Template:Short description Template:Distinguish Template:Infobox anatomy
The urethra (Template:Plural form: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus,<ref>Template:Cite journal</ref><ref>Template:Cite book</ref> through which placental mammals urinate and ejaculate.<ref name="Wake1992">Template:Cite book</ref>
The external urethral sphincter is a striated muscle that allows voluntary control over urination.<ref>Template:Cite book</ref> The internal sphincter, formed by the involuntary smooth muscles lining the bladder neck and urethra, receives its nerve supply by the sympathetic division of the autonomic nervous system.<ref name=Chancellor2004>Template:Cite journal</ref> The internal sphincter is present both in males and females.<ref name=Jung2012>Template:Cite journal</ref><ref name=Karam2005>Template:Cite journal</ref><ref name =AshtonMiller2007>Template:Cite journal</ref>
StructureEdit
The urethra is a fibrous and muscular tube which connects the urinary bladder to the external urethral meatus. Its length differs between the sexes, because it passes through the penis in males.
MaleEdit
In the human male, the urethra is on average Template:Convert long and opens at the end of the external urethral meatus.<ref name=Grays2016 />
The urethra is divided into four parts in men, named after the location:<ref name=Grays2016 />
| Region | Description | Epithelium | |
|---|---|---|---|
| Pre-prostatic urethra | This is the intramural part of the urethra surrounded by the internal urethral sphincter and varies between 0.5 and 1.5 cm in length depending on the fullness of the bladder. | Transitional | |
| Prostatic urethra | Crosses through the prostate gland. There are several openings at the posterior wall:
These openings are collectively called the verumontanum (colliculus seminalis). The prostatic urethra is a common site of obstruction to outflow of urine in BPH patients |
Transitional | |
| Membranous urethra | A short (1 or 2 cm) portion passing through the external urethral sphincter. This is the narrowest part of the urethra. It is located in the deep perineal pouch. The bulbourethral glands (Cowper's gland) are found posterior to this region but open in the spongy urethra. | Pseudostratified columnar | |
| Spongy urethra (or penile urethra) | citation | CitationClass=web
}}</ref> with steady diameter of 6 mm,<ref name="lumen-urethra">{{#invoke:citation/CS1|citation |
CitationClass=web
}}</ref> and travels through the corpus spongiosum. The ducts from the urethral gland (gland of Littré) enter here. The openings of the bulbourethral glands are also found here.<ref>Atlas of Human Anatomy 5th Edition, Netter.</ref> Some textbooks will subdivide the spongy urethra into two parts, the bulbous and pendulous urethra. The urethral lumen runs effectively parallel to the penis, except at the narrowest point, the external urethral meatus, where it is vertical. This produces a spiral stream of urine and has the effect of cleaning the external urethral meatus. The lack of an equivalent mechanism in the female urethra partly explains why urinary tract infections occur so much more frequently in females. || Pseudostratified columnar – proximally Stratified squamous – distally |
There is inadequate data for the typical length of the male urethra; however, a study of 109 men showed an average length of 22.3 cm (SD = 2.4 cm), ranging from 15 cm to 29 cm.<ref>Template:Cite journal</ref>
The urethra in male placental mammals is typically longer than in females.<ref name="Hamilton">Template:Cite book</ref>
FemaleEdit
In the human female, the urethra is about 4 cm long,<ref name=Grays2016>Template:Cite book</ref><ref name="lumen-urethra"></ref> having 6 mm diameter,<ref name="lumen-urethra"/> and exits the body between the clitoris and the vaginal opening, extending from the internal to the external urethral orifice. The meatus is located below the clitoris. It is placed behind the symphysis pubis, embedded in the anterior wall of the vagina, and its direction is obliquely downward and forward; it is slightly curved with the concavity directed forward. The proximal two-thirds of the urethra is lined by transitional epithelial cells, while the distal third is lined by stratified squamous epithelial cells.<ref>Manual of Obstetrics. (3rd ed.). Elsevier. pp. 1-16. Template:ISBN.</ref>
Between the superior and inferior fascia of the urogenital diaphragm, the female urethra is surrounded by the urethral sphincter.
