1
Q

List examples of Pathologies of the Male Reproductive System?

A
Sub - Fertility
Infection
Torsion 
Cancer
Benign Prostatic Hypertrophy
Erectile Dysfunction
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2
Q

List examples of Abnormalities of the Male Reproductive System?

A
Hydrocoele
Varicocoele
Hypospadias
Epispadias
Cryptorchidism
Epididymo - Orchitis
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3
Q

What is the Ejaculation Pathway of Sperm?

A

SEVEn UP:

  1. Seminiferous Tubules
  2. Epididymis
  3. Vas Deferens
  4. Ejaculatory Ducts
  5. Urethra
  6. Penis
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4
Q

Which 5 Anatomical Structures constitute the External Genitalia?

A
  1. Testes
  2. Epididymis
  3. Spermatic Cord
  4. Scrotum
  5. Penis
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5
Q

What is the Involuntary Muscle of the Scrotum?

A

Tunica Dartos

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6
Q

What is the Function of the Tunica Dartos?

A

Contracts to Wrinkle the Scrotal Skin.
This Decreases the Surface Area reducing Heat Loss.
Regulates the Temperature of the Testicles which promote Spermatogenesis.

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7
Q

Which other Muscles performs the same function as the Dartos?

A

The Cremaster Muscle which is over the Testes.

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8
Q

What is the Female equivalent of the Scrotum?

A

Labia Majora

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9
Q

What does the Labia Majora contain?

A
  • Round Ligament
  • Fat
  • Sweat Glands
  • Oil Glands
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10
Q

Where do the Lymphatics of the Scrotum drain to?

A

Super๏ฌcial Inguinal Nodes

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11
Q

Where do the Testes form?

A

Developmentally the Testes form High up on the Posterior Abdominal Wall and are Retro - Peritoneal.

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12
Q

Which Blood Vessels supply the Testes?

A

Testicular Arteries

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13
Q

Where do the Testicular Arteries arise?

A

Arise from the Abdominal Aorta

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14
Q

At which Vertebreal Level do the Testicular Arteries arise?

A

L2

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15
Q

Describe the Venous Drainage of the Testes?

A

Pampiniform Plexus:

The Testicular Veins emerge from the Testes and the Epididymis as this Venous Network.

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16
Q

What does the Paminiform Plexus become?

A

This becomes reduced to a Single Vein as it ascends through the Inguinal Canal.

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17
Q

What does each Testicular Vein drain into?

A

Right Testicular Vein drains into the Inferior Vena Cava

Left Testicular Vein drains into the Left Renal Vein.

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18
Q

What is the Clinical Signi๏ฌcance of Left Venous drainage?

A
  1. Left Testicular Vein goes all the way up to the Left Renal Vein before it empties.
  2. The Left Testicular Vein meets the Renal Vein at a 90 degree angle.
  3. So, there is more Gravity working on the column of Blood in this Vein.
  4. This can create a backlog of Pressure.
  5. Resulting in a higher tendency for the Left Testicle to develop Varicocele,
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19
Q

Where do the Lymphatics of the Testes drain to?

A

Lumbar Lymph Nodes

Paraortic Lymph Nodes

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20
Q

How can Lymphatics facilitate Cancer?

A

Cancers can Metastasise to other Organs through their shared Lymphatic Drainage.
Cancer of Paired Organs Metastasises to other Paired Organs.

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21
Q

What is a Variocele?

A

Swelling caused by Dilated or Enlarged Veins within the Testicle.

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22
Q

What are the Clinical Signs of a Variocele?

A

Visibly Enlarged/Twisted Veins in the Scrotum

Often described as looking like a Bag of Worms.

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23
Q

What is a Hydrocele?

A

Swelling caused by Fluid around the Testicle.

Clear Serous Fluid within the Tunica Vaginalis

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24
Q

What are the Clinical Signs of a Hydrocele?

A

Transilluminates if you shine a torch on it.

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25
Q

Where do the Testes develop before Birth?

A

In the Abdomen.

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26
Q

How do the Testes reach the Scrotum?

A
  1. The Testes descend on the Posterior Abdominal Wall to the Deep Inguinal Ring.
  2. Then they enter the nascent version of the Spermatic Cord.
  3. They Traverse down the Inguinal Canal to enter the Scrotum.
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27
Q

What do the Testes acquire as they Descend to the Scrotum?

