Urinary System BMS 10103 Past Paper PDF

BMS 10103 Urinary System Dr. Nor Fadhilah bt. Abdullah FP, UniSZA  Learning Outcomes Identify the external and internal features, important relations and major blood supply of the kidney, ureter, urinary bladder and urethra.  Kidneys - Location P...

BMS 10103 Urinary System Dr. Nor Fadhilah bt. Abdullah FP, UniSZA  Learning Outcomes Identify the external and internal features, important relations and major blood supply of the kidney, ureter, urinary bladder and urethra.  Kidneys - Location Pair of bean shaped excretory organs Location- Posterior abdominal wall – Retroperitoneal organ Extends from T12 to L3 Protected by the 11th and 12th ribs Right kidney is lower than left due to presence of liver  DIMENSIONS Length 11-12cm Breadth 6cm Thickness 3cm Weight 150 gms Moves with respiration (sub diaphragmatic organ) Surface marking - Morris parallelogram 9cm Bimanual palpation 2cm T11 of kidney Transpyloric plane L3  COVERINGS OF KIDNEY From deep to superficial Fibrous capsule (True capsule) Perinephric fat. Renal Fascia of Gerota (False capsule) Paranephric fat 1.FIBROUS CAPSULE Formed by dense irregular connective tissue. Easily stripped from the kidney. 2.PERINEPHRIC FAT The fat is more along the borders of the kidney and renal sinus.  3. RENAL FASCIA OF GEROTA  Condensation of extra peritoneal connective tissue.  Anterior layer-Thin- Fascia of Told.  Posterior layer-Thick - Fascia of Zuckerkendl. 4. Para-nephric fat: Renal fascia Occupies the space between the renal fascia and the anterior layer of thoraco lumbar fascia. Paranephric fat Thoraco It is abundant on the lumbar fascia posterior surface and lower part of the kidney.  PRESENTING PARTS TWO SURFACES Anterior surface Posterior surface TWO ENDS Superior pole Inferior pole TWO BORDERS Medial Lateral  POSTERIOR SURFACE Flat- non peritoneal Presents Upper part Lower part Upper part – relation of posterior surface 1. Diaphragm origin from medial & lateral arcuate ligaments. 2. 11 & 12 ribs on the left side 3. 12th rib alone on the right side.  Lower part - relation of posterior surface 1. Para nephric fat 2. Medial to lateral (3 muscles) ▪ Psoas major ▪ Quadratus lumboram ▪ Transversus abdominus Lower part - relation of posterior surface 3. Deep to thoraco lumbar fascia (3 nerves) 1. Subcostal vessels and nerve 2. Ilio-hypogastric nerve 3. Ilio inguinal nerve  RELATION OF ANTERIOR SURFACE - RIGHT KIDNEY Supra renal gland Duodenum Liver Colon Jejunum RELATION OF ANTERIOR SURFACE - LEFT KIDNEY Supra renal gland Pancreas Spleen Stomach Colon Jejunum UPPER END  2.5cms from median plane  Level – opposite to T12  Thicker and more rounded LOWER END  7.5cms from median plane  Level-opposite to L3  Above the highest point of iliac crest MEDIAL BORDER Concave Indentation in the middle --- Hilum Level - lower border of L1 vertebra Structures passing through hilum Renal vein Renal artery Pelvis of ureter LATERAL BORDER Convex, thin and on a more posterior plane. Gross Internal Features Of Kidney Contains ❑Outer cortex. ❑Inner medulla.  RENAL MEDULLA 8-18 Renal pyramid Pyramid - striated conical structures Base towards cortex Apex towards renal sinus opens into minor calyx at the renal papilla.  RENAL CORTEX Granular in appearance Contains- Cortical arch ❑ Cortical arches- between the base of pyramid and the surface of kidney. ❑ Renal columns between the adjacent pyramids. Lobe of kidney A single pyramid with the adjoining cortex  RENAL SINUS Hilum extends into a space within the kidney called as renal sinus. Wall of the sinus is lined by capsule. Contents Branches of renal artery and renal vein Renal pelvis with 2-3 major and 8-18 minor calyxes Perirenal fat  RENAL PELVIS ❑ Minor calyces(8-18) receives renal papillae. ❑ Major calyx (2- 3) formed by union of minor calyces. ❑ Renal Pelvis : -Funnel shaped dilatation, -passes downwards medially through hilum -continuous with abdominal part of ureter below the lower pole of the kidney.  