063: Surgical, radiographic and endoscopy anatomy of the male reproductive system

Question 1

The homologue of the prostate in the females is the ____.

The prostate is fixed to the pubic bone anteriorly by the puboprostatic ligaments at the ___ of the prostate.

The prostate is palpable __ cm form the anus on DRE.

The prostate capsule and the pelvic fascia separates/join below the parietal and visceral endopelvic fascia juncture.

Answer 1

The homologue of the prostate in the females is the Skene’s Gland.

The prostate is fixed to the pubic bone anteriorly by the puboprostatic ligaments at the APEX of the prostate.

The prostate is palpable 4 cm form the anus on DRE.

The prostate capsule and the pelvic fascia SEPARATES below the parietal and visceral endopelvic fascia juncture.

Question 2

The seminal vesicle has a capacity of __ ml.

A non-obstructed seminal vesicle has a length of about ___ centimeters.

On transrectal ultrasound, the seminal vesicles appear ___ and are ___.

The arterial supply of the seminal vesicles comes from the _____

Answer 2

The seminal vesicle has a capacity of 3-4 ml

A non-obstructed seminal vesicle has a length of about 5 to 7 centimeters.

On transrectal ultrasound, the seminal vesicles appear HYPOECHOIC and are crescent-shaped.

The arterial supply of the seminal vesicles comes from the SUPERIOR VESICAL ARTERY

Question 3

The route that sperm travel through from the seminiferous tubules to the epididymis:

straight tubules, efferent ductules, rete testis

rete testis, straight tubules, efferent ductules

efferent ductules, rete testis, straight tubules

straight tubules, rete testis, efferent ductules

Question 4

Which statement is true regarding the arterial blood supply of the testis?

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The testicular artery passes into the mediastinum testis and supplies the tunica vasculosa and the posterior portion of the of the upper pole of the testis.

To minimize devascularization, biopsy should be done on the medial and lateral surfaces of the lower pole of the testis.

The deferential artery comes from the internal iliac artery or from the superior vesical artery.

The cremasteric artery comes from the inferior epigastric artery and primarily supplies the tunica albuginea.

Question 5

The vas deferens’ embryologic origin is the mullerian duct.

The vas is about 50 to 70 cm in length from the cauda epididymis to the ejaculatory duct.

The vas travels posteriorly along the spermatic cord and enters the pelvis medial to the epigastric vessels.

The arterial supply of the vas deferens comes from the deferential artery which comes from the superior vesical artery.

Question 6

Which statement is true regarding transrectal ultrasound of the prostate?

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TRUS overestimates prostate volume compared with transabdominal ultrasound.

TRUS is not sensitive in locating focal abnormalities.

TRUS may be used in assessing obstructive azoospermia.

It is difficult to assess the prostate zones on TRUS.

Question 7

Which statement is true regarding the scrotum?

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The median raphe runs longitudinally in the midline from the urethral meatus to the anus.

The external oblique extends down to the scrotum to form the cremasteric muscles.

The gubernaculum fixes the testis at the anterior pole.

The venous drainage of the anterior scrotal wall is to the external pudenal veins.

Question 8

Which statement is true regarding the testis?

The normal testicular volume is 15-25 ml.

The appendix testis is a small pedunculated or sessile structure at the lower pole of the testis.

The tunica vaginalis covering the testis is composed of smooth muscle that give the ability to the testis to contract and propel seminiferous tubule fluid out of the testis.

The left testis hangs lower than the right in 85% of men.

Question 9

What is the correct order of the layers of the testis from outside to inside?

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Tunica Vaginalis (parietal layer), Tunica Vaginalis (visceral layer), Tunica Vasculosa, Tunica Albuginea, Parenchyma of testis

Tunica Vaginalis (parietal layer), Tunica Vaginalis (visceral layer) , Tunica Albuginea, Tunica Vasculosa, Parenchyma of testis

Tunica Vaginalis (visceral layer), Tunica Vaginalis (parietal layer), Tunica Albuginea, Tunica Vasculosa, Parenchyma of testis

Tunica Vaginalis (parietal layer), Tunica Vaginalis (visceral layer) , Tunica Vasculosa, Tunica Albuginea, Parenchyma of testis

Question 10

Choose the correct answer regarding magnetic resonance imaging of the prostate:

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Zonal anatomy is best demonstrated by T1-weighted images.

A multiparametric MRI exam consists of two separate imaging techniques (‘parameters’): T2-weighted imaging and dynamic contrast-enhanced imaging.

The peripheral zone has the lowest signal intensity on MRI compared to the other zones.

MRI of the prostate is being used more frequently for pathological processes.

Question 11

Which of the following statements is true regarding prostate volume as measured using transrectal ultrasound?

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It has an accuracy of within 10% of the prostate’s true weight.

Transverse orientation is is used to measure length, width and height of the prostate.

The ellipsoid formula to measure the estimated volume of the prostate is length X width X height X 4/3 π can be used.

The oblate spheroid formula to measure the prosate volume is length X width X height X 0.523 can be used.

Question 12

Which statement is true regarding the nerve supply of the testis?

