I think there’s potential for another part after this one if you’re lucky, same warning as with the others. I can be quite graphic in my descriptions so if that’s not your cup of tea stick with my nicer posts. For everyone else, it’s on to the urogenital block!
Urogenital is obviously the combination of the urinary and genital or reproductive systems. I learnt recently that this is combined due to them being intertwined in the male system; both sperm and urine come out of the urethra. In women we have two separate openings, the urethra and the vagina.
In most people both kidneys lie inside a thick amount of fat towards the posterior and either side of the spine. They are usually fairly easy to remove, you can scoop up and under them using ‘blunt dissection’, or using your finger tips as opposed to using a blade. They trace back towards the spine and are removed attached to the abdominal aorta, or the section of aorta underneath the diaphragm. This section of aorta is where most aneurysms occur and where you can sometimes find an un-ruptured one just hanging out like it was waiting for it’s time to go.
Once this is all ‘loose’ we move to the bladder. The bladder sits neatly in the bottom of the pelvis, if it is full you can make it out very clearly and it’s very easy to take urine samples for toxicology. You can just insert a needle with a syringe and withdraw the urine. When empty it often lies very flat to the other tissues there. It took me an incredibly long time to be able to easily find the place where you can separate the bladder from the tissue in the pelvis. I would often miss, or go to low and burst the bladder. Thankfully I’ve seen so many other people struggle with this, I can say for certain it’s one of the tricker parts of evisceration to master.
Once the bladder is free you are able to get your hand around the entire middle and hold it with your fingers meeting underneath. It’s still connected at the top to the ureters from the kidneys and at the bottom to the urethra, either with a prostate in men or next to the cervix in women. We cut as low as possible to remove the entire structures here but not to cause a larger opening on the outside. It’s quite difficult to do in a lot of people and can require some blind work.
From there you can lift from the posterior and towards the superior, or in other words back and up towards the head, removing all of the kidneys, aorta, ureters, urinary bladder and either the uterus/Fallopian tubes/ovaries or prostate. Note I used urinary bladder here, I’ve just remembered that I’ve also been told recently that there are many different bladders in the body for different purposes so technically we should always refer to it in that way. Noted.
Any other pathology found here can be very interesting. Sometimes you only have one kidney (confusing) or three or four (very confusing) due to transplants. People can also be born with one kidney, but could donate a kidney, and if you receive a transplant they leave your originals and give you one or two extra in front of them. Sometimes kidneys can be joined at the base and this is know as a horseshoe kidney. Urinary bladders can be large and distended, prostates can be enlarged, as can be the uterus or ovaries. You can also see cysts on the kidneys and ovaries which can be absolutely huge and prone to bursting towards your face when you don’t want them to. Hence why I will always wear at least eye protection if not more.
I think I’ve gone on about this enough for one entry! If you would like anything further or have any questions please get in touch via the comments or contact page. Now I know I have to do a Part IV because I’m not quite done. Bonus points to anyone who knows what I’m missing or haven’t covered yet!
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