RENAL ANGLE (Costovertebral angle) Angulation between lower border of 12th rib and lateral border of erector spinae muscle. Posterior surface of lower part of kidney lies in this angle  ARTERIAL SUPPLY ▪ Renal arteries are branches of aorta. ▪ Each artery at the hilum divides into anterior and posterior division. ▪ Each division then divides into segmental branches. ▪ Seg. A Interlobar.A Arcuate A. Interlobular.A Afferent Glomerular.A Glomerulus Efferent Glomerular A. ▪ 1 L of blood circulates through both kidneys per minute.  Blood flow through cortical and juxtramedullary nephrons In cortical nephrons the efferent arteriole breaks up into peritubular capillaries which surround the tubular portions of the cortical nephrons.  Blood flow through cortical and juxtramedullary nephrons In juxtamedullary nephron the efferent arterioles form long loop shaped capillaries called vasa recta which surround the tubular portion of the juxtramedullary nephrons  ARTERIAL VASCULAR SEGMENTS ▪ Whole kidney divided into five independent vascular segments. ▪ The anterior division divides into 4 segmental branches at the hilum. ▪ Apical, Upper anterior, Middle anterior and Lower segmental arteries. ▪ Posterior division continues as posterior segmental artery. ▪ Brodel’s line is a relatively avascular plane (lateral wall).  VENOUS DRAINAGE Right and left renal veins Left is longer and drains blood from left kidney, left gonad, left suprarenal gland Both renal veins drain into the inferior vena cava. LYMPHATIC DRAINAGE ▪ Lateral aortic lymph nodes NERVE SUPPLY ▪ Sympathetic- derived from renal plexus Origin-T10,T11,T12 (least splanchnic nerve) and L1 (Lumbar splanchnic nerve) Vaso motor in function and stimulates production of renin by juxta glomerular apparatus. ▪ Parasympathetic-derived from Vagus nerve.  URETERS The ureters are a pair of narrow but thick-walled muscular tube (histologically fibromuscular) It conveys urine from kidneys to urinary bladder Ureter Retroperitoneal organs  URETERS: Gross features 25 - 30cm in length. 3mm in diameter. Continuous superiorly with renal pelvis. Constricted (relatively) at 3 sites: pelvi-ureteric junction, pelvic brim vesico-ureteric junction.  URETERS: Gross features Ureters: Bifurcation of common iliac artery Upper half lies in the abdominal cavity. Lower half is in pelvic Abdomen cavity. As ureters cross the bifurcation of common iliac artery, it exit the abdomen & enter the pelvis. Ureters in the pelvis  URETERS: Parts Can be divided into 2 parts: 1. Abdominal part 2. Pelvic part: a) Extramural part Abdominal part (outside the urinary bladder) b) Intramural part (inside the urinary bladder) *Pelvic part run on the lateral wall of Pelvic part pelvis  ***URETERS:Relations Ureter Abdominal part Pelvic part Anterior Testicular or ovarian artery / vein Ductus deferens (male) relations Right or left colic artery / vein Sigmoid (left) or iliocolic artery /vein (right) Terminal ileum (right) or jejunum & sigmoid colon (left) Sigmoid mesocolon (left) or Mesentery (right) Posterior Genitofemoral nerve Bifurcation of common iliac relations artery Psoas major Internal iliac artery Tip of transverse processes of L2 – L5 Superior Uterine artery (female) relation  URETERS: Course Ureters continuous superiorly with renal pelvis. Renal pelvis: funnel-shaped structure Formed by condensation of 2 or 3 major calyces Renal pelvis narrows as it passes inferiorly & Ureteropelvic junction becomes continuous with the ureter at the ureteropelvic junction  URETERS: Course (abdominal part) Ureters starts at lower pole of kidney (ureteropelvic junction) pass inferiorly (On the anterior & medial part of psoas major muscle) Ureter is located anterior to the tip of transverse processes (L2 – L5)  URETERS: Course (abdominal part) Along the way anterior to psoas major: Ureters are: Posteriorly crossed Anteriorly crossed by by Genitofemoral nerve 1. Gonadal vessels (testicular/ovarian arteries & veins) 2. Colic vessels (right & left colic arteries) Iliocolic vessels (only right) Sigmoid vessels (only left)  Right ureter Left ureter SMA Right colic artery IMA Iliocolic artery Left colic artery Genitofemoral nerve Testicular vessels sigmoid artery  URETERS: Course (abdominal part) Near the pelvic brim: Peritoneum of posterior abdominal wall The The left ureter: right ureter: passes passes posterior posterior to the Root of mesentery to the 1. Jejunum 1. Mesentry 2. Sigmoid Root of 