The urethra in female placental mammals is typically shorter than in the male.<ref name="Hamilton"/>
MicroanatomyEdit
The cells lining the urethra (the epithelium) start off as transitional cells as it exits the bladder, which are variable layers of flat to cuboidal cells that change shape depending on whether they are compressed by the contents of the urethra.<ref name=Wheaters2013>Template:Cite book</ref> Further along the urethra there are pseudostratified columnar and stratified columnar epithelia.<ref name=Wheaters2013 /> The lining becomes multiple layers of flat cells near the end of the urethra, which is the same as the external skin around it.<ref name=Wheaters2013 />
There are small mucus-secreting urethral glands, as well as bulbo-urethral glands of Cowper, that secrete mucous acting to lubricate the urethra.<ref name=Wheaters2013 />
The urethra consists of three coats: muscular, erectile, and mucous, the muscular layer being a continuation of that of the bladder.
Blood and nerve supply and lymphaticsEdit
Somatic (conscious) innervation of the external urethral sphincter is supplied by the pudendal nerve.
DevelopmentEdit
Template:Further In the developing embryo, at the hind end lies a cloaca. This, over the fourth to the seventh week, divides into a urogenital sinus and the beginnings of the anal canal, with a wall forming between these two inpouchings called the urorectal septum.<ref name=Langman2019>Template:Cite book</ref> The urogenital sinus divides into three parts, with the middle part forming the urethra; the upper part is largest and becomes the urinary bladder, and the lower part then changes depending on the biological sex of the embryo.<ref name=Langman2019 /> The cells lining the urethra (the epithelium) come from endoderm, whereas the connective tissue and smooth muscle parts are derived from mesoderm.<ref name=Langman2019 />
After the third month, urethra also contributes to the development of associated structures depending on the biological sex of the embryo. In the male, the epithelium multiples to form the prostate. In the female, the upper part of the urethra forms the urethra and paraurethral glands.<ref name=Langman2019 />
FunctionEdit
UrinationEdit
Template:See also The urethra is the vessel through which urine passes after leaving the bladder. During urination, the smooth muscle lining the urethra relaxes in concert with bladder contraction(s) to forcefully expel the urine in a pressurized stream. Following this, the urethra re-establishes muscle tone by contracting the smooth muscle layer, and the bladder returns to a relaxed, quiescent state. Urethral smooth muscle cells are mechanically coupled to each other to coordinate mechanical force and electrical signaling in an organized, unitary fashion.<ref>Template:Cite journal</ref>
EjaculationEdit
The male urethra is the conduit for semen during orgasm.<ref name="Wake1992"/> Urine is removed before ejaculation by pre-ejaculate fluid – called Cowper's fluid – from the bulbourethral gland.<ref>Template:Cite journal</ref><ref name="chughtai">Template:Cite journal</ref>
Clinical significanceEdit
Infection of the urethra is urethritis, which often causes purulent urethral discharge.<ref name=Davidsons2018urethritis /> It is most often due to a sexually transmitted infection such as gonorrhoea or chlamydia, and less commonly due to other bacteria such as ureaplasma or mycoplasma; trichomonas vaginalis; or the viruses herpes simplex virus and adenovirus.<ref name=Davidsons2018urethritis /> Investigations such as a gram stain of the discharge might reveal the cause; nucleic acid testing based on the first urine sample passed in a day, or a swab of the urethra sent for bacterial culture and sensitivity may also be used.<ref name=Davidsons2018urethritis /> Treatment usually involves antibiotics that treat both gonorrhoea and chlamydia, as these often occur together.<ref name=Davidsons2018urethritis /> A person being treated for urethritis should not have sex until the infection is treated, so that they do not spread the infection to others.<ref name=Davidsons2018urethritis /> Because of this spread, which may occur during an incubation period before a person gets symptoms, there is often contact tracing so that sexual partners of an affected person can be found and treatment offered.<ref name=Davidsons2018urethritis>Template:Cite book</ref>
Cancer can also develop in the lining of the urethra.<ref name=Davidsons2018cancer>Template:Cite book</ref> When cancer is present, the most common symptom in an affected person is blood in the urine; a physical medical examination may be otherwise normal, except in late disease.<ref name=Davidsons2018cancer /> Cancer of the urethra is most often due to cancer of the cells lining the urethra, called transitional cell carcinoma, although it can more rarely occur as a squamous cell carcinoma if the type of cells lining the urethra have changed, such as due to a chronic schistosomiasis infection.<ref name=Davidsons2018cancer /> Investigations performed usually include collecting a sample of urine for an inspection for malignant cells under a microscope, called cytology, as well as examination with a flexible camera through the urethra, called urethroscopy. If a malignancy is found, a biopsy will be taken, and a CT scan will be performed of other body parts (a CT scan of the chest, abdomen and pelvis) to look for additional Template:Wt lesions.<ref name=Davidsons2018cancer /> After the cancer is staged, treatment may involve chemotherapy.Template:Uncited
InjuryEdit
Passage of kidney stones through the urethra can be painful. Damage to the urethra, such as by kidney stones, chronic infection, cancer, or from catheterisation, can lead to narrowing, called a urethral stricture.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The location and structure of the narrowing can be investigated with a medical imaging scan in which dye is injected through the urinary meatus into the urethra, called a retrograde urethrogram.<ref name=Maciejewski2015>Template:Cite journal</ref> Additional forms of imaging, such as ultrasound, computed tomography and magnetic resonance imaging may also be used to provide further details.<ref name=Maciejewski2015 />
Injuries to the urethra (e.g., from a pelvic fracture<ref name=Stein2015>Template:Cite journal</ref>)
Foreign bodies in the urethra are uncommon, but there have been medical case reports of self-inflicted injuries, a result of insertion of foreign bodies into the urethra such as an electrical wire.<ref>Template:Cite journal</ref>
OtherEdit
Hypospadias and epispadias are forms of abnormal development of the urethra in the male, where the meatus is not located at the distal end of the penis (it occurs lower than normal with hypospadias, and higher with epispadias). In a severe chordee, the urethra can develop between the penis and the scrotum.