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The genital branch of the genitofemoral nerve primarily supplies sensation to the parietal and visceral tunica vaginalis, and the seminiferous tubules.

Visceral innervation to the testis and epididymis arise in the renal and aortic plexuses and course alongside abdominal aorta.

There are abundant intertubular nerves in the epithelium of the seminiferous tubules.

There are 3 distinct groups of nerves isolated in the spermatic cord, namely, the perivasal complex, posterior periarterial complex and the intracremasteric complex.

Question 13

Which statement is true regarding the gross structure of the epididymis?

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The epididymis is attached to the posterolateral aspect of the testis and is close to the upper pole.

The epididymis has 2 distinct areas- the tail (cauda) and the head (caput).

20 to 25 ductuli efferentes from the testis make up the caput epididymis.

The appendix epididymis is a cystic structure on the upper pole of the tail of the epdidiymis.

Question 14

Which statement is true regarding ultrasonographic and magnetic resonance imaging of the testis?

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The scrotal wall is hyperechoic on ultrasound.

The testis has a coarse and scattered mid-level echopattern on ultrasound.

The MRI cannot distinguish intratesticular from extratesticular lesion.

The ultrasound is the primary imaging modality of the scrotum and its content

Question 15

Which statement is true regarding the blood supply of the prostate?

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The superior vesical artery is the main arterial supply of the prostate

The periprostatic plexus anastomoses with the the deep dorsal vein of the penis and the internal iliac veins.

The capsular artery has small branches that supply the posterior prostatic capsule.

The inferior vesical artery travels anterolateral to the prostate to form the neurovascular bundles

Question 16

Which statement is true regarding the penis?

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The glans penis is an expansion of the urethra.

There is a septum that separates the corpora cavernosa but is permeable proximally to allow the corporal bodies to function physiolgically and pharmacologically as one.

The tunica albuiginea is a tough primarily collagenous connective tissue layer that envelopes the corpora cavernosa and has a mean thickness of 2-3 mm.

Endothelial nitric oxide synthase is expressed in the endothelium of the corpus spongiosium and is responsible for erectile function.

Question 17

The prostatic utricle in the prostatic urethra is a mullerian remnant and can be a cause of recrurrent urinary tract infection.

There is normal physiologic narrowing of the membranous urethra due to the prostate.

The urethral diameter is consistent all throughout the length of the urethra.

The fossa navicularis is covered with transitional cell epithelium.

Question 18

The seminal vesicle has a capacity of 10-15 ml.

A non-obstructed seminal vesicle has a length of about 5 to 7 centimeters.

On transrectal ultrasound, the seminal vesicles appear hyperechoic and are crescent-shaped.

The arterial supply of the seminal vesicles comes from the inferior vesical artery.

Question 19

Which statement is true about the arterial blood supply of the testis?

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The testis has 2 arterial supplies.

The testicular artery arises from the abdominal aorta before entering the spermatic cord.

The testicular artery branches into the gubernacular artery and the inferior testicular artery and a capital artery to the caput of the epididymis.

The deferential artery, which is derived from the external iliac artery, supplies the testis together with the testicular artery.

Question 20

Which statement about the interstitial tissue of the testis is true?

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The interstitial tissue contain mast cells, macrophages and Sertoli cells.

Sertoli cells are found in the interstitial tissue of the testis and secrete testosterone.

The interstitial tissue makes up 20% of the testicular volume.

The Leydig cells line the seminiferous tubules. They have a low mitotic index and prominent nucleoli.

Question 21

Which statement is true about the anatomic zones of the prostate?

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The largest zone of the prostate is the transitional zone.

BPH most commonly occurs in the central zone.

The central zone is cone-shaped and extends to the base of the bladder surrounding the ejaculatory ducts.

20% of cancers are found in the peripheral zone.

Question 22

Which statement is true regarding the arterial supply and venous drainage of the penis?

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The external pudendal arteries supply the deep arterial system of the penis.

The deep arterial system of the penis is supplied by the internal pudendal artery.

The arterial supply of the penile skin is from the internal pudendal arteries which run longitudinally in the Dartos fascia.

The dorsal vein travels between the corporal bodies in a groove and drains into the pelvic plexus.

Question 23

Which statement is true regarding the venous drainage of the testis?

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Veins in the testis travel with their corresponding artery.

The testicular veins can anastomose with the external pudendal, the cremasteric and the vasal veins, hence the possibility of recurrence of a varicocele after surgery.

The testicular vein drains into the inferior vena cava on the left and into the renal vein on the right.

The pampiniform plexus allows for a countercurrent heat exchange that warms the blood flow within the testicular artery.

Question 24

Which statement is true regarding the urethra?

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The anterior urethra starts at the perineal membrane and continues towards the urethral meatus.

The posterior urethra begins proximal to the bladder neck all the way to the perineal membrane.

The urethra is covered by transitional epithelium from the bladdder neck all the way to the glans penis.

The Cowper’s glands are in the submucosa and their ducts empty in to the urethral lumen that lubricate the urethra before ejaculation.