2. Terminal colons sigmoid ilium 3. Sigmoid mesocolon mesocolon  URETERS: Course (abdominal part) Then, ureters cross the bifurcation part of common iliac artery Pass over pelvic brim (anterior to sacroiliac joint) Enter the lesser (true) pelvis Ureter (abdominal) Common iliac artery (bifurcation) Ureter (pelvic)  URETERS: Course (pelvic part) In lesser (true) pelvis, ureters pass: ❑along the anterior border of greater sciatic notch. Relation: anterior to internal iliac artery ureters Internal iliac artery  Revision – Hip bone Greater sciatic notch Ischial spine  URETERS: Course (pelvic part) Opposite the ischial spine: - ureters turn forward & medially (superior to levator ani muscle) To reach the base of urinary bladder Urinary bladder  URETERS: Course (pelvic part) Before it enter the bladder,ureters are: Male Female crossed crossed anterior & superiorly by Ductus medially uterine deferens by artery ductus deferens URETERS: Relation in male (pelvic part) Ductus deferens ureter  URETERS: Relation in female (pelvic part) Clinical application: Uterine artery ❖ Iatrogenic injury of ureters during ligation of uterine artery (e.g. during hysterectomy)  URETERS: Course (pelvic part) Obliquely enter the bladder wall at the postero-superior angle of the bladder Urinary bladder: superior view  URETERS: Course (pelvic part) Intramural part (inside the bladder wall) of ureters lie obliquely within bladder Function as valve Prevent regurgitation of Ureter urine from bladder into ureters Ureteric orifice Intramural Open into the part bladder cavity as ureteric orifice (at lateral angle of trigone)  URETERS: Blood supply Renal artery Abdominal part: 1. Renal artery 2. Gonadal artery Ovarian artery 3. Colic arteries Colic 4. Branches of artery aorta  URETERS: Blood supply Pelvic part: Branches of common iliac Branches of internal iliac arteries Uterine artery 1. Superior vesical artery Inferior 2. Inferior vesical vesical artery artery 3. Uterine artery Superior (female) vesical artery  URETERS: Nerve supply Innervation are all Renal sensory (afferent) plexus Supplied by autonomic nervous system (ANS): ❑ Sympathetic : T11- Superior hypogastric L1/L2 plexus ❑ Parasympathetic : S2- S4 (sacrum) Nerve supply reach ureter through renal, aortic & hypogastric plexuses  URINARY BLADDER: Introduction The temporary reservoir for urine (before gets emptied through the urethra) Is a hollow organ with distensible & strong muscular wall  URINARY BLADDER: Position In general, the position of empty bladder, In infant & < 6 y.o. children: In the abdomen, not completely descend into the pelvis. Fusiform in shape 6 years old: Enters the greater pelvis After puberty & adult: Entirely in lesser pelvis  URINARY BLADDER: Gross features Size, shape, position & relations varies depend on the: ✓ Amount of urine in the bladder (empty bladder vs full bladder) ✓ State of neighbouring viscera Urinary bladder URINARY BLADDER: Shape Empty bladder: Empty bladder small, pyramid- like (tetrahedral) Full bladder: globular/ovoid Full bladder  URINARY BLADDER: Parts Based on tetrahedral shape of empty bladder: 1. Apex pointing toward the superior edge of pubic symphysis 2. Fundus Opposite to apex Apex Formed by convex posterior wall 3. Base Fundus Triangular shape Body of posterior wall 4. Body Base Neck Between apex & fundus 5. Neck Opening of urethra  URINARY BLADDER: Surfaces 4 surfaces: 1. Right inferolateral Superior surface 2. Left inferolateral 3. Superior (mobile) 4. Posterior Right Left inferolateral inferolateral  URINARY BLADDER: Relations Relations varies depend on the: 1. amount of urine in the bladder (empty bladder vs full bladder) 2. state of neighbouring viscera (bladder bed) *Bladder bed: formed by structures that directly contact urinary bladder  URINARY BLADDER: Relation of surfaces with peritoneum Superior surface and uppermost 1-2 cm of Superior surface covered by posterior aspect (male) peritoneum covered by peritoneum (below the lowest extent of the peritoneum) The rest (inferolateral & posterior surfaces) is devoid of peritoneum  URINARY BLADDER: Position In adult: Empty bladder Extraperitoneal fatty tissue of Lies in lesser (true) anterior abdominal wall pelvis