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Y1 - Anatomy of the Abdomen, Peritoneum and Pelvis > Lecture 5 - Male pelvis and perineum > Flashcards

Lecture 5 - Male pelvis and perineum Flashcards

1
Q

What is the X distance a measure of?

A

Distance between the pubic symphysis and the anterior margin of the acetabulum.

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2
Q

What is the Y distance a measure of?

A

Diameter of the acetabulum.

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3
Q

What is the shape of the male pelvic inlet?

A

Narrow and heart-shaped.

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4
Q

What is the sub-pubic angle in males?

A

Narrow - roughly 50-60 degrees.

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5
Q

What is the sub-pubic angle in females?

A

Wide - roughly 80-85 degrees.

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6
Q

What is the shape of the female pelvic inlet?

A

Oval or round - wider than male pelvic inlet.

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7
Q

How does the ischial spine differ between males and females?

A

In males it projects medially however in females it does not.

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8
Q

What is the X:Y ratio for males and females?

A

Male - less than 1

Female - 1 or larger

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9
Q

How do the greater and lesser pelvises differ in male and females?

A

Greater (false)
Male - deep
Female - shallow

Lesser (true)
Male - narrow, deep and tapering
Female - wide, shallow and cylindrical

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10
Q

Where does the parietal peritoneum end?

A

Continues into the pelvic cavity but does not reach the pelvic floor.

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11
Q

What is covered in peritoneum?

A

All of the pelvic viscera, apart from the uterine tubes/

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12
Q

What is found between the pelvic wall and peritoneum?

A

If it is not occupied by viscera, it will contain pelvic fascia.

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13
Q

What do pelvic fascial condensations do?

A

Form ligaments that support the viscera, such as the cervix, vagina and prostate.

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14
Q

What is found in the male pelvic cavity?

A
  • Ureter (25cm long), bladder and urethra
  • Prostate, ductus deferens, seminal vesicles and bulbourethral glands
  • Rectum
  • Some of the GI tract (laterally - caecum, appendix, parts of the sigmoid colon and ileum)
  • Vessels, nerves and lymphatics
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15
Q

How long is the male and female urethra?

A

Male - 20cm

Female - 4cm

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16
Q

Where is the prostate gland found?

A

Surrounds the first part of the urethra, known as the prostatic part - the bladder sits on top of it.

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17
Q

Where can the catheter get stuck sometimes?

A

The tip of a urinary catheter can become lodged in the prostatic utricle (a cul-de-sac)

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18
Q

How is urine prevented from passing through the urethra during ejaculation?

A

The internal urethral sphincter is closed during ejaculation by sympathetic stimulus.

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19
Q

How is the internal urethral sphincter opened and closed?

A

Opened - parasympathetic

Closed - sympathetic

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20
Q

Describe the pathway of the ductus deferens?

A

Passes from the testis through and then over the inguinal canal, behind the ureter to enter the urethra through the prostate gland.

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21
Q

Where are the seminal vesicles located?

A

Situated at the back of the bladder, which open into the ductus deferens between the ampulla and ejacultatory duct.

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22
Q

How much of the secretions in the ductus deferens are from the seminal vesicles and the prostate gland?

A

Seminal vesicles - 60%
Prostate gland - 40%
Form the semen alongside sperm from the epididymis.

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23
Q

Where can it be difficult to pass a catheter through in the male?

A

There are three narrowing in the male urethra at:

  • External urethral orifice (narrowest)
  • Prostatic part of the urethra
  • Near the bulbourethral gland (90 degrees angle)
  • Can also get caught in the navicular fossa (fossa terminals) at the head of the penis
24
Q

How are the testis supplied with blood?

A

Supplied via the testicular artery which is a branch off of the abdominal aorta. Unlike the rest of the pelvis which is perfuse via the internal iliac artery.

25
Q

What does the inferior vesicle artery?

A

Prostate, bladder and ductus deferens - it is a branch of the internal iliac artery. The superior vesicle arteries also supply the bladder and the ductus deferens.

26
Q

How is the gluteal region perfused?

A

Via the superior and inferior gluteal arteries/

27
Q

What is the perineum?

A

A diamond-shaped area between the pubic symphysis, ischial tuberosities and the coccyx. It is divided into the anterior urogenital and the posterior anal triangles.

28
Q

How can the urogenital triangle be further divided?

A

Divided into superficial and posterior parts by the perineal membrane.

29
Q

What is the anal triangle composed of?

A

Composed of fat-filled spaces which separate the anal canal and levator ani from the pelvic walls. These are the same in both genders.

30
Q

What is the perineal membrane?