A

The Testes and Spermatic Cord acquire a covering,

From all but one of the components of the Anterior Abdominal Wall.

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28
Q

Which of the components of the Anterior Abdominal Wall,

cover the Testes?

A
  1. External Oblique Muscle
  2. Internal Oblique Muscle
  3. Transversalis Fascia
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29
Q

Which of the components of the Anterior Abdominal Wall,

DO NOT cover the Testes?

A

Transverse Abdominis Muscle

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30
Q

What is the Gubernaculum?

A

A Fibrous Cord that connects the Foetal Testes with the bottom of the Scrotum.

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31
Q

What structure pulls the Testes down to the Scrotum and How?

A

Gubernaculum:

  • By failing to elongate in proportion to the rest of the Foetus causes the Descent of the Testes.
  • Connects to the Inferior Pole of the Testes.
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32
Q

At what stage of Development do the Testes reach the Scrotum?

A

Testes reach the scrotum at 32 - 33 Weeks.

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33
Q

What go wrong with the Descent of the Testes?

A

The Descent can be arrested, at any stage.

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34
Q

What is Cryptorchidism?

A

Condition in which one or both Testicles fail to move from the Abdomen
Down into the Scrotum.

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35
Q

What risk is increased with Cryptorchidism?

A

Boys who have had Cryptorchidism that was not corrected in early Childhood,
Are at increased risk for developing Cancer of the Testicles.

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36
Q

What is the Tunica Albuginea?

A

Fibrous envelope of the Corpora Cavernosa.

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37
Q

What is formed by the Tunica Albuginea?

A

Mediastinum Testis:

  • Tunica Albuginea protrudes into the Posterior Border of the Testis,
  • Forming a Longitudinal Ridge called the Mediastinum Testis.
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38
Q

How is the Testis divided?

A

The Testis is divided into 200 - 300 Lobules by Fibrous Strands,
Radiating from the Mediastinum Testis to the Tunica Albuginea.

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39
Q

What does each Lobule in the Testis contain?

A

Each of the Lobules contain 1 - 4 Highly Convoluted Seminiferous Tubules.

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40
Q

What are the Seminiferous Tubules?

A

Tightly Coiled Tubules found in the Testis.
Make up 90% of the Testis.
They are the site of Spermatogenesis

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41
Q

What is the Total Length of all the Seminiferous Tubules?

A

500m Total Length

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42
Q

List the structures that the Sperm pass through:

A
  1. Seminiferous Tubules (Production of Sperm)
  2. Rectus Tubules
  3. Efferent Ductules
  4. Epididymus (Maturation/Storage of Sperm)
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43
Q

How many Sperm are Produced per day?

A

300 Million on Average produced per day.

Only 120 Million are viable.

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44
Q

What is the Rete Testis?

A

Network of Tubules carrying Sperm from Seminiferous Tubules to the Efferent Ducts
A collection point for the Sperm before they go to the Epididymis.

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45
Q

How does the Sperm reach the Epididymus from the Rete Testis?

A

15 - 20 E๏ฌ€erent Ductules pass Sperm from the Rete Testis into the Epididymis

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46
Q

What is the Epididymus?

A

The Epididymis is a Highly Coiled Tube (6 - 7m Long).

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47
Q

Where is the Epididymus located?

A

Situated Postero - Lateral (back and to the side),

To the Upper Part of the Testis.

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48
Q

What are the 3 Divisions of the Epididymus?

A
  1. Head
  2. Body
  3. Tail
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49
Q

How is the Epididymus connected to the Testis?

A

The Head of the Epididymus is attached to the Upper Pole of the Testis,
By the Vasa Efferentia.

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50
Q

What are the Vasa Efferentia?

A

Several Highly Convoluted Tubules that lead from the Rete Testis to the Vas Deferens,
And form the Head of the Epididymis.

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51
Q

What is the Ductus/Vas Deferens?

A

Tiny Muscular Tube that carries Sperm from the Epididymis to the Ejaculatory Duct.

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52
Q

Which part of the Epididymus does the Ductus/Vas Deferens arise?

A

Ductus/Vas Deferens lies on Medial Side of Epididymis.

It arises from the Tail of the Epididymus.

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53
Q

What structure do the Epididymis and Vas Deferens arise from?