Posterior to pubic bones Full bladder As bladder fills, it enters greater pelvis Ascends in the extraperitoneal fatty tissue of anterior abdominal wall Pubic Full bladder may extends up to the umbilicus  URINARY BLADDER: Relations Median umbilical ligament Apex: Connected to umbilicus by median umbilical ligament *median umbilical ligament = obliterated embryonic urachus Anterior: Pubic symphysis Pubic bone (separated by retropubic space of Retzius) Pubic  Retropubic space (of Retzius) Potential space behind pubic bones and symphysis pubis Containing: ✓ Male: Pubovesical & Puboprostatic ligaments ✓ Female: Pubovesical ligament ✓ Loose fatty tissue ✓ Veins  URINARY BLADDER: Relations Inferolateral: (inferior & lateral) 1. Pubic bones 2. Retropubic space (of Retzius) 3. Levator ani Obturator internus 4. Obturator internus Levator ani  URINARY BLADDER: Relations Base (posterior): Female: Cervix ✓ Uterine ✓ cervix Vagina ✓ Vagina *no peritoneal covering at Rectovesical all pouch Male: ✓ rectovesical pouch rectum ✓ rectum ✓ seminal vesicles Seminal ✓ ampulla of vesicle ductus deferens URINARY BLADDER: Relations Ampulla of ductus deferens Seminal vesicle  URINARY BLADDER: Relations Neck of bladder: Female: Pelvic diaphragm Pelvic Male: diaphragm Prostate gland Prostate  URINARY BLADDER: Relations Superior surface: Vesicouterine Covered by peritoneum Uterus pouch Female: Relations :1. Uterus 2. Vesicouterine pouch 3. Intestine Sigmoid colon Male: Relations: 1. Sigmoid colon 2. Terminal ileum *Uterus rides up/down on filling/emptying bladder  URINARY BLADDER: Clinical application Uterus rides up/down on filling/emptying bladder Thus, in abdominal ultrasound, uterus is better visualised in full bladder patient  URINARY BLADDER: Clinical application Suprapubic catheterization: As the bladder fills, the superior part of bladder will extends above the pubic symphysis (between the parietal peritoneum & anterior abdominal wall). The anterior surface of bladder comes into direct contact with anterior abdominal wall. Thus, bladder can be approached surgically at the suprapubic region without entering peritoneal cavity. Important in emergency urinary retention secondary to obstructed urethra.  URINARY BLADDER: Wall ▪ The wall composed of destrusor muscle (mainly) & mucous Ureteric membrane orifices Detrusor muscle: Involuntary smooth muscle. Arranged in whorls and spirals Some runs radially & encircled opening of ureteric orifices. At the neck of bladder (male),it form internal urethral sphincter Internal ▪ Mucous membrane is loose and urethral distensible (able to stretch & expand) Detrusor muscle sphincter Ureteric orifices: - When bladder contracts, loops of muscle tighten the opening (prevent reflux of urine into ureters) Internal urethral sphincter: - Contracts during ejaculation (prevent ejaculatory reflux of semen into bladder)  URINARY BLADDER: Interior surface Empty bladder: Most part of mucosa shows irregular folds (d/t loose attachment to muscular layer) Trabeculae can be seen through mucous membrane But mucosa is smooth (d/t firm attachment to muscular layer) at the trigone of bladder Distended/full bladder: Mucous membrane is thin & smooth  URINARY BLADDER: Ureteric Trigone orifices A small triangular area at the lower part of the base. Internal urethral sphincter Lies internally between: ✓ Ureteric orifices (above & posterolaterally) ✓ Internal urethral sphincter (below & centrally) Mucosa is smooth Base is formed by interureteric ridge Apex directed anterior & inferiorly  URINARY BLADDER: Trigone Male: Fixed to prostate by urethra Median Overlies median lobe of lobe prostate gland May project upwards above internal urethral orifice as uvula Uvula Prostate Uvula is a slight elevation part. (produced by median lobe of prostate) Female: Fixed to anterior vaginal wall by fascia  URINARY BLADDER: Trigone Female bladder: trigone fixed to Male bladder: trigone fixed to anterior vagina by fascia Prostate Prostate Vagina  URINARY BLADDER: Trigone Remain in shape or size with state of distension Functions as Flap-valve mechanism prevents reflux into ureters - the intramural part of ureters pierce bladder wall very obliquely - closed when intravesical pressure