3.1 Clinical Anatomy - Male Flashcards
List 4 important structures in the male reproducrive system
1) Scrotum & testis
2) Spermatic cord
3) Seminal vesicles and Prostate gland
4) Penis
Describe the pathway of sperm before and during an ejaculation
1) immature sperm are produced in the seminiferous tubules
2) transported through ➞ the retes testes ➞ effernt ductules ➞ epididymis (stored while they mature)
3) during ejaculation, sperm exit tail of the epididymis pushed by SM contraction to the ductus deferens (contained in spermatic cord)
4) from ductus deferens sperm travel into the prostatic urethra to be expelled from the male tract
What embryological layer do the testis derive from and what was their original position prior to decent?
What accompanies the testis during their decent?
The testicle is an intermediate mesoderm derivative that develops high on the posterior abdominal wall
As the testes descend, their accompanying vessels, ducts, and nerves pass through the inguinal canal and are therefore surrounded by the same fascial layers of the abdominal wall.
Where does lymph from the testis drain?
Drains to para-aortic nodes L2 (not inguinal nodes!!)
Briefly describe the decent of the testis and what happens to it during its decent
The testis descend through inguinal canal following gubernaculum
As it passes through the inguinal canal it picks up coverings from the muscles of the anterior abdominal wall
These form the coverings of the spermatic cords and the testis itself.
Spermatic cord coverings = layers of anterior abdominal wall
What is the thick fibrous capsule that encloses the testis and what is it derived from?
What is the double layer of peritoneum found surrounding this structure?
Label the diagram below
Tunica albuginea formed from the distal ends of the proccessus vaginalis (proximal regions obliterate)
This is surrounded by a layer of tunica vaginalis
1) If a cyst forms in the epididymis what would this be known as?
2) If a cyst forms in tunica vaginalis what would this be known as?
3) If a cyst is blood filled, what would this be known as?
1) Spermatocoele/ Epididymal Cyst
2) Hydrocoele
3) Haematocoele
Label the image below and explain what the processus vaginalis is
In which structure is a potential weak spot that may cause an indirect inguinal hernia?
the processus vaginalis is a a peritoneal outpouching that forms and protrudes through the various layers of the anterior abdominal wall and acquires coverings
The processus vaginalis is a potential weak spot and is the
route taken by indirect inguinal hernias
What are the 3 coverings aquired by the Processus vaginalis? (from deep to superficial)
Why is there no covering by the Transversis abdominis as you may expect?
1) the transversalis fascia forms its deepest covering
2) second covering is formed by the musculature of the internal oblique
* There is NO covering acquired from the transversus abdominis muscle because the processus vaginalis passes under the arching fibers of this abdominal wall muscle
3) The most superficial covering is the aponeurosis of the external oblique
What is a hernia?
A hernia occurs when an organ or internal body part pushes through the tissue that usually surrounds and protects it
What are the 2 types of inguinal hernias?
State which is which on the image below and briefly explain each
Direct Hernias: Usually develops in adulthood. Occurs within a “weak area” known as Hesselbach’s triangle (usually acquired muscle weakness)
Indirect Hernias: Usually a congenital disorder. Caused by failure of deep inguinal ring to close up
List 3 arteries, 3 nerves and 3 deep structures found in the sepermatic cord
Arteries: Testicular, Ductus deferens and Cremasteric artery
Nerves: Genital, Autonomic and Ilioinguinal nerve
Deep structures: Pampiniform plexus, Ductus deferens, Lymphatics
List the 3 layers of fascia covering the spermatic cord and state which layer of the anteriolateral abdominal wall muscles is each derived from?
1) Internal spermatic fascia: continuation of the transversalis fascia
2) Cremasteric fascia: derived from internal oblique muscle
3) External spermatic fascia: derived from the external oblique muscle
What is a Varicocele?
lump in the scrotum caused by abnormal enlargement of the pampiniform venous plexus
What nerve is located between the internal spermatic fascia and cremasteric fascia?
What are its divisions and subsequent innervations?
The genitofemoral nerve which has two branches:
- genital branch: supplies the cremaster muscle (lowers and raises the testis)
- femoral branch innervates the medial thigh
Which fasical layer contains the 3 arteries?
Internal Spermatic fascia
State the following regarding the Cremasteric reflex:
- how it is performed
- nerve innervation
- normal response (positive CR)
1) ellicited by lightly stroking the superior-medial thigh
2) this stimulates sensory fibers of the ilioinguinal nerve which activate motor fibers of the genitofemoral nerve (genital branch)
3) normal response ➞ contraction of the cremaster muscle, pulling the testis UP on the same side of the body
List 4 reasons why the cremasteric reflex may be negative
- testicular torsion
- upper and lower motor neuron disorders
- spine injury of L1-L2
- accidental ligation of the ilioinguinal nerve during hernia repair
What is Testicular Torsion?
Testis are not attached well, can cause the testes to twist around the spermatic cord resulting in lack of/no blood flow to the testicle
Causes pain and swelling, and should be treated as a medical emergency!
What is the ONLY structure that runs superior to the ureter within the male pelvis and when could this be visualised?
The Ductus Deferens, can be seen on abdominal endoscopy
The prostate can be divided into 3 lobes OR 3 zones… what are these?
Which zone do tumors tend to form in and how would you examine?
Lobes: median lobe, posterior lobe, anterior lobe
Zones: peripheral zone, central zone, transitional zone
Tumours tend to form in the peripheral zone of the prostate, use DRE to examine
What are the 3 regions of the prostate?
Lable the diagram below
1) Prostatic urethra
2) Membranous urethra
3) Penile (spongy ) urethra
What are the 3 erectile bodies (vascular structures) within the penis (in the shaft)?
What does EUM stand for and what is it?
1) 1x corpus spongiosium = located at the bottom
2) 2x corpus cavernosum = these are blood spaces
3) Roots = attached parts
EUM ➞ external urethral meatius➞ the enlarged portion (head)
The Levator Ani is a broad, thin muscle, situated on either side of the pelvis, what 3 muscle components make up this muscle?
What is its nerve supply?
Iliococcygeus
Pubococcygeus
Puborectalis
Nerve supply = S4
