L1: clinical anatomy and histology of the male reproductive system

Question 1

Describe the testes, its blood supply and lymphatic drainage

Answer 1

Two paired testes lie in the scrotum (through embryological development have descended into the scrotum to allow spermatogenesis -> requires a cooler temperature)
Blood supply: testicular artery
Venous drainage: pampiniform plexus
Lymphatic drainage: para-aortic lymph nodes (different from the scrotum which are more superficial at the inguinal lymph nodes)

Question 2

What do the right and left testicular veins drain into?

Answer 2

Right – drains directly into the inferior vena cava
Left – drains into the left renal vein which drains into the inferior vena cava
If obstructed, this can enlarge leading to a varicocoele

Question 3

What is testicular torsion?

Answer 3

Spermatic cord twists on itself

Emergency -> if blood supply is restricted it can lead to ischaemia and ultimately lead to the loss of the testes

Question 4

Outline the formation of the inguinal canal

Answer 4

The testes took layers of the abdominal wall to form the inguinal canal -> common point of hernias (also took the peritoneum with them, which envelopes the testes as the tunica vaginalis)

Question 5

What is a hydrocoele?

Answer 5

Pathological condition where the tunica vaginalis fills with fluid

Question 6

What are the seminiferous tubules?

Answer 6

Spermatogenesis occurs here
Formed of Sertoli cells, which are responsible for spermatogenesis & Leydig cells that produce testosterone
The tubules come together at the rete testis & join to the epididymis (sperm maturation occurs here)

Question 7

What is the vas deferens?

Answer 7

Sperm travels from the testis through the vas deferens, which travels through the spermatic cord
Joins the ejaculatory duct at the prostate
Ureter passes underneath the vas deferens (‘water under the bridge’)

Question 8

What is in the spermatic cord?

Answer 8

3 fascial layers
-external spermatic fascia (external oblique aponeurosis)
-cremasteric fascia (internal oblique muscle + fascia)
-internal spermatic fascia (transversalis fascia)
3 arteries/veins
-testicular vessels
-artery to vas deferens 
-cremasteric vessels 
3 nerves
-nerve to the vas deferens 
-nerve to cremaster/genital branch of the genitofemoral nerve 
-ilioinguinal nerve 
3 others
-vas deferens
-lymphatics
-processes vaginalis

Question 9

What are the seminal vesicles?

Answer 9

Most of the ejaculate is produced here

• 65%
• fructose-based alkaline fluid
• provides nutrition for sperm & neutralises the acidic environment

Question 10

What does the prostate produce?

Answer 10

A milky secretion, which makes up about 25% of ejaculatory fluid
-contains proteolytic enzymes and is mildly acidic

Question 11

How can you tell the difference between BPH & prostate cancers on examination?

Answer 11

Benign prostatic hyperplasia (BPH) tends to affect the transitional zone
-causes urinary symptoms
Prostate cancers tend to be in the peripheral zone
-doesn’t cause urinary symptoms

Question 12

What are the bulbourethral glands?

Answer 12

Produce secretions that reduce friction – only a tiny percentage of ejaculate

Question 13

What are the two different tissue types of the penis?

Answer 13

Corpus spongiosum – expansile tissue through which the urethra travels
Corpus cavernosum – paired tissue, main erectile tissue -> attached to bone to help anchor the penis