Anatomy of the Lower Urinary Tract and Male Reproductive Tract Flashcards
How do the ureters pass to the true pelvis?
Pass from the retroperitoneum through the false pelvis and into the true pelvis
What is the false pelvis?
From the iliac crests to pelvic inlet = part of the abdominal cavity
What is the true pelvis?
Pelvic cavity = pelvic inlet to pelvic floor
What forms the pelvic diaphragm?
Levator ani and other pelvic floor muscles
What body cavity is the bladder found in?
The pelvic cavity
What does the urethra pass through to reach the peritoneum?
The pelvic floor
What forms the pelvic floor?
The bowl shaped pelvic diaphragm
What structures pass through the pelvic floor?
Distal parts of alimentary, renal and reproductive tracts
What is the perineum?
Shallow compartment between the pelvic floor and the skin
What is the course of the ureters?
Pass anterior to the common iliac vessels to enter the pelvis, run anteriorly along the lateral pelvic walls
What do the ureters do at the level of the ischial spine?
Turn medically to enter the posterior aspect of the bladder
What can be said for the route of the ureters?
It is completely sub-peritoneal
What direction do the ureters enter the posterior bladder wall?
Inferomedial direction = helps prevent reflux of urine back into ureters when the bladder contracts
What is special about the rectovesicle pouch?
Most inferior part of the male peritoneal cavity in the anatomical position
What structures does the round ligament of the uterus attach?
Attaches uterus to the perineum via the inguinal canal
Where is the vesico-uterine pouch located?
Between the bladder and the uterus
What is significant about the recto-uterine pouch of Douglas?
Most inferior part of the female peritoneal cavity in the anatomical position
What does the inferior part of the parietal peritoneum form?
The floor of the peritoneal cavity and a roof and over the pelvic organs
What are some anatomical relations of the ureter in females?
Runs inferiorly to the uterine tubes and the uterine artery
What structure does the ureter in males run inferior to?
The vas deferens
Where do the arteries that enter the pelvis originate from?
The internal iliac artery
What are some branches that the internal iliac artery gives off into the pelvis?
Uterine artery, middle rectal artery, vaginal artery
What vessels supply the bladder?
Vesical arteries
What do the pelvic veins drain into?
The internal iliac vein
What branches does the vesical artery give rise to?
The prostatic arteries
What is the trigone of the bladder?
Internal aspect of bladder = formed by 2 ureteric orifices and the internal urethral orifice
How are the orifices arranged in the trigone?
Ureteric orifices are the posterior aspect
Internal urethral orifice in the inferior aspect
What does the detrusor muscle form?
The main bulk of the bladder wall
How does the detrusor muscle prevent urine reflux?
Fibres encircle ureteric orifices and tighten when the bladder contracts
What does the detrusor muscle form in the male bladder?
The internal urethral sphincter muscle = contracts during ejaculation to prevent reflux
What is the most anterior organ in the pelvis?
The bladder (when empty) = lies posterior to the pubic bone
What are the anatomical relations of the bladder in males?
Prostate lies inferior to bladder, rectum is posterior to bladder
What are the anatomical relations of the bladder in females?
Body of uterus usually lies superior (separated by uterovesical pouch)
What bears most of the weight of the uterus?
The bladder
Where is the empty bladder located?
Lies within pelvis and it’s superior surface is covered by peritoneum
Where is the full bladder located?
Can extend out of pelvis = superior part lies superior to pubic bone, peritoneum still only covers superior surface
What are the two ways of catheterising the bladder?
Urethral = more common Supra-pubic = through anterior abdominal wall and avoids peritoneal cavity
How long is the urethra?
Male = 20cm long Female = 4cm long
Where is the spongy urethra located in males?
Within the corpus spongiosum
How are the urethral sphincters controlled?
External urethral sphincter = voluntary
Internal urethral sphincter = involuntary
Where should the testes be located at birth?
Within the scrotum
What is the course of the testes during development?
Move from original position in the posterior abdomen, through the posterior inguinal canal and to the scrotum
What is the spermatic cord?
Collection of structures which support the functioning of the testes
What vessels are within the spermatic cord?
Testicular artery, testicular vein, lymphatic vessels
What nerves are contained within the spermatic cord?
Autonomic nerves for the smooth muscle of the vas
Somatic nerves for the cremaster muscle
What covers the epididymis and testis?
Visceral tunica vaginalis
What is a hydrocele?
Excess fluid within the tunica vaginalis
What venous plexus is contained within the spermatic cord?
Pampiniform plexus
What is the function of the vas deferens?
Transports sperm = begins at inferior pole of testes
What is testicular tortion?
Twisting of the spermatic cord = may disrupt blood supply and lead to testicular necrosis, causes severe pain
What is the function of the deep inguinal ring?
Allows passage of the spermatic cord into and out of the inguinal canal
Where can the epididymis be palpated?
At posterior aspect of testes
Where is the proximal end (head) of the epididymis located?
At the posterior aspect of the superior pole of the testes
Where can the vas deferens be palpated?
Within the spermatic cord = within scrotum superior to testes
What is the course of the vas deferens?
Passes superiorly within the spermatic cord to the deep inguinal ring, where it turns medially into the pelvis
Where do the secretions from the prostate gland drain in to?
The prostatic urethra via the prostatic ducts
What structures form the ejaculatory duct?
Vas deferens and the duct from the seminal gland
How big is the prostate gland?
Walnut sized = surrounds prostatic urethra
What is the inferior aspect of the prostate in contact with?
The levator ani muscle
What are the zones of the prostate gland?
Peripheral and central zones
What part of the prostate can be felt during a PR examination?
The peripheral zone = site of most prostate cancers
Where is the penis located?
Within the perineum
What is the root of the penis attached to laterally?
Ischium of the pelvis
What happens to the penis during an erection?
The three cylinders of erectile tissue become engorged with blood at arterial pressure
What are the erectile tissues of the penis?
Right and left corpus cavernosum, corpus spongiosum
Where are the right and left corpus cavernosum located?
Located posteriorly = transmit deep arteries of blood to penis
Where is the corpus spongiosum located?
Located anteriorly = transmits spongy urethra
What forms the glans of the penis?
Distal expansion of the corpus spongiosum
What is the blood supply of the penis?
Deep arteries of penis = branches of internal pudendal artery from internal iliac artery
What is the blood supply to the scrotum?
Internal pudendal artery and branches from the external iliac artery
Where does lymph from the scrotum and most of the penis (not glans) drain to?
Superficial inguinal lymph nodes = in superficial fascia in the groin
Where does lymph from the testis drain to?
Lumbar nodes around the abdominal aorta
