17. Male Reproductive System Flashcards
1
Q
List examples of Pathologies of the Male Reproductive System?
A
Sub - Fertility Infection Torsion Cancer Benign Prostatic Hypertrophy Erectile Dysfunction
2
Q
List examples of Abnormalities of the Male Reproductive System?
A
Hydrocoele Varicocoele Hypospadias Epispadias Cryptorchidism Epididymo - Orchitis
3
Q
What is the Ejaculation Pathway of Sperm?
A
SEVEn UP:
- Seminiferous Tubules
- Epididymis
- Vas Deferens
- Ejaculatory Ducts
- Urethra
- Penis
4
Q
Which 5 Anatomical Structures constitute the External Genitalia?
A
- Testes
- Epididymis
- Spermatic Cord
- Scrotum
- Penis
5
Q
What is the Involuntary Muscle of the Scrotum?
A
Tunica Dartos
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.
7
Q
Which other Muscles performs the same function as the Dartos?
A
The Cremaster Muscle which is over the Testes.
8
Q
What is the Female equivalent of the Scrotum?
A
Labia Majora
9
Q
What does the Labia Majora contain?
A
- Round Ligament
- Fat
- Sweat Glands
- Oil Glands
10
Q
Where do the Lymphatics of the Scrotum drain to?
A
Super๏ฌcial Inguinal Nodes
11
Q
Where do the Testes form?
A
Developmentally the Testes form High up on the Posterior Abdominal Wall and are Retro - Peritoneal.
12
Q
Which Blood Vessels supply the Testes?
A
Testicular Arteries
13
Q
Where do the Testicular Arteries arise?
A
Arise from the Abdominal Aorta
14
Q
At which Vertebreal Level do the Testicular Arteries arise?
A
L2
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.
16
Q
What does the Paminiform Plexus become?
A
This becomes reduced to a Single Vein as it ascends through the Inguinal Canal.
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.
18
Q
What is the Clinical Signi๏ฌcance of Left Venous drainage?
A
- Left Testicular Vein goes all the way up to the Left Renal Vein before it empties.
- The Left Testicular Vein meets the Renal Vein at a 90 degree angle.
- So, there is more Gravity working on the column of Blood in this Vein.
- This can create a backlog of Pressure.
- Resulting in a higher tendency for the Left Testicle to develop Varicocele,
19
Q
Where do the Lymphatics of the Testes drain to?
A
Lumbar Lymph Nodes
Paraortic Lymph Nodes
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.
21
Q
What is a Variocele?
A
Swelling caused by Dilated or Enlarged Veins within the Testicle.
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.
23
Q
What is a Hydrocele?
A
Swelling caused by Fluid around the Testicle.
Clear Serous Fluid within the Tunica Vaginalis
24
Q
What are the Clinical Signs of a Hydrocele?
A
Transilluminates if you shine a torch on it.
25
Where do the Testes develop before Birth?
In the Abdomen.
26
How do the Testes reach the Scrotum?
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.
27
What do the Testes acquire as they Descend to the Scrotum?
The Testes and Spermatic Cord acquire a covering,
| From all but one of the components of the Anterior Abdominal Wall.
28
Which of the components of the Anterior Abdominal Wall,
| cover the Testes?
1. External Oblique Muscle
2. Internal Oblique Muscle
3. Transversalis Fascia
29
Which of the components of the Anterior Abdominal Wall,
| DO NOT cover the Testes?
Transverse Abdominis Muscle
30
What is the Gubernaculum?
A Fibrous Cord that connects the Foetal Testes with the bottom of the Scrotum.
31
What structure pulls the Testes down to the Scrotum and How?
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.
32
At what stage of Development do the Testes reach the Scrotum?
Testes reach the scrotum at 32 - 33 Weeks.
33
What go wrong with the Descent of the Testes?
The Descent can be arrested, at any stage.
34
What is Cryptorchidism?
Condition in which one or both Testicles fail to move from the Abdomen
Down into the Scrotum.
35
What risk is increased with Cryptorchidism?
