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3002 > 74 Urogenital triangle > Flashcards

74 Urogenital triangle Flashcards

1
Q

Features of pelvic outlet?

A
  • Pubic symphysis
  • Ischiopubic ramus
  • Ischial tuberosity
  • Sacrotuberous ligament
  • Sacrum and coccyx

Hugely important in childbirth

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2
Q

What is the perineum?

A
  • Below the pelvic floor/ diaphragm - outside pelvis
  • Diamond-shaped
  • Divided into an anterior urogenital triangle and a posterior anal triangle
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3
Q

What is the urogenital triangle between?

A

Between the pubic symphysis and the ischiopubic rami anterior to the ischial tuberositites

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4
Q

What passes through the greater sciatic foramen?

A
  1. Above piriformis:
    • Superior gluteal nerves and vessels
  2. Below piriformis:
    • Sciatic nerve with inferior gluteal vessels emerging into the buttock
    • Pudendal nerve with internal pudendal vessels re-curving into the perineum inferior to the pelvic floor/ diaphragm
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5
Q

Which vessels pass through the lesser sciatic foramen to reach the perineum?

A

Pudendal nerve

Internal pudendal vessels

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6
Q

What passes through obturator canal?

A

Obturator nerve and vessels

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7
Q

2 divisions of the urogenital triangle?

A

Divided by perineal membrane into:

  1. Deep compartment/ pouch (superior) - external urethral sphincter
  2. Superficial compartment/ pouch (inferior)
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8
Q

Perineal membrane:
• Attachments
• Aperture
• Function

A
  • Spans the urogenital triangle between the ischiopubic rami
  • Attached to perineal body in the midline posteriorly
  • Anterior aperture for the passage of nerves and vessels to penis/ clitoris
  • Provides major support for the urogenital organs
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9
Q

Superficial pouch:
• Contents
• Their attachments and boundaries

A
  • Contains the genitalia (penis in males and clitoris in females; labia minora and major forming the vulva and vaginal vestibule in females; scrotum in males
  • These structures are attached to the perineal membrane and ischiopubic ramus and are bounded inferiorly by superficial fascia/ subcutaneous tissue
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10
Q

Function of bulbourethral gland and duct?

A

Pierces perineal membrane and contributes to seminal fluid

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11
Q

Penis and clitoris comparison

A
  1. Both have 2 crura:
    Attached to ischiopubic rami and become corpora cavernosa that fill with blood during erection
  2. One central bulb:
    Female: Split as the bulb of vestibule
    Male: Becomes the corpus spongiosum that houses the urethra to prevent compression during erection

• Crura and blue form the root

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12
Q

How many corpora does the penis have?

A

3 corpora:

2 dorsal cavernosa and ventral spongosium

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13
Q

Structural features of penile skin

A
  • Dark, loose, no fat
  • Superficial dartos fascia surrounds whole penis
  • The skin “doubles back on itself” to form the prepuce/foreskin that is continuous with the glans at the corona
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14
Q

Structure of the corpora cavernosa?

A

• Divided by a septum that is complete proximally, but pectiniform distally (to even out pressure and stay straight)

  • Corpora cavenosa are each surrounded by thick tunica albuginea
  • Deep fascia (Buck’s) surrounds all 3 corpora
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15
Q

What fascia surrounds all 3 corpora of penis?

A

Deep fascia (Buck’s)

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16
Q

Function of the corpus spongosium?

A

Transmits the urethra and forms the glans as a cap over the corpora cavernosa

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17
Q

Muscles of the penis?

A
  1. Ischiocavernosus muscle surrounds each crus
  2. Bulbospongiosus surrounds the bulb

Muscles support the penis and contribute to erection with bulbospongiosus also compressing the urethra during ejaculation or to expel urine

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18
Q

Supportive ligaments of the penis?

A

Fundiform and triangular/ suspensory ligaments from the line alba and pubic symphysis

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19
Q

What is the foreskin or prepuce?

