Anatomy: Normal and erectile dysfunction Flashcards
point and shoot
para - erection
symp- ejaculation
crops cavernous erectile tissue of the penis
for artery branch of the internal iliac is needed for erection
internal pudendal artery
eexternal does tissue surrounding it
venous drainage of the penis
prostatic venous plexus then to internal iliac artery
r testicle to IVC then left to left renal vein
variocelle of varicose vein of left testicle - scan left kidney for renal cancer
innervation to the penis controlled by
somatic pudendal - conscious control
inconcisous
para - S2-4 pelvic splanchnic nerves and sympathetic is T12-L2
all skeletal muscles are controlled by
the somatic nervous system
what are the 4 parts to an erection
erection
ejaculation - emissions dn expulsion ( gather and fire)
remission
normal eerection in brain
erotic stimulus, triggers para( pelvic splanchnic nerves stimulate pre aortic and pros tai plexuses) and act of limbic system then act on cc on penis - vasodilation of pudendla artery and deep penile arteries mediated by nitric oxide. Erectile tissue fills with blood compression the dorsal vein.
normal ejacultion
what causes retrograde ejaculation
emission - initial part of ejaculation
signals from lateral horns of T10-12
sympathetic system
NA released - DD, seminal vessels nd smooth muscle of prostate contract and internal urethral sphincter constricts
final act is pudendal nerve contract and send pulses - construct arteries and pressure decrease
symathetic system constrict bladder to prevent retrograde ejacutlaiton - TURP can cause this
bulbospongioussu fire it
erectile dysfunction causes
psychological tired drugs anxierty depression anti-hypertensives MS tumorus larches syndrome ( button claudication)
how does viagra work
sidinafil - works on NO hangs around longer so more blood filling
phimosis
is a condition where the foreskin is too tight to be pulled back over the head of the penis (glans)
paraphismosis
treatment
where the foreskin cannot be returned to its original position after being retracted. It causes the glans to become painful and swollen and requires emergency medical treatment to avoid serious complications, such as increased pain, swelling and restricted blood flow to the penis.
circumcission
afte rpuberty should be Abel to
squeeze penis tight to get back
balanitis
pain and inflammation (swelling and irritation) of the glans (head) of the penis that happens most often in uncircumcised males rf poor hygiene diabetes obese STI middle aged to older
foul smell and smegam
painful ruination
redness
hydrospadiads
hole somewhere else
don’t circumsize
treatment for balinits
anti fungal tcreasm for yeast infection like clotrimazole antibiotics improved hygiene diabetes cicumcission
What artery supplies the main body (i.e the corposa cavernosa) of the penis
What arteries is this a branch of?
cavernosal artery
bulbourethral artery
What artery supplies the skin of the penis?
dorsal artery
How does blood drain from the penis?
The deep dorsal vein receives blood from emissary veins, which arise from subtunical venules draining trabecular and passing through the tunica albuginea and circumflex veins. In the infrapubic region, the deep dorsal
What nerves are involved in somatic (i.e. motor and sensory) pathways to/from the penis
pudendal
What plexus and then nerves are involved in the sympathetic control of the penis?
superior hypogastric
What nerves are involved in the parasympathetic control of the penis?
sacral nerve roots S2-4
Correctly order the following stages of erection and ejaculation
Nitric Oxide release causes the cavernous arteries to dilate and blood flows into the corposa cavernosa and spongiosum.
· Sympathetic fibres cause the urethral bulb to expand and contract both internal and external urethral sphincters
· Sensory pudendal nerves are stimulated by sexual arousal.
· Engorgement of the corposa cavernosa constricts outflow to the deep dorsal vein maintaining erection
· The muscles of the external urethral sphincter then relax and waves of muscular contraction from the base of the penis through the urethra eject semen from the penis
· At the same time parasympathetic fibres stimulate secretion of sperm and seminal fluid.
· Parasympathetic chain stimulates eNOS to produce Nitric Oxide in the endothelium of the penis
Stimulation of erection
S2-S4 pudendal nerve
Stimulation of genitals sends signals along the pudendal nerve, to the spinal cord
Somatic innervation
Erection due to parasympathetic innervation (POINT)
Pelvic splanchnic nerve stimulates pre-aortic and prostatic plexuses, which carry nerve signals to the penis
Deep penile arteries vasodilate due to nitric oxide
Erectile tissues fill the corpus cavernosum mainly with blood, compressing the dorsal veins.
Tunica albuginea also aids in preventing blood from flowing out of the corpus cavernosum
ejaculation
Emission
-due to sympathetic innervation (SHOOT)
Emission= initial part of ejaculation
Signals initiated by the lateral horns of T10-L2
Lumbar and sacral splanchnic nerves carry signals via the pre-aortic and prostatic plexuses to the spermatic cords
Release of noradrenaline:
Ductus deferens, seminal vesicles (produce seminal fluid), and smooth muscle of the prostate begin to contract
Internal urethral sphincter constricts (stops urine coming out and semen up into the bladder)
Somatic innervation
Signals arise from the ventral horn of S2-S4 in the spinal cord
Motor signal carried by the pudendal nerve
Diagram
Description automatically generatedMotor nerve impulses cause bulbospongiosus and ischiocavernosus to contract rhythmathly
case 1
27yr man with 5hr history of painful erectile
PMH SCD
smokes and takes cocaine what is it
Priprism - low flow probs very painful
case 2
43yr with inflamed swollen glands, unable to retract foreskin and complains of pain on passing urine
PMH diabetes
DH metfromin and recent cause of antibiotic for chest infection
balanitis
Inflammation of the glans penis
If the foreskin is also inflamed, the correct term is balanoposthitis
Uncommon in circumcised males
Risk factors: diabetes, oral antibiotics, poor hygiene, immunosuppression, irritation of the glans
Causes: Usually simple intertrigo Infection Dermatological Irritation Trauma Stevens Johnson syndrome -dermatological emergency usually related to antibiotics Right heart failure – peripheral oedema Morbid obesity
case 3
26y man on abdo surgery. unable to replace foreksin since returning from their as cathertires by junior member of staff
Paraphimosis
Inability to replace a retracted foreskin over the glans penis
Often due to constriction by a tight band of the foreskin
Glans become oedematous due to reduced venous return, followed by vascular engorgement of the distal penis
Urological emergency due to risk of ischaemia and infection
RF: phimosis, indwelling urethral catheter, poor hygiene, previous episodes
case. 4
52yr with hypertension and can’t maintain erection. PMH hypertension and T2DM
DH rmaipril, bisporlol, metfomrin
smoker
Erectile Dysfunction
The inability to attain and maintain an erection sufficient for sexual performance
RF: obesity, smoking, lack of exercise, High blood pressure, hypercholesterolaemia, diabetes, metabolic syndrome
Causes:
Vascular, neurological, hormonal, anatomical ,medications (antihypertensives) ,psychogenic
case 5
36yr acute penile pain. feels a popping sensation during sex with new partner, following acute swelling and detumescence
penis darker in colour than usual
Penile Fracture
Urological emergency- prompt intervention
Traumatic rupture of corpus cavernosum and tunica albuginea whilst the penis is erect
Causes: blunt trauma
Often reported as a popping sensation or audible snap, before immediate pain, swelling and detumescence
O/E: swelling and discolouration due to haematoma. May deviate away from the affected side
Haematoma may be palpable ‘rolling sign’. Butterfly shaped bruising to the perineum is suggestive of urethral injury