Boys who have had Cryptorchidism that was not corrected in early Childhood,
Are at increased risk for developing Cancer of the Testicles.
36
What is the Tunica Albuginea?
Fibrous envelope of the Corpora Cavernosa.
37
What is formed by the Tunica Albuginea?
Mediastinum Testis:
- Tunica Albuginea protrudes into the Posterior Border of the Testis,
- Forming a Longitudinal Ridge called the Mediastinum Testis.
38
How is the Testis divided?
The Testis is divided into 200 - 300 Lobules by Fibrous Strands,
Radiating from the Mediastinum Testis to the Tunica Albuginea.
39
What does each Lobule in the Testis contain?
Each of the Lobules contain 1 - 4 Highly Convoluted Seminiferous Tubules.
40
What are the Seminiferous Tubules?
Tightly Coiled Tubules found in the Testis.
Make up 90% of the Testis.
They are the site of Spermatogenesis
41
What is the Total Length of all the Seminiferous Tubules?
500m Total Length
42
List the structures that the Sperm pass through:
1. Seminiferous Tubules (Production of Sperm)
2. Rectus Tubules
3. Efferent Ductules
4. Epididymus (Maturation/Storage of Sperm)
43
How many Sperm are Produced per day?
300 Million on Average produced per day.
| Only 120 Million are viable.
44
What is the Rete Testis?
Network of Tubules carrying Sperm from Seminiferous Tubules to the Efferent Ducts
A collection point for the Sperm before they go to the Epididymis.
45
How does the Sperm reach the Epididymus from the Rete Testis?
15 - 20 E๏ฌerent Ductules pass Sperm from the Rete Testis into the Epididymis
46
What is the Epididymus?
The Epididymis is a Highly Coiled Tube (6 - 7m Long).
47
Where is the Epididymus located?
Situated Postero - Lateral (back and to the side),
| To the Upper Part of the Testis.
48
What are the 3 Divisions of the Epididymus?
1. Head
2. Body
3. Tail
49
How is the Epididymus connected to the Testis?
The Head of the Epididymus is attached to the Upper Pole of the Testis,
By the Vasa Efferentia.
50
What are the Vasa Efferentia?
Several Highly Convoluted Tubules that lead from the Rete Testis to the Vas Deferens,
And form the Head of the Epididymis.
51
What is the Ductus/Vas Deferens?
Tiny Muscular Tube that carries Sperm from the Epididymis to the Ejaculatory Duct.
52
Which part of the Epididymus does the Ductus/Vas Deferens arise?
Ductus/Vas Deferens lies on Medial Side of Epididymis.
| It arises from the Tail of the Epididymus.
53
What structure do the Epididymis and Vas Deferens arise from?
Mesonephric/Wolffian Duct
54
What is a Vasectomy?
Surgical procedure for male sterilization or permanent contraception
55
How is a Vasectomy perfomed?
Male Vas Deferens are Cut and Tied or Sealed,
| So as to prevent Sperm from entering into the Urethra and thereby prevent Fertilization
56
What is Testicular Torsion?
Testicular Torsion occurs when a Testicle Rotates,
| Twisting the Spermatic Cord that brings Blood to the Scrotum.
57
Why is Testicular Tostion a medical emergency?
The reduced Blood Flow causes sudden and often Severe Pain and Swelling.
This is a Medical Emergency if not fixed within 6 Hours.
58
What is Epididymo - Orchitis?
Inflammation of the Epididymis and Testes.
59
What can be the consequences of Epididymo - Orchitis?
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).
60
How can the incidence of Epididymo - Orchitis be reduced?
Antibiotics
61
Describe the passage of the Ductus/Vas Deferens?
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.
62
What structures does the Ductus/Vas Deferens pass through
| when it is within the Spermatic Cord?
1. Scrotum
2. Inguinal Canal
3. Into the Abdominal Cavity through the Deep Inguinal Ring, where it is Extra - Peritoneal.
63
What does the Ampulla of the Ductus merge onto?
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.
64
Describe the relation of the Ductus Deferens to the Iliac Vessels?