rises Valve kept closed until peristalsis from ureter opens the valve  URINARY BLADDER: Nerve supply Urinary bladder supplied by inferior hypogastric plexus The plexus contains both sympathetic & parasympathetic (motor & sensory) Inferior hypogastric plexus  Full bladder: promotes urination  URINARY BLADDER: Parasympathetic innervation From sacral S2-S4 Actions: ✓ Motor to detrusor will contract ✓ Inhibits (relaxes) internal urethral sphincter in male ✓ Promotes urination ❖ Thus, when bladder is full, - parasympathetic fibres are stimulated, lead to contraction of bladder & relaxation of internal urethral sphincter - urine flows into urethra  URINARY BLADDER: Sympathetic innervation From inferior thoracic & upper lumbar (T11-L2/L3) Actions: 1. Contracts internal urethral sphincter (prevent urinate) 2. Vasoconstriction of renal vessels to slow urine formation 3. Stimulates ejaculation & simultaneously contracts internal urethral sphincter to prevent reflux of semen into bladder  URINARY BLADDER: Nerve supply Parasympathetic: S2- S4 ✓ Main motor innervation to detrusor muscle ✓ promotes urination Sympathetic: T11 - L2/L3 Inhibit detrusor ✓ Motor to Internal Urethral Sphincter ✓ Vasomotor (Affecting the narrowing and widening of the blood vessels). ✓ prevent urination  URINARY BLADDER: Sensory innervation The pain fibres from superior part of bladder follow sympathetic fibres retrogradely to T11- L2/L3 Sensory fibres (visceral reflex afferents & pain sensation e.g. overdistension of bladder) from inferior part follow the course of parasympathetic fibres (S2- S4)  URINARY BLADDER: Blood supply Main blood supply from: ✓ Branches of internal iliac arteries 1. Superior vesical arteries Obturtor (anterosuperior part) arteries 2. Inferior vesical arteries Superior vesicle (male) or Vaginal arteries arteries (female) Inferior vesicle arteries 3. Obturator arteries /vaginal arteries 4. Inferior gluteal arteries Inferior gluteal arteries  URINARY BLADDER Veinous drainage: Tributaries of internal iliac veins From vesicle venous plexus, blood drain into internal iliac veins Lymph drainage External iliac LN (superolateral part) Internal iliac LN (fundus & neck)  FEMALE URETHRA 4 cm long and 6 mm in diameter It starts from internal urethral orifice of bladder > opposite midline of pubic symphysis > embedded in anterior wall of vagina Crosses the perineal membrane (fibrous membrane in perineum) Ends at external urethral orifice and opens into vestibule. Distensible, so easier to catheterise Internal urethral sphincter is a urethral sphincter muscle which constricts the internal urethral orifice (opening to urethra from bladder )  FEMALE URETHRA: Sphincters ❖ Internal or sphincter vesicae -surrounds the internal urethral orifice. - Involuntary ❖ External sphincter -surrounds the membranous urethra - Voluntary.  FEMALE URETHRA: Blood supply Internal pudendal artery Superior vesical artery vaginal arteries. Venous plexus around internal urethra> vesical venous pudendal plexus> internal pudendal artery vein> internal iliac vein  FEMALE URETHRA: Nerve supply External urethral sphincter : somatic fibers from pudendal nerve ,S2- S4 *fx: voluntary control of urination Internal urethral sphincter : from autonomic nervous system  MALE URETHRA A muscular tube, 18 -20 cm long. internal urethral orifice Starts from internal urethra orifice of the urinary bladder to the external urethral orifice at the end of the penis Provides an exit for urine and semen external urethral orifice (sperm and glandular secretions)  MALE URETHRA: Parts 1. Pre-prostatic: surrounded by internal urethral sphincter 2. Prostatic: merging of urinary & reproductive tracts 3. Membranous: narrowest part, shortest 4. Spongy: longest, most mobile, presence of openings of bulbo- urethral (Cowper’s) glands  MALE URETHRA: Dimension 3cms 1 – 2 cms Total length-18-20 cms Prostatic part- 3cm Membranous part- 1- 2cm Spongy part- 15cm Diameter- 6mm 15 cms  MALE URETHRA: Preprostatic part (intramural urethra) The length varies between 0.5 cm and 1.5 cm (Both the length and diameter of the pre-prostatic urethra vary depending on whether the bladder is filling or emptying) Extends almost vertically from bladder