A

Mesonephric/Wolffian Duct

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54
Q

What is a Vasectomy?

A

Surgical procedure for male sterilization or permanent contraception

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55
Q

How is a Vasectomy perfomed?

A

Male Vas Deferens are Cut and Tied or Sealed,

So as to prevent Sperm from entering into the Urethra and thereby prevent Fertilization

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56
Q

What is Testicular Torsion?

A

Testicular Torsion occurs when a Testicle Rotates,

Twisting the Spermatic Cord that brings Blood to the Scrotum.

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57
Q

Why is Testicular Tostion a medical emergency?

A

The reduced Blood Flow causes sudden and often Severe Pain and Swelling.
This is a Medical Emergency if not fixed within 6 Hours.

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58
Q

What is Epididymo - Orchitis?

A

Inflammation of the Epididymis and Testes.

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59
Q

What can be the consequences of Epididymo - Orchitis?

A
  1. Testicular Atrophy:
    • Orchitis can eventually cause the affected Testicle to shrink.
  2. Scrotal Abscess:
    • The Infected Tissue fills with Pus.
  3. Infertility:
    - Occasionally, Orchitis can cause Infertility,
    - Or inadequate Testosterone production (Hypogonadism).
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60
Q

How can the incidence of Epididymo - Orchitis be reduced?

A

Antibiotics

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61
Q

Describe the passage of the Ductus/Vas Deferens?

A
  1. The Ductus/Vas Deferens is the continuation of the Tail of the Epididymis.
  2. It runs in the Spermatic Cord.
  3. Terminating into a Sacculated Structure called the Ampulla of the Ductus.
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62
Q

What structures does the Ductus/Vas Deferens pass through

when it is within the Spermatic Cord?

A
  1. Scrotum
  2. Inguinal Canal
  3. Into the Abdominal Cavity through the Deep Inguinal Ring, where it is Extra - Peritoneal.
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63
Q

What does the Ampulla of the Ductus merge onto?

A

The Ampulla attenuates at the base of the Prostate,
And merges with the Seminal Vesicle Duct to form the Ejaculatory Duct.
Opening into Prostatic Part of Urethra.

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64
Q

Describe the relation of the Ductus Deferens to the Iliac Vessels?

A

Crosses External Iliac Vessels to reach Lateral Wall of Lesser Pelvis.
Medial to Iliac Vessels at the front.

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65
Q

Describe the relation of the Ductus Deferens to the Ureters?

A

Pass Superior to Ureters to reach Post - Lateral Angle of Bladder.
Medial to Ureter at the back.

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66
Q

Describe the relation of the Seminal Vesicles and Prostate?

A

Lies Superior to Seminal Vesicles and bends Infero - Medially.
Medial to the Seminal Vesicles.
Superior to the Prostate.

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67
Q

What is formed when the Vas Deferns and Seminal Vesicle join?

A

Ejaculatory Duct

68
Q

What does the Ejaculatory Duct open into?

A

Opens into the Prostatic Urethra on Seminal Colliculus

69
Q

How many Ejaculatory Ducts are there?

A

There are 2 Ejaculatory Ducts

70
Q

Where does the Artery of the Ductus Deferens arise from?

A

Superior Vesicle Artery

71
Q

What does the Spermatic Cord contain?

A

Contains a Bundle of Structures passing to and from the Testis:

72
Q

Where does the Spermatic Cord Begin and End?

A

Begins: At the Deep Inguinal Ring
Ends: At the Tail of the Epididymus

73
Q

What are the 3 Coverings of the Spermatic Cord?

A
  1. Internal Spermatic Fascia
  2. Cremasteric Muscle and Fascia
  3. External Spermatic Fascia
74
Q

What does the Internal Spermatic Fascia arise from?

A

From Transversalis Fascia

75
Q

What does the Cremasteric Muscle and Fascia arise from?

A

From the Internal Oblique Muscle and Fascia

76
Q

What does the External Spermatic Fascia arise from?

A

From the External Oblique Muscle

77
Q

Which Arteries does the Spermatic Cord contain?

A
  1. Testicular Artery
  2. Cremasteric Artery
  3. Ductus Deferens Artery
78
Q

Which Veins does the Spermatic Cord contain?

A
  1. Testicular Vein
  2. Cremasteric Vein
  3. Ductus Deferens Vein
79
Q

Which Nerves does the Spermatic Cord contain?