Crosses External Iliac Vessels to reach Lateral Wall of Lesser Pelvis.
Medial to Iliac Vessels at the front.
65
Describe the relation of the Ductus Deferens to the Ureters?
Pass Superior to Ureters to reach Post - Lateral Angle of Bladder.
Medial to Ureter at the back.
66
Describe the relation of the Seminal Vesicles and Prostate?
Lies Superior to Seminal Vesicles and bends Infero - Medially.
Medial to the Seminal Vesicles.
Superior to the Prostate.
67
What is formed when the Vas Deferns and Seminal Vesicle join?
Ejaculatory Duct
68
What does the Ejaculatory Duct open into?
Opens into the Prostatic Urethra on Seminal Colliculus
69
How many Ejaculatory Ducts are there?
There are 2 Ejaculatory Ducts
70
Where does the Artery of the Ductus Deferens arise from?
Superior Vesicle Artery
71
What does the Spermatic Cord contain?
Contains a Bundle of Structures passing to and from the Testis:
72
Where does the Spermatic Cord Begin and End?
Begins: At the Deep Inguinal Ring
Ends: At the Tail of the Epididymus
73
What are the 3 Coverings of the Spermatic Cord?
1. Internal Spermatic Fascia
2. Cremasteric Muscle and Fascia
3. External Spermatic Fascia
74
What does the Internal Spermatic Fascia arise from?
From Transversalis Fascia
75
What does the Cremasteric Muscle and Fascia arise from?
From the Internal Oblique Muscle and Fascia
76
What does the External Spermatic Fascia arise from?
From the External Oblique Muscle
77
Which Arteries does the Spermatic Cord contain?
1. Testicular Artery
2. Cremasteric Artery
3. Ductus Deferens Artery
78
Which Veins does the Spermatic Cord contain?
1. Testicular Vein
2. Cremasteric Vein
3. Ductus Deferens Vein
79
Which Nerves does the Spermatic Cord contain?
1. Genital Branch Of Genitofemoral Nerve (Cremaster Nerve)
2. Sympathetic Nerves (Autonomic Nerves)
3. Ilio - Inguinal Nerve
80
Which Tubes does the Spermatic Cord contain?
1. Ductus/Vas Deferens
2. Remnant of Processus (Processus Vaginalis)
3. Lymphatics
81
What is the Cremasteric Reflex?
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
How can the Cremasteric Reflex cause diagnostic confusion?
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
What are the 2 Main parts of the Penis?
1. Root
| 2. Body
84
What are the 3 Cylindrical Bodies in the Penis?
Paired Corpus Cavernosa: Erectile Tissue
| Single Corpus Spongiosum: Urethra
85
Where are the Corpus Cavernosa located?
Two Dorsally situated Corpora Cavernosa Fused in Penis
| Forming the Body of the Penis
86
When do the Corpus Cavernosa diverge?
Diverge in the Perineum as the Crura of the Penis
87
Where do the Corpus Cavernosa attach?
Attach to Ramus of the Ischium.
| Covered by Ischio - Cavernosus Muscle.
88
Which structure contains the Erectile Tissue?
Corpora Cavernosa
89
Where are the Corpus Spongiosum located?
Single Ventrally Placed Corpus Spongiosum,
| Between the 2 Corpora Cavernosa which Transmits the Urethra.
90
What does the Corpus Spongiosum form Distally?
Distally the Spongiosum expands to form the Glans Penis.
91
What is the Bulb of the Penis?
Refers to the bottom portion/Base of the Penis.
| The Bulb is located above the Scrotum, which contains the Testicles.
92
What does the Corpus Spongiosum form Proximally?
Proximally, the Spongiosum enlarges as the Bulb,
| And is attached to the Perineal Membrane.
93
Which structure does the Penil Urethra pass through?
Corpus Spongiosum
94
Which structure covers both Corpus Cavernosum and Spongiosum?
Tunica Albuginea
95
What are the 3 Fascial Coverings of the Penis?
