Anatomy Flashcards
Superficial Inguinal lymph node dissection superior limit: lateral limit: medial limit: inferior limit:
-superior limit: external oblique fascia at level of spermatic cord -lateral limit: a sagittal plane through the anterior superior iliac spine (ASIS) -medial limit: sagittal plane through the ipsilateral pubic tubercle -inferior limit: transverse plane 20 cm inferior to the ASIS
Deep Inguinal Lymph Node Dissection
Nodes removed from the femoral triangle - DO NOT go lateral to the femeral artery (avoids injury to femoral nerve and profunda femoris artery) - NAVEL
Femoral Triangle
superior boundary -
medial boundary -
lateral boundary -
anterior surface -
Arrangement of structures in femoral triagle
Lateral boundary - sartorius
Superior boundary - inguinal ligament
Medial boundary - Adductor Longus
Anterior surface - fascia lata (superficial to facia lata are superficial inguinal lymph nodes)
NAVEL (from lateral to medial)
The node of Cloquet
the most cephalad node in the deep inguinal ring
When should you do a pelvic lymph node dissection in patients with penile cancer?
only if ipsilalteral inguinal nodes have cancer (>2 nodes).
penis lymphatics do not drain directly to the pelvic nodes. Inguinal lymph node mets must be present before cancer can reach the pelvid nodes. Also, does not spread to contraleteral pelvic nodes from ILN
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What is the obturator reflex?
stimulation of the obturator nerve that causes sudden leg adduction
this can happen when you are resecting tumors of the lateral bladder wall
can prevent this by using neuromuscular blockade during surgery
progression fo cancer spread from penis through nodes
penis –> sentinel node –> superficial inguinal nodes –> deep inguinal nodes –> pelvic nodes –> distant metastasis
Metastasis from Testis Tumors:
Right testis –> ?
Left Testis –> ?
How to lymphatic metastases spread?
Right testis –> tumor spreads to the interaortocaval retroperitoneal nodes
Left testis –> tumor spreads to the left para-aortic retroperitoneal nodes
Lymphatic metastases can spread from RIGHT –> LEFT but they do NOT usually spread from LEFT –> RIGHT
When will testis tumor mets go to the inguinal nodes?
When would it go to the pelvic nodes?
May also get to INGUINAL NODES if tumor invades through tunica vaginalis or scrotum
PELVIC NODES if tumor invades into the epididymus or spermatic cord
Radical Pelvic Lymph Node dissection - Full Bilateral template
superior, lateral and inferior limit
Superior limit –> renal vessels
Lateral Limit –> ureters bilaterally
Inferior limit –> where ureters cross the common iliac arteries
What causes impaired ejaculation after RPLND?
Injury to post-ganglionic sympathetic nerves (T2-T4) and to the hypogastric plexus (sympathetic nerve plexus) near the origin of the IMA
-Can use modified RPLND template or nerve sparing surgery to avoid this if this is clinically possible
Superficial to deep, layers of the penis
1) Skin
2) Superficial (DARTOS) fascia
3. Areolar tissue
4. Deep (BUCKS) fascia
5. Tunica albuginea
6. Corpus cavernosum
Superficial to deep, layers of the scrotum
- Skin
- Dartos fascia and muscle
- External spermatic fascia
- Cremasteric fascia
- Internal spermatic fascia
- Tunica vaginalis
- Tunica albuginea
Layers of scrotum/spermatic cord derived from what abdominal wall layers?
Internal spermatic fascia –> transversalis fascia
Cremasteric fascia –> interal oblique muscle
External spermatic fascia –> external oblique muslce
what is unique about the cremasteric muscle
striated and innervated by the genital brance of the genitofemoral nerve to elevate the testis
what is the gubernaculum, what does it do? What does it become later in development?
paired organ, embryonic strucure that attaches to the caudal end of the gonads (Testis/ovaries) and assists in their descent
Testes eventually pulled through inguinal canal
In males it becomes a scrotal ligament (secures testis to inferior scrotum)
In females it becomes with ovarian ligament and the round ligament
Bell Clapper Deformity
Failure of the normal posterior anchoring of the gubernaculum, epididymus and testis.
Leaves testis free to swing and rotate within the tunica vaginalis of the scrutum like the gong (clapper) insude of a BELL
Layers of the testis
- Tunica vaginalis (parietal layer, cavity, visceral layer)
- Capsule (tunica albuginea)
- Seminiferous tubule
pathway of sperm from seminiferous tubule
seminiferous tubule –> straight tubule –> rete testis –> efferrent ductules –> head of epididymus –> body –> tail of epididymus –> vas deferens
Layers of the abdominal wall (1-8)
- skin
- subcutaneous tissue (fat)
- external oblique
- Internal oblique
- Fascia of both superficial and deep surfaces of the internal oblique muscle
- Transversus abdominis
- Transversalis fascia
- Peritoneum
