Lecture 1 - Male Repro Flashcards
Look at the male repro notes in the prework tab
2nd image and label:
1 = corpus cavernosum
2 = corpus spongiosum
3 = pubic symphysis
4 = bladder
5 = prostate
6 = rectum
7 = vas/ductus deferens
8 = deep inguinal ring
What is the cord structure that passes from the testis to the prostate?
Ductus deferens (vas deferens)
What tube connects the prostate to the ductus deferens to the testis?
Ejaculatory duct
Within the testes what is the site of spermatogenesis?
Seminiferous tubules
What do the seminiferous tubules join up to?
Epididymis
What is the name of the connective tissue that holds the seminiferous tubules in place?
Tunica albuginea
What is the name of the serosa that envelopes the testis?
Tunica vaginalis
What membrane is the serosa Tunica vaginalis derived from?
Peritoneum
What is Hydrocoele?
Is it painful or painless?
When there is excess fluid in the Tunica vaginalis (scrotal swelling)
Painless
Why do hydrocoeles in young boys get bigger when they cough?
Why doesn’t it change in men?
When you cough the abdominal muscles contract, this forces fluid from the abdomen through the patent processes vaginalis pushing more fluid into the Tunica vaginalis
In normal development, in adults the processus vaginalis closes so there isn’t an opening into the tunica vaginalis
How can a hydrocoele be diagnosed?
Use a flashlight to transilluminate it
Except for the stem cells producing sperm cells in the seminiferous tubules what are 2 other important cells?
Sertoli cells
Leydig cells
What is the function of Sertoli cells?
Support (essential for) spermatogenesis by removing excess cytoplasm from developing sperm
Where are leydig cells found and what is their function?
In spaces between seminiferous tubules
They help make testosterone
How are leydig cells adapted to help make testosterone?
Have lots of/prominent Smooth Endoplasmic Reticulum (SER)
Describe the arterial blood supply to the testicles:
The abdominal aorta branches to the testicular arteries
(Symmetrical)
Why is the venous supply to the testicles described as non symmetrical?
The left and right testicular veins drain into different blood vessels
Describe the venous drainage of the testicles:
The right testicular vein drains straight into the vena cava
Whereas the left testicular vein drains into the left renal vein first
Think it’s because the inferior vena cava is more on the right in terms of the aorta
How are the testicular veins structured?
They form into branches called the pampiniform plexus
What is varicocele?
What does it fell like on palpation?
When the pampiniform veins in the scrotum get enlarged usually due to valvular dysfunction
A bag of worms
Why is varicocele more common on the left than the right?
The left testicular vein drains into the left renal vein then vena cava whereas the right testicular vein drains straight into the vena cava
This means theres more chance for valvular dysfunction to happen on the left making the enlargement of the pampiniform veins more likely
What lymph nodes do the testes drain to and why?
Lumbar lymph nodes and para aortic nodes
The testes develop near the diaphragm
What lymph nodes does the skin of the scrotum drain to?
The superficial Inguinal lymph nodes
Why is a cancer that has metastasised from the testes not palpable at the superificala Inguinal lymph nodes?
It would go to the lumbar or para arotic lymph nodes
What is Bell-clapper deformity?
When the testes has completely become completely enveloped (instead of only being partially enveloped) in tunica vaginalis, this would allow the testes to twist in the tunica vaginalis
What is testicular torsion?
When the testes twists within the tunica vaginalis leading to the twisting of the spermatic cord
What happens to the blood supply during testicular torsion?
Spermatic cord is twisted
Venous drainage cut off (pampiniform plexus) causing pressure to build up
This cuts of the arterial blood supply
Leading to ischameic damage to the testes
How is testicular torsion treated?
Untwist testes
Put sutures in preventing testes twisting in tunica vaginalis
What separates the left and the right testes?
Septum of scrotum
How does the testes end up in place if they develop in the diaphragm?
They evaginate the abdominal wall muscles as they are pulled through the by the gubernaculum forming the spermatic fascia
What is the gubernaculum?
Its a structure connecting lower pole of testes to bottom of scrotum guiding the testes down to the scrotum
What strucutre follows attached to the testis as it descends to the scrotum?
Vas deferens (ductus deferens )
Testicular artery
Testicular vein
What 3 layersss form the spermatic fascia?
The 3 abdominal wall muscles
What is the rule of 3 for what makes up the spermatic cord?
Made of 3 fascial layers, 3 arteries and veins, 3 nerves and 3 other things
What are 3 fascial layers of the spermatic cord?
From deepest to most superficial:
Internal spermatic fascia (derived from transversalis fascia)
Cremasteric fascia (derived from internal oblique)
External spermatic fascia (derived fro external oblique)
What is internal spermatic fascia derived from?
Transversalis abdominis fascia
What is cremasteric fascia derived from?
Internal oblique muscle of abdominal wall
What is external spermatic fascia derived from?
External oblique (abdominal wall)
What are the 3 arteries and veins making up the spermatic cord?