A
  1. Genital Branch Of Genitofemoral Nerve (Cremaster Nerve)
  2. Sympathetic Nerves (Autonomic Nerves)
  3. Ilio - Inguinal Nerve
80
Q

Which Tubes does the Spermatic Cord contain?

A
  1. Ductus/Vas Deferens
  2. Remnant of Processus (Processus Vaginalis)
  3. Lymphatics
81
Q

What is the Cremasteric Reflex?

A

When the Inner Part of the Thigh is Stroked.
This causes the Cremaster Muscle to Contract,
And pull up the Ipsilateral Testicle toward the Inguinal Canal.

82
Q

How can the Cremasteric Reflex cause diagnostic confusion?

A

In young children the Testicle can actually go back up the Inguinal Canal.
So if Cremasteric Reflex is elicited unintentially the Cremaster Muscle will contract.
And this will pull the Testicle into the Inguinal Canal making it appear as though they are undescended.
Leading to an inaccurate diagnosis of Undescended Testis.

83
Q

What are the 2 Main parts of the Penis?

A
  1. Root

2. Body

84
Q

What are the 3 Cylindrical Bodies in the Penis?

A

Paired Corpus Cavernosa: Erectile Tissue

Single Corpus Spongiosum: Urethra

85
Q

Where are the Corpus Cavernosa located?

A

Two Dorsally situated Corpora Cavernosa Fused in Penis

Forming the Body of the Penis

86
Q

When do the Corpus Cavernosa diverge?

A

Diverge in the Perineum as the Crura of the Penis

87
Q

Where do the Corpus Cavernosa attach?

A

Attach to Ramus of the Ischium.

Covered by Ischio - Cavernosus Muscle.

88
Q

Which structure contains the Erectile Tissue?

A

Corpora Cavernosa

89
Q

Where are the Corpus Spongiosum located?

A

Single Ventrally Placed Corpus Spongiosum,

Between the 2 Corpora Cavernosa which Transmits the Urethra.

90
Q

What does the Corpus Spongiosum form Distally?

A

Distally the Spongiosum expands to form the Glans Penis.

91
Q

What is the Bulb of the Penis?

A

Refers to the bottom portion/Base of the Penis.

The Bulb is located above the Scrotum, which contains the Testicles.

92
Q

What does the Corpus Spongiosum form Proximally?

A

Proximally, the Spongiosum enlarges as the Bulb,

And is attached to the Perineal Membrane.

93
Q

Which structure does the Penil Urethra pass through?

A

Corpus Spongiosum

94
Q

Which structure covers both Corpus Cavernosum and Spongiosum?

A

Tunica Albuginea

95
Q

What are the 3 Fascial Coverings of the Penis?

A
  1. Deep Penile (Bucks) Fascia
  2. Dartos Fascia
  3. Penile Skin
96
Q

What is the Prepuce?

A

Prepuce is Fold of Skin that covers the Head of the Penis, also known as Foreskin.

97
Q

What is the Frenulum of the Prepuce?

A

Frenulum of the Prepuce anchors the Prepuce to the Glans.

98
Q

What are the 3 pairs of Arteries that supply the Penis?

A
  1. Deep Artery of the Penis
  2. Artery of the Bulbourethral
  3. Dorsal Artery
99
Q

What does the Deep Artery of the Penis supply?

A

Corpus Cavernosum

100
Q

What does the Artery of the Bulbourethral supply?

A

Corpus Spongiosum

Glans

101
Q

What does the Dorsal Artery supply?

A

Penile Skin

Glans

102
Q

What is the Venous Drainage of the Penis?

A
  1. Deep Dorsal Vein

2. Superficial Dorsal Vein

103
Q

Where do the Lymphatics of the Penis drain to?

A

Inguinal Lymph Nodes

104
Q

How does an Erection occur?

A

During erection the Parasympathetic System causes:

  • Constriction of the Venous drainage from the Penis.
  • Vasodilation of the Arterial blood flow into the Corpus Cavernosum.
  • The Corpus Cavernosum becomes full of blood.
  • The Hydrostatic Pressure of the blood causes the penis to become Erect.
105
Q

What Nervous Innervation controls Erection and Ejaculation?

A

POINT: Parasympathetic System
- Controls ERECTION.

