Fields- anatomy of male pelvis and perineum Flashcards
3 bones of pelvis
pubis
ischium
ilium
covered by the pectineal ligament and crossed by the femoral v, a, n, medial to lateral
pectineal line
how nerves and arteries leave the pelvis and enter the perineum
greater and lesser sciatic foramen
a full bladder will extend into ____ pelvis
false
b/t the iliopectineal line and the pelvic diaphragm
true pelvis
prevents organs from spilling out to the feet
pelvic diaphragm
posterior boundary of true pelvis
sacrum, coccyx, piriformis m.
floor of the true pelvis
pelvic diaphragm
anterior boundary of true pelvis
pubic bone
lateral boundary of true pelvis
obturator internus m
main innervation of the pelvic diaphragm
somatic innervation (skeletal muscle)
innervation of coccygeus/ischiococcygeus of pelvic diaphragm
S4-S5 (somatic)
innervation of levator ani of pelvic diaphragm
S3-S4 (somatic)
supports male pelvic organs and helps prevent urinary and fecal incontinence
pelvic diaphragm
strengthened by Kegel exercise to prevent urinary and fecal incontinence
Levator Ani
fascia of the obturator internus muscle from which the iliococcygeus m. takes its origin
Arcus Tendineous
3 parts of pubococcygeus muscle
puboprostate
puborectalis
pubococcygeus
connects to ischial spine
coccygeus muscle
The physician’s diagnosis is injury to the nerves supplying the pelvic diaphragm. What are the muscles and their innervation?
Levator Ani: S3, S4
Coccygeus: S4, S5
transports sperm from testis to penis
vas deferens
Where the duct of the seminal vesicle joins the vas dererens.
It empties into the prostate gland
Ejaculatory Duct
passes behind the ureters
vas deferens
where sperm is stored until smooth m. contractions force it out
ampulla (vas deferens)
will secrete bicarbonate to increase the pH so sperm can still function in acidic environment of vagina
prostate gland
bone is white on CT or MRI
CT
arrows
seminal vesicle
MRI (?)
seminal vesicle
secretion from seminal vesicle that causes lubrication of vagina
mucoid material
seminal vesicle secretion that provides nutrients for the sperm
fructose
seminal vesicle secretion that enhances sperm migration
prostaglandins
seminal vesicle secretion that activates sperm motility
calcium
seminal vesicle secretion that is fibrinogen-like clotting protein that coagulates semen when acted on by clotting enzyme secreted by the prostate gland. Causes the semen to stick to the
cervical and vaginal wall.
Prosemenogelin
what separates median and posterior lobes of prostate gland
ejaculatory duct
what separates anterior lobe from median and posterior lobes
prostatic urethra
small bump along prostatic urethra
verumontanum
opening in verumontanum
prostatic utricle
prostate gland secretion that neutralizes the acid in the vagina
bicarbonate and phosphate
prostatic gland secretion that acts on prosemenogelin and coagulates semen
clotting enzyme
prostate gland secretion that liquifies coagulated semen
serine protease
prostate gland secretion that is nutrient for the sperm
citrate
prostate gland secretion that prevents premature capacitation and acromosome reaction of the sperm
spermine
secretes mucus and acts as a buffer
cowper’s gland/bulbourethral gland
most of the composition of semen
seminal fluid
pelvic floor fascia; adheres to prostate posteriorly
aka rectovesical septum
Denonvillier fascia
b/t rectum and bladder and prostate gland
rectovesical septum (Denonvillier fascia)
b/t rectum and bladder in peritoneum
rectovesicular pouch
______following a prostectomy.
The rectum bulges into the space vacated
by the prostate gland & bladder.
This prevents proper filling of the bladder.
Rectocele
Frequently associated with prostatectomy, which can result in postoperative deficiency of the Denonvillier fascia
Rectocele
bilateral drooping of bladder wall
saddle bag sign
A deficiency of _____ can lead to posteriolateral drooping of the bladder wall
Denonvillier fascia
supplies pelvis and perineum
internal iliac a
bottom R arrow
vesicular, prostatic, and seminal vesicle a.
where does the caudal portion of prostate drain
sacral lymph nodes to aortic all the way up
where does the lateral portion of prostate drain
internal iliac lymph nodes to common iliac to aortic and up
where does cranial portion of prostate drain
external iliac to common iliac to aortic and up
where do the seminal vesicle and vas deferens drain
internal iliac to common iliac to aortic and up
most common lobe for BPH
median
restricts prostatic urethra (bladder wont empty properly)
BPH
most common lobe for prostate cancer
posterior
bladder won’t empyt well, urine can back up and damage kidneys due to this
prostatitis
how to treat prostatitis if it doesnt get better on its own
antibiotics
releases PSA (prostate specific antigen) into blood
prostate gland
high levels of _____ can be associated with cancer or prostatitis or other things
PSA
Symptoms:
Infertility (low semen volume).
Hematospermia (blood in the semen).
Pain when urinating or ejaculating.
Pain in the perineum (groin & anal regions), lower abdomen or back.
Rx: antibiotics
seminal vesiculitis
during this exam, can palpate an enlarged prostate gland or inflamed seminal vesicle
digital rectal exam
cause bladder obstruction in males that can
manifest along a spectrum of severity, ranging from disease
incompatible with postnatal life to conditions that have such minimal
impact that they may not manifest until later in life.
posterior urethral valve (PUV)
This involves taking a piece of tissue from the intestinal tract and adding it to the bladder tissue. This has two intended consequences. One is an increase in bladder volume. And the proportion of the bladder that participates in contractions is reduced, resulting in a decrease in bladder pressure during urination.
bladder augmentation
The appendix is used to connect the umbilicus to the urinary bladder. The appendix blood supply is preserved.
