1 - Male Reproductive System Flashcards
Label this diagram of the testis.
What are the following pouches?
- Rectovesical
- Vesicouterine
- Rectouterine (Pouch of Douglas)
- They are all double foldings of peritoneum. Peritoneum is not closed in females.
- Uterine tubes open into peritoneal cavity, providing a route female genital tract and the abdominal cavity.
Infections of vagina, uterus, or uterine tubes may lead to peritonitis. Usually doesn’t occur due to mucus plug
What is the origin of the testicular arteries (along with cremasteric and vesicular)?
- Front of the aorta below the renal arteries but above the inferior mesenteric artery
- Cremasteric from external iliac and vesicular from internal iliac
Complete the table, including where the vas deferens and the seminal vesicles drain lymph to.
VD: external iliac
SV: internal and external iliac
Label the following diagram.
Cowpers/Bulbourethral Glands
Label this diagram of the spermatic cord and explan where the fascial layers come from.
Internal spermatic fasica: transversalis fascia
Cremasteric fascia: internal oblique
External spermatic fascia: extenal oblique
What is the difference between the tunica vaginalis and the tunica albuginea?
Tunica Albugineas is the capsule and the septa run between the seminiferous tubules
What are the components of semen and where do they come from?
Prostate allows urinary continence
Label this diagram of the prostate.
Where is the corpus spongiosum and ejactulatory duct?
Ejaculatory duct is in the prostate where the seminal vesicles enter the prostate
Where does spermatogenesis and spermatic maturation occur?
- Spermatogenesis: Seminiferous tubule
- Head of epididymis: Fluid absorption and concentration to mature
What is a hydrocoele?
Scrotal swelling where the tunica vaginalis gets excess fluid in it. Can transilluminate it.
What are the two main cells in the seminiferous tubules and what are their roles?
Sertoli: support the developing sperm from the germinal epithelium and prune away the cytoplasm to mature it so they can swim
Leydig: make sex hormones like testosterone, lots of SER so know involved in lipid metabolism
What is the function of the pampiniform plexus?
Countercurrent flow cools the blood from the arteries before it enters the testes
Where does the lymph of the scrotum and the lymph of the testes drain to?
Scrotum: inguinal nodes
Testicular: paraortic nodes so if testicular cancer big surger as have to go retroperitoneal
What are the veins and arteries of the testicles?
- Use renal vessels as guide
- Left testicle lower than right so left testicular vein drains into left renal vein
- Right testicular vein drains into IVC
What is the treatment for testicular torsion and what predisposes to this condition?
- Immediate surgery as this stops venous drainage, then oedema from this blocks the arteries
- If necrotic needs removal as antigens from dead testicle are on healthy testicle so immune system will attack healthy one too, making infertile
- Bell Clapper Deformity (fix with scrotal orchiopexy)
Draw an axial cross section of the spermatic cord.
3 fasica, 3 nerves, 3 arteries, 3 veins, vas deferens
What is the clinical relevance of the proccessus vaginalis?
Connection between peritoneum and scrotum that has to disconnect when the testicals are descending as you grow. (down the gubernaculum). Can cause hernias if doesn’t disconnect
Where is the best place to disconnect the vas deferens to complete a vasectomy?
Where does prostatic cancer mainly occur?
In the peripheral zone so usually asymptomatic. BPH in transitional zone but both luckily usually happen at same time so caught
How do you catheterise a male patient?
Lots of bends so straighten the penis and pull downwards to pull out second kink
What are the functions of the penis?
What is a varicocoele?
Feels like bag of worms. Enlargement of the veins in the scrotum, can lead to infertility and low sperm quality. More likely to occur on the left as renal vein can become obstructed by abdominal or renal pathology
What is the relationship between the vas deferens and the ureter?
Ureter passes below
What are the two different tissue types in the penis and what is their role?
Corpus spongiosum: expansile tissue that the urethra passes, stays patent for passage of sperm
Corpus Cavernosum: erectile tisssue attached to bone to anchor penis. (also help by suspensory ligaments, think about penis enlargement)
What parts of the nervous system are involved in erection and ejaculation?
POINT AND SHOOT
- Vasodilation in arterioles causes venous compression in penis so erection. Parasymphathetic
- Erection terminated by vasoconstriction by sympathetics
Where is the tunica albugenia and what is its role?
- Collagen fibres around CC and CS arrange at right angles to each other to hold the erectile tissue in the right shape when erect
- One in the penis and one in the testes
What is the blood supply to the penis and what could cause impotence?
What is the diagnosis and why does it need to be resolved quickly?
Fractured penis
- Ruptured tunica albugenia and corpus cavernosum in erect penis leading to a large haematoma*
- Scar tissue can form and it can become wonky
- Popping, pain, swelling
What is the bulb and the crus of the penis?
What are some differentials for a scrotal swelling?
- Epididymal cysts
- Testicular malignancy
- Testicular torsion
- Orcitis
- Hydrocoele
- TB
- Torsion of appendix
- Inguinal Hernia
- Spermatocoele (epididymis)
How would you discriminate between an inguinal hernia and a scrotal swelling?
Lay down and a hernia will dissapear and you can’t get above a hernia
What veins are dilated in a varicocoele and why is it more common on the left?
Pampiniform plexus causing a spongy bag of worms appearance.
- The acute angle formed by left testicular vein and renal vein.
- Lack of valves
- The increased pressure transmitted to the left testicular vein via the renal vein which is compressed between the superior mesenteric artery and aorta [nutcracker effect].
Why do hydrocoeles get bigger when a young boy coughs or cries?
Increased intraabdominal pressure pushing fluid into the scrotum
What is the cremasteric reflex?
- Rub on medial thigh to stimulate femoral nerve and the testes will move up ipsilaterally as cremaster muscle contracts
- Reflex absent in testicular torsion and MS
- Reflex done by genitofemoral nerve
Describe the histological features of the testes, in particular the seminiferous tubules.
This is a histological slide of the rete testes and the seminiferous tubules, explain what is shown.
Explain the histiological features of the efferent ductules and the epididymis.
Explain the histology of the Vas Deferens.
Describe the histology of a seminal vesicle.
Folded mucosa due to smooth muscle
What are the different groups of glands within the prostate gland?
Tubuloalveolar
Describe the histology of the prostate gland.