SHOOT: Sympathetic Nervous System

  • Controls EJACULATION.
  • The Sympathetic Nervous System causes a series of Smooth Muscle contractions.
  • This moves the sperm into the Urethra.

SCORE: Sympathetic/Somatic Nervous System

  • Expulsion of the sperm from the Urethra is partly under Sympathetic Control.
  • But there is some Somatic Nervous System.
106
Q

What are the 4 Main Structures of the Internal Male Genitalia?

A
  1. Vas Deferens
  2. Seminal Vesicles
  3. Prostate Gland
  4. Urethra
  5. Bulbourethral Gland
107
Q

What is the Female Equivalent of the Vas Deferens?

A

Gartners Duct

108
Q

What is the Female Equivalent of the Seminal Vesicles?

A

Gartners Duct

109
Q

What is the Female Equivalent of the Prostate Gland?

A

Skenes Gland

110
Q

What is the Female Equivalent of the Bulbourethral Gland?

A

Bartholins Gland

111
Q

When does the Prostate Gland develop?

A

The Prostate Gland develops Rapidly at Puberty.

112
Q

List the main structural features of the Prostate:

A
  1. Base
  2. Apex
  3. Anterior Surface
  4. Posterior Surface
  5. Two Infero - Lateral Surfaces
113
Q

Describe the Shape of the Prostate Gland?

A

Resembles an Inverted Cone with its Apex clasped by the Pelvic Diaphragm.

114
Q

Describe the Tissue in the Prostate Gland?

A

Partly FIbrous

Partly Glandular

115
Q

Which structure passes through the Prostate Gland?

A

Urethra traverses the whole Gland and emerges immediately Above and Anterior to the Apex.

116
Q

What is the Clinical Significance of the Urethra in the Prostate?

A

If the Prostate is enlarged due to Cancer,

This could impinge the passage of Urine through the Prostatic Urethra.

117
Q

Which structures pierce the Posterior Aspect of the Prostate?

A

Ejaculatory Ducts pierce the Posterior Surface and Pass Obliquely through the Gland

118
Q

Where do the Ejaculatory Ducts open?

A

Open into the Prostatic Urethra.

119
Q

What are the 3 Zones that the Prostate is divided into?

A
  1. Peripheral Zone
  2. Central Zone
  3. Transition Zone
120
Q

What does the Transitional Zone surround?

A

The Urethra

121
Q

Where is most of the Glandular Tissue in the Prostate?

A

Peripheral Zone

Posterior & Lateral Parts

122
Q

What percentage of the Glandular Tissue does each Zone have?

A

Peripheral: 70%
Central: 25%
Transition: 5%

123
Q

What is Benign Prostatic Hyperplasia (BPH)?

A

An Enlarged Prostate

124
Q

Which Zone of the Prostate is involved in BPH?

A

Prostate Cancer mostly starts in the Peripheral Zone

The Transitional Zone is most commonly affected by BPH.

125
Q

What gets consticted due to BPH?

A

There is Constriction of the Urethra

As the Transitional Zone surrounds the Urethra.

126
Q

What are the Symptoms of BPH?

A
  1. Frequent or urgent need to Urinate.
  2. Nocturia: Increased frequency of Urination at Night.
  3. Difficulty starting Urination.
  4. Weak urine stream or a stream that stops and starts.
  5. Dribbling at the end of Urination
  6. Inability to completely empty the Bladder.
127
Q

Which substance is commonly Elevated in cases of Prostate Cancer?

A

Prostate Specific Antigen (PSA):

A Glycoprotein normally expressed by Prostate Tissue.

128
Q

What is the Threshold for Elevated PSA?

A

PSA > 4 ng/mL

129
Q

How would you confirm Prostate Enlargement Clinically?

A
  1. Digital Rectal Exam
  2. Urine Test
  3. Prostate - Specific Antigen (PSA) Blood Test
130
Q

What is a Digital Rectal Exam?

A

The Doctor inserts a Finger into the Rectum to check your Prostate for Enlargement.

131
Q

How would a Cancerous Prostate feel on Examination?

A

On examination, Prostate Cancer would feel Rough.

132
Q

Which Blood Vessels supply the Prostate?

A
  1. Superior Vesical Artery

2. Inferior Vesical Artery

133
Q

Where do the Superior/Inferior Vesical Arteries arise from?

