDNEYS • • • •

Two kidneys, purplish brown organs Located below the ribs toward the back Remove waste from the blood Keep a stable balance of salts and other substances • Produce erythropoietin, aids in the formation of red blood cells

GROSS ANATOMY

• • • • • •

Adrenal gland caps each kidney Enclosed within Gerota’s fascia Each adrenal receives three arteries Right adrenal vein empties into the vena cava Left terminates in the left renal vein Lymphatic vessels drain into the lumbar lymph nodes

HISTOLOGY • Functioning units of the kidneys are nephrons

• Secretory portion contained in the cortex • Excretory portion is the collecting tubule

BLOOD SUPPLY • One renal artery, branch of the aorta • Renal artery divides into the anterior and posterior branches • Renal veins are paired with the ateries • Accessory renal vessels are common

URETERS • Two ureters • Narrow tubes carry urine from the kidneys to the bladder • Adult ureter 30 cm long

STONES

BLADDER • Triangular-shaped, hollow organ • Located in the lower abdomen • Attached by ligaments to other organs and pelvic bones • Nerves alert when time to urinate • Two sphincter muscles circular muscles that keep urine from leaking

HISTOLOGY OF THE BLADDER • Bladder is composed of transitional epithelium • Beneath is well-developed submucosal layer • Detrusor muscle is made of a mixture of smooth muscle fibers, three different layers

MALE GU ANATOMY • Seminal vesicles lie cephalic to the prostate • Spermatic cord extends from the internal inguinal ring • Epididymis connected to the testis by numerous ducts, markedly coiled

PENIS AND MALE URETHRA • Two corpora cavernosa and the corpus spongiosum, contains the urethra • Aterial supply internal pudenda arteries • Each artery divides into a deep artery of the penis • Dorsal vein lies external to Buck’s fascia • May be 15 to 23 cm in length

PROSTATE GLAND • • • • • •

Fibromuscular and glandular organ Inferior to the bladder Weighs about 20 g Contains the posterior urethra Consists of 5 lobes Glands drain into the major excretory ducts, which open in the floor of the urethra

Digital Rectal Exam

TESTIS • Average testicle 4X3X2 cm • Dense covering, tunica albuginea • Covered anteriorly and laterally by serous tunica vaginalis • Blood supply associated with that of the kidneys

SCROTUM • Beneath skin of the scrotum dartos muscle • Three fascial layers from the abdominal wall • Two sacs divided by septum of connective tissue • Helps to regulate environmental temperature

Normal Male Anatomy

Paraphimosis

An Interesting Thought: More money is spent today on Viagra and breast reconstruction than on Alzheimer's research. So by the year 2040, there will be lots of elderly people walking around with perky boobs, huge erections, and no idea what to do with them.

FEMALE PELVIC ANATOMY • • • • • • • •

Ovaries Uterine fallopian tubes Uterus Cervix Urinary bladder Ureters Vagina Rectum

FEMALE URETHRA • About 4 cm long • Lies beneath the pubic symphysis anterior to the vagina • Arterial supply from the vesical, vaginal, and internal pudendal arteries • Lymphatic drainage from the external portion is to the inguinal and subinguinal lymph nodes

NORMAL DEVELOPMENT OF THE GU SYSTEM • Three embryonic kidneys pronephros 3 weeks mesonephros 5 weeks metanephros 5 weeks Nephrogenesis complete at 34 – 36 weeks

NORMAL DEVELOPMENT • • • • •

Bladder and ureter development third week of gestation Formation of the trigone by day 33 Urine production by 10-12 weeks gestation Genital formation begins during the fifth week of gestation

GU ASSESSMENT OF THE INFANT AND CHILD • Abdomen: pain, masses • External genitalia: normal or abnormal • Consider sexual abuse: must be reported

Tanner System

Balanitis

Elements of Examination • • • • • • • • • •

Constitutional Head, face, eyes, ears, nose, mouth and throat Neck Respiratory Cardiovascular Gastrointestinal (Abdomen) Lymphatic Musculoskeletal/Extremities Skin Neurologic

MALE GENITOURINARY EXAM • • • •

Scrotum: lesions, cysts, rashes Epididymides: size, symmetry, masses Testes: size, symmetry, masses Urethral meatus: size, location, lesions, discharge • Penis: lesions, presence or absence of foreskin, foreskin retractibility, plague, masses, scarring, deformities

DIGITAL RECTAL EXAM • Prostate gland: size, symmetry, nodularity, tenderness • Sphincter tone, presence of hemorrhoids, rectal masses

FEMALE GENITOURINARY EXAM • External genitalia: general appearance, hair distribution, lesions • Urethral meatus: size, location, lesions, prolapse • Bladder: fullness, masses, tenderness • Vagina: general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, rectocele

Female • Cervix: general appearance, lesions, discharge • Uterus: size, contour, position, mobility, tenderness, consistency, descent or support • Adnexa: masses, tenderness, organomegaly • Anus, perineum