neck to superior aspect in prostatic urethra  MALE URETHRA: Prostatic part Runs through the prostate gland from base to the apex. This part is the widest (8mm) and most dilatable one. On coronal section - fusiform in shape (wide in middle) On transverse section - Crescentic lumen. It has an anterior wall and posterior wall  MALE URETHRA: Prostatic part Internal surface of posterior wall: urethral crest - a midline ridge prostatic sinus - shallow urethral crest depression, perforated by 15- prostatic 20 of prostatic ducts utricle prostatic utricle (pouch ejaculatory duct opening of prostate) 2 opening of ejaculatory duct prostatic sinus  EJACULATORY DUCT 2cms long Formed by union of vas deferens and seminal vesicle Passes postero-lateral to median lobe of prostate Opens at colliculus seminalis on each side of prostatic utricle.  MALE URETHRA: Membranous part 1.5 cm , shortest Pass through urogenital urogenital diaphragm (external diaphragm urethral sphincter & perineal membrane) the narrowest part of urethra  MALE URETHRA: Spongy part Situated in the corpus spongiosum of penis 15 cms long Passes through the bulb ,body and glans penis Terminates at the external urethral orifice.  MALE URETHRA: Sphincters Internal urethral sphincter or sphincter vesicae - surrounds the internal urethral orifice. Involuntary External sphincter - surrounds the membranous urethra. Derived from sphincter urethrae muscle. Voluntary.  MALE URETHRA: Blood supply Inferior vesical artery Middle rectal artery Internal pudental artery Urethral branch of artery to bulb of penis  MALE URETHRA: Lymphatic drainage Prostatic and Membranous part - Internal and external iliac lymph nodes. Spongy part - Deep inguinal nodes.  MALE URETHRA: Nerve supply Sympathetic –from superior hypogastric plexus. Preganglionic fibres - from L1 and L2 segments Para sympathetic fibres - from pelvic splanchnic nerves. Pre ganglionic fibres - S1,S2,S3 Somatic from urethral branch of pudendal nerve.  Comparison of male & female urethra Features Male urethra Female urethra Length 20 cm 4 cm Diameter 6 mm 6 mm Function Passage for urine Passage for urine only and semen Parts Preprostatic Pelvic Prostatic Perineal Membrano Spongiose Course Traverses : Traverses : Prostate gland Urogenital diaphragm Urogenital Perineal membrane diaphragm Perineal membrane Corpus spongiosum External urethral orifice Located at the glans penis Located at the vestibule (vulva) Sphincter Has internal Has no internal urethral sphincter urethral sphincter  Comparison of male & female urethra Features Male urethra Female urethra Relations Posterior: rectum Posterior : vagina Anterior & superior : Anterior & superior : symphysis pubis symphysis pubis Associated glands Prostatic gland Paraurethral glands Seminal vesicles Urethral gland of Littre Urethral glands of Littre Greater vestibular glands Bulbourethral glands (Glands of Bartholin) (Cowper’s glands) Blood supply Internal pudendal artery Vaginal artery Inferior vesical artery Internal pudendal artery Prostatic artery Rectal arteries Venous drainage Vein accompany named Vein accompany named arteries arteries Nerve supply Pudendal nerve Pudendal nerve Pelvic splanchnic nerve Pelvic splanchnic nerve Inferior hypogastric plexus  URETHRA: Relations In Female: Superiorly - neck of the urinary bladder Inferiorly – external urethral orifice Anteriorly - symphysis pubis Posteriorly - vagina  URETHRA: Relations Male Urethra :Prostatic Part Superiorly - neck of the urinary bladder Inferiorly - urogenital diaphragm Anteriorly – Prostate and symphysis pubis Posteriorly - Prostate and anterior surface of rectal ampulla Rectal ampulla  URETHRA: Relations Superiorly - Male Urethra: Spongy Part Inferiorly – external urethral orifice Anteriorly, Posteriorly and laterally-corpus spongiosum & cavernosum (outer)  REFERENCES ✓ Snell, Richard S.. Clinical Anatomy By Regions, 8th edition (2008), Lippincott Williams & Wilkins, Philadelphia. ✓Moore, K.L., Dalley, Arthur F., Agur, Anne M.R. Clinically Oriented Anatomy, 6th edition (2009), Lippincott Williams & Wilkins, Philadelphia. ✓ Richard L. Drake, Wayne Vogl & Adam W.M. Mitchell. Gray’s Anatomy for Students. ✓ teachmeanatomy.info ✓ kenhub.com