A

Thick, triangular fascial structure that is attached to the pubic arch. It fills the urogenital triangle and erectile tissues are anchored to it.

31
Q

What is the deep perineal space?

A

Above the perineal membrane and below the fascia of the pelvic diaphragm.

32
Q

What is the superficial perineal space?

A

Space below the perineal membrane and perineal fascia (subcutaneous tissue).

33
Q

What is the ischio-anal fossae?

A

Fat-filled spaces in the anal triangle that allow recto-anal and vaginal expansion. In their lateral wall is the pudendal neurovascular bundles which supplies the perineum and lower rectum.

34
Q

How does the erectile tissue develop in males?

A

Forms the bulb of the penis (corpus spongiosum)

35
Q

How does the erectile tissue develop in females?

A

Divides around the vestibule to form vestibular bulbs.

36
Q

What two tissues meet to form the shaft and head of the penis (or clitoris in females)?

A
  • Corpus spongiosum (internal)

- Corpora cavernosae

37
Q

How is the rectum perfused?

A

One pair of arteries from inferior mesenteric artery and two from the internal iliac artery.

38
Q

How is blood drained from the rectum?

A

Has similar venous drainage to the arteries that supply it so there is an important portal-systemic venous anastomosis around the lower rectum and anal canal.

39
Q

What are the contents of the spermatic cord?

A
  • External spermatic fascia (external oblique aponeurosis)
  • Internal spermatic fascia (trasversali fascia)
  • Cremasteric fascia (from internal oblique muscle)
  • Testicular artery and pampiniform plexus of veins
40
Q

What tissues is the penis made up of?

A
  • Corpus cavernous (bi-lobed)

- Corpus spongiosum (smaller and runs on the underside of the penis)

41
Q

What is the glans of the penis formed from?

A

Corpus spongiosum

42
Q

How is the corpus cavernosum attached to the ischiopubic rami?

A

Via the left and right crus

43
Q

How is the penis supplied with blood?

A
  • Mainly supplied by the pudendal artery (branch of the internal iliac artery)
  • Deep artery supplies corpora cavernosum
  • Dorsal artery supplies the skin and connective tissue
  • Artery of the bulb supplies the bulb, corpus spongiosum, glans and urethra
  • Helicine arteries (coiled) supply the cavernous spaces
44
Q

What causes blood to flow to the penis in an erection?

A

Parasympathetic stimulation, causing the helicon arteries to relax.

45
Q

What does parasympathetic innervation of the penis result in?

A
  • Blood flow (vasodilation of arterioles in erectile tissue)
  • Secretions from the prostate and bulbourethral glands
46
Q

What does sympathetic innervation of pelvic organs result in?

A
  • Contraction of smooth muscle of epididymis, vas deferens, seminal vesicles and prostate causing emission
  • Contraction of internal urethral sphincter to prevent reflux of semen and no urine from passing through the urethra
47
Q

Where is visceral pain referred to from the pelvic region?

A

Pelvic sensation is visceral and poorly localised so it is often referred to the suprapubic region and perineum.

48
Q

How are perineal skeletal muscles innervated?

A

Via somatic nerves by the pudendal nerve (S2-4).

49
Q

How do the pudendal nerve/somatic nerves leave the pelvis?

A

Via the lumbosacral plexus.

50
Q

What do the sensory somatic nerves supply?

A

Penis (penile skin and glands 0 dorsal nerve)

51
Q

What do the motor somatic nerves supply?

A
  • Perineal msucles
  • Bulbospingiosus and ischivacernosus tissue
    This cause ejaculation and contraction of the external urethral sphincter.
52
Q

What innervation is involved in an erection?

A
  • Central parasympathetic pathway that is activated by psychic stimulation
  • Pudenal artery and arterioles (as well as helicine arteries) relax to allow blood flow into he cavernous spaces of erectile tissue
53
Q

What stimulates secretion from the prostate, seminal vesicles and other glands?

A

Sympathetic innervation.

54
Q

What stimulates emission?

A
  • Central sympathetic pathway activates smooth muscle contraction of vas deferens, prostate nad seminal vesicles
  • Internal urethral sphincter contracts and bladder muscle contraction is prevented by sympathetic inhibitory action so there is no urine flow
55
Q

What stimulates ejaculation?

A

Entry of semen into the urethra triggers a somatic reflex via the pudendal nerve, causing the contraction of the bulbospongiosus skeletal muscle.

56
Q

How is detumescence stimulated?

A

Selective sympathetic nerves supplying the pudendal arterioles are activated, causing arteriole construction to restrict blood flow to the cavernous spaces.

Y1 - Anatomy of the Abdomen, Peritoneum and Pelvis (10 decks)

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