1. Deep Penile (Bucks) Fascia
2. Dartos Fascia
3. Penile Skin
96
What is the Prepuce?
Prepuce is Fold of Skin that covers the Head of the Penis, also known as Foreskin.
97
What is the Frenulum of the Prepuce?
Frenulum of the Prepuce anchors the Prepuce to the Glans.
98
What are the 3 pairs of Arteries that supply the Penis?
1. Deep Artery of the Penis
2. Artery of the Bulbourethral
3. Dorsal Artery
99
What does the Deep Artery of the Penis supply?
Corpus Cavernosum
100
What does the Artery of the Bulbourethral supply?
Corpus Spongiosum
| Glans
101
What does the Dorsal Artery supply?
Penile Skin
| Glans
102
What is the Venous Drainage of the Penis?
1. Deep Dorsal Vein
| 2. Superficial Dorsal Vein
103
Where do the Lymphatics of the Penis drain to?
Inguinal Lymph Nodes
104
How does an Erection occur?
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
What Nervous Innervation controls Erection and Ejaculation?
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
What are the 4 Main Structures of the Internal Male Genitalia?
1. Vas Deferens
2. Seminal Vesicles
3. Prostate Gland
4. Urethra
5. Bulbourethral Gland
107
What is the Female Equivalent of the Vas Deferens?
Gartners Duct
108
What is the Female Equivalent of the Seminal Vesicles?
Gartners Duct
109
What is the Female Equivalent of the Prostate Gland?
Skenes Gland
110
What is the Female Equivalent of the Bulbourethral Gland?
Bartholins Gland
111
When does the Prostate Gland develop?
The Prostate Gland develops Rapidly at Puberty.
112
List the main structural features of the Prostate:
1. Base
2. Apex
3. Anterior Surface
4. Posterior Surface
5. Two Infero - Lateral Surfaces
113
Describe the Shape of the Prostate Gland?
Resembles an Inverted Cone with its Apex clasped by the Pelvic Diaphragm.
114
Describe the Tissue in the Prostate Gland?
Partly FIbrous
| Partly Glandular
115
Which structure passes through the Prostate Gland?
Urethra traverses the whole Gland and emerges immediately Above and Anterior to the Apex.
116
What is the Clinical Significance of the Urethra in the Prostate?
If the Prostate is enlarged due to Cancer,
| This could impinge the passage of Urine through the Prostatic Urethra.
117
Which structures pierce the Posterior Aspect of the Prostate?
Ejaculatory Ducts pierce the Posterior Surface and Pass Obliquely through the Gland
118
Where do the Ejaculatory Ducts open?
Open into the Prostatic Urethra.
119
What are the 3 Zones that the Prostate is divided into?
1. Peripheral Zone
2. Central Zone
3. Transition Zone
120
What does the Transitional Zone surround?
The Urethra
121
Where is most of the Glandular Tissue in the Prostate?
Peripheral Zone
| Posterior & Lateral Parts
122
What percentage of the Glandular Tissue does each Zone have?
Peripheral: 70%
Central: 25%
Transition: 5%
123
What is Benign Prostatic Hyperplasia (BPH)?
An Enlarged Prostate
124
Which Zone of the Prostate is involved in BPH?
Prostate Cancer mostly starts in the Peripheral Zone
| The Transitional Zone is most commonly affected by BPH.
125
What gets consticted due to BPH?
There is Constriction of the Urethra
| As the Transitional Zone surrounds the Urethra.
126
What are the Symptoms of BPH?
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
Which substance is commonly Elevated in cases of Prostate Cancer?
Prostate Specific Antigen (PSA):
| A Glycoprotein normally expressed by Prostate Tissue.
128
What is the Threshold for Elevated PSA?
PSA > 4 ng/mL
129
How would you confirm Prostate Enlargement Clinically?
1. Digital Rectal Exam
2. Urine Test
3. Prostate - Specific Antigen (PSA) Blood Test
130
What is a Digital Rectal Exam?
The Doctor inserts a Finger into the Rectum to check your Prostate for Enlargement.