A

Internal Iliac Artery

134
Q

What is the Prostate Surrounded by?

A
  1. True Capsule: Thin and Strong, Closest to the Prostate.

2. False Capsule: A Condensation of Fascia more Peripheral.

135
Q

What is the Venous Drainage of the Prostate?

A

Prostatic Venous Plexus

136
Q

Where does the Prostatic Venous Plexus lie?

A

Between the True and False Capsules

137
Q

What does the Prostatic Venous Plexus drain into?

A

Prostatic Venous Plexus drains into the Internal Iliac Vein

138
Q

What does the Internal Iliac Vein connect onto?

A

The Internal Iliac Vein connects with the Vertebral Venous Plexus

139
Q

What is the Clinical Significance of the Prostate Venous Drainage?

A

The connection between the Internal Iliac Vein and the Vertebral Venous Plexus,
Is thought to be the route of Bone Metastasis of Prostate Cancer.

140
Q

Where do the Lymphatics of the Prostate drain to?

A

Obturator Lymph Nodes

Internal Iliac Lymph Nodes

141
Q

Describe the Shape of the Seminal Vesicles?

A

Piriform (Pear Shaped) Structures,

Consisting of a Sacculated Tube Folded upon itself.

142
Q

Where do the Seminal Vesicels develop from?

A

Develop as an Outgrowth of the Ductus Deferens

143
Q

What is the Seminal Colliculus?

A

The structure at which the Ejaculatory Ducts open into the Prostatic Urethra

144
Q

What is the Function of the Semincal Vesicles?

A

To produce Seminal Fluid,
These secretions that comprise 50 - 70% of the Ejaculate.
It is NOT a storage depot for Sperm.

145
Q

What do the Bulbourethral Glands produce?

A

Contribute to the Final Volume of Semen by producing a Lubricating Mucus Secretion.

146
Q

Where are the Bulbourethral Glands located?

A

Posterior and Lateral to the Membranous Portion of the Urethra,
At the Base of the Penis.

147
Q

What are the Bulbourethral Glands between?

A

Between the Two Layers of the Fascia of the Urogenital Diaphragm,
In the Deep Perineal Pouch.

148
Q

Which part of the Urethra do the Bulbourethral Glands open up into?

A

The Ducts of these Glands open into the Proximal Part of the Spongy Urethra in the Bulb of the Penis.

149
Q

What is the Female equivalent of the Bulbourethral Glands?

A

Bartholinโ€™s Glands

150
Q

What are the 3 Parts of the Male Urethra?

A
  1. Prostatic Urethra
  2. Membranous Urethra
  3. Spongy Urethra
151
Q

Where is the Prostatic Urethra?

A

The Uppermost Segment within the Prostate
Passes from the Base of the Prostate to its Apex
Most Dilated Segment

152
Q

How long is the Prostatic Urethra?

A

3 cm

153
Q

Where is the Membranous Urethra?

A

The segment within the Urethral Sphincter

Least Dilated Segment

154
Q

How long is the Membranous Urethra?

A

1.5 cm

155
Q

Where is the Spongy Urethra?

A

The Lowermost and Longest Section within the Penis.

156
Q

How long is the Spongy Urethra?

A

16 cm

157
Q

What is the Groove on either side of the Urethral Crest?

A

Prostatic Sinus

158
Q

What is the Rounded Eminence at the Middle of the Prostatic Sinus?

A

Seminal Colliculus

159
Q

Which structure opens up into the Seminal Colliculus?

A

Prostatic Utricle

160
Q

What opens on either side of the Prostatic Utricle?

A

Ejaculatory Ducts

161
Q

Why is the Membranous Urethra called this?

A

It is surrounded by a Membrane.

162
Q

Which part of the Urethra is most likely injured by Catheterisation?

A

Spongy Urethra is most likely to be injured with a Catheter

163
Q

What are the consequences of damage by Catheterisation?

A

Allowing Urine and Blood to Escape into the:

  • Scrotum
  • Penis,
  • Superficial Peritoneal Space.
164
Q

What is the Narrowest part of the Male Urethra?

A

External Meatus

165
Q

What can a ruptured Urethra lead to?

A

Extravasation of Urine

166
Q

Which structures normally prevent Urine Extravasation?

A

Camperโ€™s Fascia
Buckโ€™s Fascia
Perineal Body