Mitrofanoff appendicovesicostomy
D.
pelvic organ mesenteric structures
superior bladder
upper 1/2 of rectum
mesenteric structures of pelvic organs referred pain by _____
sympathetics (L1, L2)
retroperitoneal structures of pelvic organs
lower 1/2 rectum
anus
bladder
SV
prostate
retroperitoneal structures of pelvic organs referred pain by _____
pelvic splanchnics (S2-S4)(parasympathetics)
The ______ cell bodies are located in the dorsal root ganglion at spinal cord levels of the lateral horns L1 & L2 (sympathetic) and S2-S4 (parasympathetic)
GVA
lumbar splanchnics (preganglionic) synapse where
inferior hypogastric plexus
sacral splanchnics (preganglionic) synapse where
inferior hypogastric plexus
Important with regards to visceral (referred) pain to dermatomes L1 & L2
sympathetic lumbar and sacral splanchnic nerves
____ nerves travel to pelvic organs from inferior hypogastric plexus
postganglionic sympathetic nerves
enter pelvic organs where they synapse in enteric ganglia
parasympathetics (pelvic splanchnic nerves)
Except for the _______., parasympathetics do not synapse in the inferior hypogastric plexus
cavernous n.
C and D
area below pelvic diaphragm
perineum
_____ consists of:
sphincter urethra m. (skeletal muscle)
covered superiorly and inferiorly
by deep fascia of the sphincter urethra m. fascia
UG diaphragm
basically is what external genitalia is attaching to
UG diaphragm
urogenital triangle anterior boundary
pubic bone
urogenital triangle floor boundary
skin
urogenital triangle roof boundary
perineal membrane
urogenital triangle posterior wall boundary
perineal body
urogenital triangle later wall boundary
ischiopubic ramus
contents of urogenital triangle
scrotum
crus of penis
bulb of penis
internal pudendal a branches and pudendal n.
anal triangle anterior wall
perineal body
anal triangle lateral wall
obturator internus m
anal triangle medial wall
levator ani m.
anal triangle posterior wall
coccyx
contents of anal triangle
external anal sphincter m
obturator internus m
levator ani m
internal pudendal a branches and pudendal n branches
MRI or CT
CT
UG Diaphragm – sphincter urethra (skeletal muscle) covered superiorly and inferiorly
by deep fascia of the sphincter urethra fascia
deep pouch of urogenital triangle
provides foundation for external genitalia
inferior fascia of UG diaphragm
contents of superficial pouch of UG triangle
scrotum
shaft (crus and bulb)
muscle that covers crus of penis
ischiocavernosus m
muscle that covers bulb of penis
bulbospongiosus m
crus of penis aka
corpus cavernosum
bulb of penis aka
corpus spongiosum
blood filled structures of penis
“corpus”
roof of superficial pouch and floor of deep pouch
perineal membrane
contents of deep pouch of UG triangle
membranous urethra
Cowper’s gland (bulbourethral gland)
sphincter urethra m
deep transverse perineal m
deep dorsal a and nerve
Prostate gland with _____ urethra
prostatic
urogenital diaphragm with the ______ urethra
membranous
corpus spongiosum with the ______ urethra
spongy penile
deep pouch of UG triangle 2 main components
UG diaphragm
bulbourethral glands
(membranous urethra)
superficial pouch main contents
bulb and crus of penis
(penile/spongy urethra)
in male bulbourethral gland is found where
deep pouch
in females, homologous gland to bulbourethral gland in males is found where
superficial pouch
______ leaves the pelvis through greater sciatic foramen and enters perineum through lesser sciatic foramen
pudendal a. and n.
3 branches of internal pudendal a. that supplies male perineum
inferior rectal a
perineal a
dorsal a
somatic innervation of the perineum
pudendal n. (S2-S4)
branch of pudendal n. that carries motor to external anal sphincter & sensory to the anal area. In the anal triangle
Inferior rectal n
branch of pudendal n. that motor to all skeletal muscles of UG triangle & sensory to the posterior scrotum. In the superficial pouch.
perineal n.
branch of pudendal n. that carries pure sensory to the glans penis.
In the deep pouch.
Dorsal n.
Painful sitting
Genital pain
Perineal pain
Pain during intercourse.
Erectile dysfunction.
Difficulty achieving orgasm.
Bladder and bowel dysfunction.
Feeling of urgency to use the toilet
pudendal n. neuralgia
Nerve entrapment between the sacrospinous and sacro-tuberous ligaments. Inflammation of the piriformis or obturator internus
possible causes of pudendal n/ neuralgia
drainage for testes and epididymis
aortic to lumbar and up
penis and scrotum drainage
superficial or deep inguinal to external iliac to common iliac to aortic and up
PREGANGLIONIC SYMPATHETIC
Sacral Splanchnic nerves (L1-L2) innervation to perineum exit the paravertebral ganglia and synapse in the _________
inferior hypogastric plexus
PREGANGLIONIC PARASYMPATHETIC
Pelvic Splanchnic nerves (S2-S4) travel to the inferior hypogastric plexus where they _______ and travel to the perineum
via the cavernous n.
synapse
Postganglionic parasympathetics to the perineum. Cell bodies are
in the inferior hypogastric plexus.
cavernous n.
parasympathetics role of penis
excitement and plateau (erection)
sympathetics role of penis
orgasm (ejaculation)
C. and D.