131
How would a Cancerous Prostate feel on Examination?
On examination, Prostate Cancer would feel Rough.
132
Which Blood Vessels supply the Prostate?
1. Superior Vesical Artery
| 2. Inferior Vesical Artery
133
Where do the Superior/Inferior Vesical Arteries arise from?
Internal Iliac Artery
134
What is the Prostate Surrounded by?
1. True Capsule: Thin and Strong, Closest to the Prostate.
| 2. False Capsule: A Condensation of Fascia more Peripheral.
135
What is the Venous Drainage of the Prostate?
Prostatic Venous Plexus
136
Where does the Prostatic Venous Plexus lie?
Between the True and False Capsules
137
What does the Prostatic Venous Plexus drain into?
Prostatic Venous Plexus drains into the Internal Iliac Vein
138
What does the Internal Iliac Vein connect onto?
The Internal Iliac Vein connects with the Vertebral Venous Plexus
139
What is the Clinical Significance of the Prostate Venous Drainage?
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
Where do the Lymphatics of the Prostate drain to?
Obturator Lymph Nodes
| Internal Iliac Lymph Nodes
141
Describe the Shape of the Seminal Vesicles?
Piriform (Pear Shaped) Structures,
| Consisting of a Sacculated Tube Folded upon itself.
142
Where do the Seminal Vesicels develop from?
Develop as an Outgrowth of the Ductus Deferens
143
What is the Seminal Colliculus?
The structure at which the Ejaculatory Ducts open into the Prostatic Urethra
144
What is the Function of the Semincal Vesicles?
To produce Seminal Fluid,
These secretions that comprise 50 - 70% of the Ejaculate.
It is NOT a storage depot for Sperm.
145
What do the Bulbourethral Glands produce?
Contribute to the Final Volume of Semen by producing a Lubricating Mucus Secretion.
146
Where are the Bulbourethral Glands located?
Posterior and Lateral to the Membranous Portion of the Urethra,
At the Base of the Penis.
147
What are the Bulbourethral Glands between?
Between the Two Layers of the Fascia of the Urogenital Diaphragm,
In the Deep Perineal Pouch.
148
Which part of the Urethra do the Bulbourethral Glands open up into?
The Ducts of these Glands open into the Proximal Part of the Spongy Urethra in the Bulb of the Penis.
149
What is the Female equivalent of the Bulbourethral Glands?
Bartholin's Glands
150
What are the 3 Parts of the Male Urethra?
1. Prostatic Urethra
2. Membranous Urethra
3. Spongy Urethra
151
Where is the Prostatic Urethra?
The Uppermost Segment within the Prostate
Passes from the Base of the Prostate to its Apex
Most Dilated Segment
152
How long is the Prostatic Urethra?
3 cm
153
Where is the Membranous Urethra?
The segment within the Urethral Sphincter
| Least Dilated Segment
154
How long is the Membranous Urethra?
1.5 cm
155
Where is the Spongy Urethra?
The Lowermost and Longest Section within the Penis.
156
How long is the Spongy Urethra?
16 cm
157
What is the Groove on either side of the Urethral Crest?
Prostatic Sinus
158
What is the Rounded Eminence at the Middle of the Prostatic Sinus?
Seminal Colliculus
159
Which structure opens up into the Seminal Colliculus?
Prostatic Utricle
160
What opens on either side of the Prostatic Utricle?
Ejaculatory Ducts
161
Why is the Membranous Urethra called this?
It is surrounded by a Membrane.
162
Which part of the Urethra is most likely injured by Catheterisation?
Spongy Urethra is most likely to be injured with a Catheter
163
What are the consequences of damage by Catheterisation?
Allowing Urine and Blood to Escape into the:
- Scrotum
- Penis,
- Superficial Peritoneal Space.
164
What is the Narrowest part of the Male Urethra?
External Meatus
165
What can a ruptured Urethra lead to?
Extravasation of Urine
166
Which structures normally prevent Urine Extravasation?
Camper's Fascia
Buck's Fascia
Perineal Body