A

A fold of skin continuous with the glans and mucous membrane of the urethra

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20
Q

What do sebaceous glands form in the penis?

A

Smegma

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21
Q

Where is the frenulum of the penis?

A

Small frenulum ventrally between the foreskin and glans with increased sensation either side

22
Q

What is penile raphe?

A

Skin and glans show a ventral midline penile raphe

23
Q

What are the clinical issues that can arise in foreskin?

A
  1. Balinits
  2. Phimosis
    3 Paraphimosis

Circumcision to treat

24
Q

4 parts of male urethra?

A
  1. Preprostatic - in bladder neck with internal urethral sphincter (smooth muscle; involuntary)
  2. Prostatic - receiving ejaculatory duct
  3. Membranous - external urethral sphincter (striated muscle)
  4. Spongy - in bulb of penis (bulbar urethra) and corpus spongiosum (penile urethra)
25
Q

Features of the membranous part of the male urethra?

A
  • ~ 1-1.5cm
  • Narrowest part except for external orifice
  • Tube of fibroelastic and smooth muscle within the striated external urethral sphincter (slow twitch) and pubourethral or puboprostatic part of levator ani (mixed slow and fast twitch) to resist surges of raised intra-abdominal pressure
26
Q

Shape and relations of external urethral sphincter?

A
  • Shaped like an inverted pear

* Base on the perineal membrane and its apex pushing up into the prostatic urethra

27
Q

Features of the spongy (bulbar and penile) part of the male urethra?

A
  • ~ 16cm with narrowest part at external orifice
  • Bulbourethral glands plus many scattered glands especially in navicular fossa (lacuna magna) before 6mm sagittal slit of external orifice
28
Q

Where are the 2 right angle bends in the male urethra?

A
  1. Between membranous and bulbar urethra
  2. In the spongy urethra as it becomes pendulous

These must be straightened when passing a catheter

29
Q

Epithelium of the male urethra?

A

Urothelium until ejaculatory ducts —> (pseudo) stratified columnar —> stratified squamous (distal urethra) —> keratinised at external orifice

30
Q

What structure in male urethra may contain concretions in the elderly?

A

Glandular fossae (urethral lacunae)

31
Q

What does the navicular fossa in the male urethra promote?

A

Promotes defensive lactobacilli (like the vagina)

32
Q

2 fascial layers of the penis?

A
  1. Superficial layer = Dartos fascia (indistinct merging of Camper’s and Scarpa’s)
  2. Deep fascia = Buck’s fascia
33
Q

What is Camper’s fascia replaced by in the scrotum?

A

Dartos muscle

34
Q

What does Scarpa’s fascia extend into in the scrotum, and fuse with?

A
  • Extends into the scrotum as Colles’/ perineal fascia

* Fuses with the fascia late of the thigh below the inguinal ligament and with the perineal body posteriorly

35
Q

What does injury to the bladder and urethra in particular (anterior urethral injuries due to pelvic fractures) lead to?

A
  • Urine extravasation/ bruising trapped under Scarpa’s and Colles’/ perineal fascia due to a breached deep penile fascia (Buck’s fascia)
  • Spread of urine/ bruising is limited to the lower anterior abdominal wall, upper thighs, penis and scrotum anteriorly with no extension posteriorly as the Colles’/ perineal fascia fuses to the perineal body

• Butterfly wing pattern of bruising (“blue swimming trunks”)

36
Q

What makes up the vulva?

A
  • Labium majus laterally, the album minus, the vaginal and urethral openings in the vestibule between the labia minor that divide into medial and lateral folds to from the prepuce of the clitoris
  • Labia majora meet anteriorly to form the mons pubis while posteriorly they form the posterior labial commissure or fourchette
37
Q

What must be done in an episiotomy?

A
  • Episiotomy must be backwards and angled laterally, usually to the right, to avoid cutting anal sphincter
  • During childbirth, to aid a difficult delivery and prevent rupture of tissues
38
Q

Structure of the clitoris?