CatheterisationEdit
A tube called a catheter can be inserted through the urethra to drain urine from the bladder, called an indwelling urinary catheter; or, to bypass the urethra, a catheter may be directly inserted through the abdominal wall into the bladder, called a suprapubic catheter.<ref name=NHS2020/> This may be to relieve or bypass an obstruction, to monitor how much urine someone produces, or because a person has difficulty urinating, for example due to a neurological cause such as multiple sclerosis.<ref name=NHS2020/> Complications that are associated with catheter insertion can include catheter-associated infections, injury to the urethra or nearby structures, or pain.<ref name="NHS2020">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Other animalsEdit
In all mammals, with the exception of monotremes, and in both sexes, the urethra serves primarily to drain and excrete urine, which in mammals, collects in the urinary bladder and is released from there into the urethra. In addition, the closing mechanisms of the urethra, together with immunoglobulins, largely prevent germs from penetrating the inside of the body.<ref>Template:Cite book</ref> In marsupials, the female's urethra empties into the urogenital sinus.<ref name="Tyndale-BiscoeRenfree1987">Template:Cite book</ref>
HistoryEdit
The word "urethra" comes from the Ancient Greek οὐρήθρα – ourḗthrā. The stem "uro" relating to urination, with the structure described as early as the time of Hippocrates.<ref name="Marx2010">Template:Cite journal</ref> Confusingly however, at the time it was called "ureter". Thereafter, terms "ureter" and "urethra" were variably used to refer to each other thereafter for more than a millennia.<ref name=Marx2010 /> It was only in the 1550s that anatomists such as Bartolomeo Eustacchio and Jacques Dubois began to use the terms to specifically and consistently refer to what is in modern English called the ureter and the urethra.<ref name=Marx2010 /> Following this, in the 19th and 20th centuries, multiple terms relating to the structures such as urethritis and urethrography, were coined.<ref name=Marx2010 />
Kidney stones have been identified and recorded about as long as written historical records exist.<ref name="Tefekli2013">Template:Cite journal</ref> The urinary tract as well as its function to drain urine from the kidneys, has been described by Galen in the second century AD.<ref name="Nahon2011">Template:Cite journal</ref> Surgery to the urethra to remove kidney stones has been described since at least the first century AD by Aulus Cornelius Celsus.<ref name="Nahon2011" />
Additional imagesEdit
- Prostatelead.jpg
Position of the urethra in males
- Gray1155 a.png
Transverse section of the penis
- Male urinary meatus.jpg
Male urethral opening on glans penis
- Skenes gland.jpg
Female urethral opening within vulval vestibule
- 1116 Muscle of the Female Perineum.png
Muscles of the female perineum
- Slide12BLA.JPG
Urethra. Deep dissection. Serial cross section.
- Penis lateral cross section.jpg
Diagram which depicts the membranous urethra and the spongy urethra of a male
- Female vaginal anatomy.jpg
See alsoEdit
- Perineal urethra
- Vulvovaginal health
- Urethral glands
- Urethral sponge
- Sexual stimulation: Urethral sounding and Urethral intercourse
- Urethrorrhagia
- Urethrotomy
- Urethrectomy
- Internal urethral orifice
ReferencesEdit
External linksEdit
- Template:KansasHistology "Male Urethra"
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