Lower Urinary Tract + Male Reproductive Tract Flashcards
What is the false pelvis?
Iliac crests to pelvic inlet
Part of abdominal cavity
What is the true pelvis?
Pelvic inlet to pelvic floor
Where is the bladder found?
True pelvis
What is the min pelvic floor muscle?
Levator ani
What is the perineum?
Shallow compartment between pelvic floor and skin
Where are the ureters in relation to the common iliac vessels?
Anterior
What is the route of the ureters?
Run anterior along the walls of the pelvis
At level of ischial spine, turn medially to enter posterior aspect of the bladder
Sub-peritoneal
In which direction to the ureters enter the bladder and why is this clinically significant?
Inferomedially
Helps prevent reflux of urine back into the ureters when the bladder contracts
Where does the ureter run in the female pelvis?
Inferiorly to the uterine tubes and uterine artery
“water under the bridge”
Where does the ureter run in the male pelvis?
Inferiorly to the vas deferens
From which artery to the arteries entering the pelvic mainly branch from?
Internal iliac artery
From which artery to the prostatic arteries usually branch from?
Vesical arteries
To where do the veins in the pelvis usually drain?
Internal iliac vein
What is the trigone of the bladder?
Smooth triangle in the bladder formed by the 2 steric orifices and internal urethral orifice
Which muscle for the main bulk of the bladder wall?
Detrusor muscle
How does the detrusor muscle prevent reflux of urine into the ureters?
Fibres encircle the ureteric orifices, which tighten when the bladder contracts
How is the internal urethral sphincter formed and what is its purpose?
Detrusor muscle
Prevents retorgrade ejaculation of semen into the bladder
Where does the bladder lie in relation to the pubic bone?
Directly posterior (when empty)
Where does the uterus lie in relation to the bladder?
Superior, in an anteflexed position
Most of the weight of the uterus is bored by the bladder (THINK pregnant women peeing)
Where does the prostate gland lie in relation to the bladder?
Inferiorly
What is the relationship of the peritoneum and bladder?
Peritoneum only ever covers the superior surface of the bladder (regardless of whether it is empty or full)
What are the 2 routes of catheterisation?
Urethral
Suprapubic
What is the danger with suprapubic catheterisation?
If bladder is empty, there is a risk that you pierce the peritoneum
How long is the female urethra?
approx 4cm
What is the external urethral sphincter?
Voluntary, skeletal muscle arranged around the urethra
Is there an internal urethral sphincter in females?
No
Is there an internal urethral sphincter in males?
Yes
How long is the male urethra?
approx 20cm
What is the prostatic urethra?
Portion of urethra passing through the prostate gland
Where is the external urethral sphincter located in males?
Below the prostate gland
What is the route of sperm in the male reproductive tract?
Testes - produced Epididymis - stored Vas Deferens Seminal gland - semen added Ejaculatory duct Prostatic urethra Spongy urethra External urethral orifice
What is the route of testes descent?
Posterior abdomen
Through inguinal canal
Scrotum
What is contained within the spermatic cord?
Testicular artery Pampiniform plexus Vas deferens Lymphatic vessels Autonomic nerves (smooth muscle of vas) Somatic nerves (cremaster muscle)
What is the tunica vaginalis?
Sac within the scrotum containing the testes
What are the two “layers” of the tunica vaginalis?
Parietal layer = In contact with scrotum
Visceral layer = In contact with testes
What is excess fluid within the tunica vaginalis known as?
Hydrocele
Why are the testes at risk of twisting?
Testis and epididymis attached to spermatic cord superiorly (quite mobile within scrotum)
Risk of torsion of spermatic cord
What is the clinical outcome of testicular torsion?
Blood supply disruption:
Severe pain
Danger of testicular necrosis
What is contained within the deep inguinal ring?
Testicular artery Testicular vein Vas deferens Lymphatics Nerves
Where does the pampiniform plexus drain to?
Testicular vein
Where do the right and left testicular veins drain to?
Right = IVC Left = Left renal vein
Where is the epididymis palpated/located?
Palpated at the posterior aspect of the testis
Its head is acted at the superior pole of the testis
Where are the vas deferens palpated/located?
Palpated within the spermatic cord, superior to testis
Begins at inferior pole of the testis
What is the route of the vas deferens?
Start at inferior pole of the testes
Pass superiorly within spermatic cord to deep inguinal ring
Turn medially into the pelvis
What are the prostatic ducts?
Openings through which the glandular secretions from the prostate drain into the prostatic urethra
What is the ejaculatory duct a combination of and where does it open?
Vas deferens and seminal gland ducts
Prostatic urethra
What are the two zones of the prostate?
Peripheral zone
Central zone
Which prostatic zone is palpated on rectal exam and why is this clinically significant?
Peripheral zone
This is where most prostate cancers arise
What are the three cylinders of erectile tissue within the penis?
Corpus spongiosum
Right and left corpus cavernosum
What is transmitted in the corpus spongiosum?
Spongy urethra
Expands distally to form the glans
What is transmitted int he corpus cavernosum?
Deep arteries of the penis
What happens to the erectile tissue during erection?
They become engorged with blood
What surface structure does the corpus spongiosum lie deep to?
Penile raphe
What surface structure does the testes lie deep to?
Scrotal raphe
What is the anatomical name for foreskin?
Prepuce
What is the clinical consequence of retraction of the prepuce?
Constriction of the neck of the glans, causing swelling (paraphimosis)
Circumsicion can be performed
What is the blood supply to the penis?
Deep arteries of the penis
Branches of internal pudendal artery (from iliac artery)
What is the blood supply to the scrotum?
Internal pudendal artery and branches from external iliac artery
Where does lymph from the scrotum and most of the penis (except the glans) drain to?
Superficial inguinal nodes (superficial fascia in the groin)
Where does lymph from the testis drain to?
Lumbar nodes (abdominal aorta)