A
  • Body of clitoris = 2 crura, while the bulb contributes minimally as a little cap over the highly sensitive glans
  • Bulb of vestibule is divided by the vagina and covered by bulbospongiosus that aids the pubovaginalis (part of levator ani) in its sphincteric affect
39
Q

Greater vestibular gland:
• Aka?
• Clinical implication

A
  • Aka Bartholin’s gland

* May be the site of painful cyst or abscess formation

40
Q

What does internal pudendal arteries supply?

A

Supplies the perineum and in both sexes gives arteries to:
• Urethra
• Posterior 2/3 of scrotum or labia (anterior 1/3 via external pudendal from femoral)
• Cavernous tissue of penis or clitoris
• Skin of shaft
• Glans or penis or clitoris

41
Q

Blood supply of the perineum?

A
  • Internal iliac anterior trunk
  • Internal pudendal
  • Arteries to bulb and urethra
  • Posterior scrotal (or labial) branches of the perineal artery
  • External iliac
  • Femoral
  • External pudendal
  • Dorsal artery of penis and clitoris
  • Deep (cavernosal) artery of penis and clitoris
42
Q

Venous drainage of the penis?

A
  • Penile skin and foreskin - drain via superficial dorsal veins —> external pudendal
  • Glans and shaft - drain via deep dorsal vein —> prostatic venous plexus and internal iliac vein
  • Deep arteries in corpora cavernosa (cavernosal arteries) accompanied by veins draining —> internal pudendal
43
Q

Blood supply of the penis?

A
  • Dorsal artery of penis

* Internal pudendal artery

44
Q

Lymphatic drainage of deep structures e.g. corpora cavernosa, corpus spongiosum, bulb of penis and vestibule, proximal vagina and urethra?

A

Drain into internal iliac lymph nodes

45
Q

Lymphatic drainage of superficial structures e.g. penis, scrotum and labia?

A

Drain into superficial inguinal lymph nodes

46
Q

Lymphatic drainage of the glans of penis and clitoris?

A

• Drain into deep inguinal (Cloquet) and external iliac lymph nodes

47
Q

Nerve supply of the perineum?

A

Require:
• Somatic motor - control of striated muscles (external urethral and external anal sphincters, bulbospongiosus and ischiocavernosus)
• Sensation - urethra, glans of penis and clitoris
• Autonomic - both sympathetic and parasympathetic, afferent and efferent

Derived from:
• S2, S3, S4 pudendal nerves and pelvic plexuses (aka inf. hypogastric)

48
Q

Branches given of by pudendal nerve (S2, S3, S4 - somatic motor and sensory)?

A
  • Dorsal nerve of penis/ clitoris - sensory as far as glans
  • Muscular branches to bulbospongiosus, ischiocavernosus and external urethral sphincter
  • Perineal nerve - giving posterior scrotal/ labial nerves
  • Inferior rectal
49
Q

Branches given of by pudendal nerve (S2, S3, S4 - somatic motor and sensory)?

A
  • Dorsal nerve of penis/ clitoris - sensory as far as glans
  • Muscular branches to bulbospongiosus, ischiocavernosus and external urethral sphincter
  • Perineal nerve - giving posterior scrotal/ labial nerves
  • Inferior rectal
50
Q

What structure is at risk in rectal or prostatic surgery?

A

Pelvic plexus

51
Q

What is the pelvic plexus?

A

• Mixed sympathetic and parasympathetic pelvic plexus (aka inferior hypogastric) at side of rectum

  • Initially sympathetic but joined by parasympathetic pelvic splanchnic from S2, S3, S4
  • Branches tend to join and be distributed with branches of the pudendal nerve
52
Q

What structures does cavernous nerves pass directly to?

A

Prostate and urethra, corpus spongiosum and erectile tissue of corpora cavernosa (penis and clitoris)

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