Testicular artery and veins (pampiniform plexus)
Vein and artery from the ductus deferens (vas)
Cremasteric vein and artery
What is the function of the cremasteric muscle?
Contracts to rise testes up ((Thermoregulation)
Relaxes allowing testes to sink
How are the testicular artery and vein arranged?
Why is this useful?
The pampiniform plexus surrounds the artery
The counter current system helps cool the arterial blood down
What are the 3 nerves in the spermatic cord?
Autonomics (mainly sympathetics to vas deferens)
Genital branch of genitofemoral (motor to cremaster)
Ilioinguinal nerve (sensory)
What is the role of parasympathetic and sympathetics in terms of erection and ejaculation?
Way to remember this
Parasympathetic = erection
Sympathetics = ejaculation
Point and Shoot
P for parasympathetic
S for sympathetic
What is thee 3 other strucutres in the spermatic cord?
Ductus deferens
Lymphatics (drain to periaortic lymph nodes in abdomen)
Patent processes vaginalis (not normal in health adults usually destroyed in development
What is the Cremasteric reflex?
What nerves are important to this?
When the superior medial thigh stroked the cremasteric muscle contracts causing the Ipsilateral teste to rise
Genitofemoral nerve and ilioinguinal nerve
Ilioinguinal nerve senses it, genitofemoral nerve sends motor impulses to cremasteric muscle
Why is the cremasteric reflex useful to asses?
Can asses nerve function following a stroke or to see if affected by diabetic neuropathy
Why is the term water under the bridge useful for locating the ureter in both men and women?
In men ureter (water) passes under ductus deferens
In women ureter (water) passes under uterine artery
How is vasectomy performed?
Local anaesthetic
Ductus deference gets cut by making small ins ion in scrotal skin
What actually is the function of the ductus deferens?
Transports sperm from the epididymis made int he testes to the ejaculatory duct which joins with the prostatic urethra
What is the journey of sperm?
Sperm made in testis
Enters epididymis
Head of epididymis continuos with the ductus deferens which is in the spermatic cord
Sperm than passes up the spermatic cord through the deep Inguinal ring (through the 3 abdominal wall layers), to the ejaculatory duct which connects to the prostatic urethra, membranous urethra then spongy urethra
What part of the prostate is normally affected by Benign Prostatic Hyperplasia (BPH)?
Why does BPH usullay lead to urinary retention?
Transitional zone
Urethra passes through prostate
What area of prostate do prostate cancers usually occur?
Peripheral zone (more superficial part)
Which gland contributes the most to the volume of the ejaculate?
Seminal vesicles
What needs to be done to the penis to catheterise and why?
Pick up penis and pull
The urethra has 2 bends that need straightening
What are the 2 main functions of the penis?
Expulsion of urine via urethra
Deposit sperm in female genital tract
What does the transverse section of the penis look like?
Slide 18
ET
Corpus cavernosum = eyes
Urethra = mouth
Corpus spongiosum = around mouth
Which muscle contributes the most to penis rigidity?
Why not the other one?
Corpus cavernosum
The corpus spongiosum surrounds urethra, would end up compressing it
How does an erection occur?
Parasympathetic system vasodilates the penile arterioles and compresses the veins causing more blood to be going in than out
Which system terminates an erection?
Sympathetic
Which muscle attaches to the pubic symphysis?
Corpus cavernosum
What is the tunica albuginea of the penis?
The dense connective white coloured tissues surrounding the erectile tissue
(COMPLETELY DIFFERENT TO THE TUNICA ALBUGINEA IN AROUND THE Seminferous tubules)
What is a fractured penis?
When the tunica albuginea of the penis gets ruptured (needs immediate repair otherwise permanent deformity)
What is the blood supply to the penis?
The internal iliac artery which then supplies the internal pudendal artery
Why can diabetics have erectile dysfunction?
Diabetic neuropathy affecting internal pudenal artery
Why is important to establish whether a trans man has a cervix or not?
If they do they need cervical screening
What blood vessel does the ureter run over?
It descend into pelvis over the bifurcation of the common iliac artery into the internal and external iliac artery
What is the rectovesical pouch?
The pouch between the rectum and bladder lined by the peritoneum
What passes through the deep Inguinal ring?
Testicular artery and vein
Ductus deferens
What are some causes of scrotal swelling?
Haematocoele
Varicocoele
Inguinal hernia
Hydrocoele
Epididymidis
Spermatocoele (cysts within epididymis
Why does a lump in the testis of a 22 yr old need follow up?
Its cancer until proven otherwise
Do ultrasound then transiluminate
How can you differentiate a hernia from a discrete testicular swelling?
Cough impulse (when cough hernia gets bigger since abdominal wall will contract since it forms the spermatic fascia)
Hernia is reducible
Where does teh testicular artery come from?
Abdominal aorta, inferior to superior mesenteric artery but superior to inferior mesenteric artery
What lymph nodes do the testicles drain to?
Para aortic nodes
