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INTRODUCTION

Urology deals with diseases and disorders of the adrenal gland, the male genitourinary tract, and the female urinary tract. These systems are illustrated in Figures 1–1 and 1–2.

Figure 1–1.

Anatomy of the male genitourinary tract. The upper tract and midtract have urologic function only. The lower tract has both genital and urinary functions.

Figure 1–2.

Relations between the kidneys, ureters, and bladder (anterior aspect).

ADRENALS

Gross Appearance

A. Anatomy

Each kidney is capped by an adrenal gland, and both organs are enclosed within Gerota’s (perirenal) fascia. Each adrenal gland weighs 4–5 g. The right adrenal is triangular in shape; the left is more rounded and crescentic. The average dimensions are 3 cm width, 5 cm length, and 1 cm thickness. Each gland is composed of a cortex, chiefly influenced by the pituitary gland, and a medulla derived from chromaffin tissue (Avisse et al, 2000; O’Donoghue et al, 2010).

B. Relations

Figure 1–2 shows the relationships between the adrenals and other organs. The right adrenal lies between the liver and the vena cava. The left adrenal lies close to the aorta and is covered on its lower surface by the pancreas. The spleen lies superior and lateral to it.

Histology

The adrenal cortex, which makes up 85% of the mass, is composed of three distinct layers: the outer zona glomerulosa, the middle zona fasciculata, and the inner zona reticularis. The medulla lies centrally and is made up of polyhedral cells with hormone-containing granular cytoplasm. These chromaffin cells are accompanied by a small number of sympathetic ganglion cells.

Blood Supply

A. Arterial

Each adrenal gland receives three arteries: one from the inferior phrenic artery, one from the aorta, and one from the renal artery.

B. Venous

Blood from the right adrenal gland is drained by a very short vein into the vena cava; the left adrenal vein terminates in the left renal vein.

Lymphatics

The lymphatic vessels accompany the suprarenal vein and drain into the lumbar lymph nodes.

KIDNEYS

Gross Appearance

A. Anatomy

The kidneys lie along the borders of the psoas muscles and are therefore obliquely placed. The position of the liver causes the right kidney to be lower than the left (Figures 1–2 and 1–3). The adult kidney weighs between 125 and 170 g in men and 115 and 155 g in women. It is about 10–12 cm long, ...

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