Lower Urinary Tract + Male Reproductive Tract

Question 1

What is the false pelvis?

Answer 1

Iliac crests to pelvic inlet

Part of abdominal cavity

Question 2

What is the true pelvis?

Answer 2

Pelvic inlet to pelvic floor

Question 3

Where is the bladder found?

Answer 3

True pelvis

Question 4

What is the min pelvic floor muscle?

Answer 4

Levator ani

Question 5

What is the perineum?

Answer 5

Shallow compartment between pelvic floor and skin

Question 6

Where are the ureters in relation to the common iliac vessels?

Answer 6

Anterior

Question 7

What is the route of the ureters?

Answer 7

Run anterior along the walls of the pelvis
At level of ischial spine, turn medially to enter posterior aspect of the bladder
Sub-peritoneal

Question 8

In which direction to the ureters enter the bladder and why is this clinically significant?

Answer 8

Inferomedially

Helps prevent reflux of urine back into the ureters when the bladder contracts

Question 9

Where does the ureter run in the female pelvis?

Answer 9

Inferiorly to the uterine tubes and uterine artery

“water under the bridge”

Question 10

Where does the ureter run in the male pelvis?

Answer 10

Inferiorly to the vas deferens

Question 11

From which artery to the arteries entering the pelvic mainly branch from?

Answer 11

Internal iliac artery

Question 12

From which artery to the prostatic arteries usually branch from?

Answer 12

Vesical arteries

Question 13

To where do the veins in the pelvis usually drain?

Answer 13

Internal iliac vein

Question 14

What is the trigone of the bladder?

Answer 14

Smooth triangle in the bladder formed by the 2 steric orifices and internal urethral orifice

Question 15

Which muscle for the main bulk of the bladder wall?

Answer 15

Detrusor muscle

Question 16

How does the detrusor muscle prevent reflux of urine into the ureters?

Answer 16

Fibres encircle the ureteric orifices, which tighten when the bladder contracts

Question 17

How is the internal urethral sphincter formed and what is its purpose?

Answer 17

Detrusor muscle

Prevents retorgrade ejaculation of semen into the bladder

Question 18

Where does the bladder lie in relation to the pubic bone?

Answer 18

Directly posterior (when empty)

Question 19

Where does the uterus lie in relation to the bladder?

Answer 19

Superior, in an anteflexed position

Most of the weight of the uterus is bored by the bladder (THINK pregnant women peeing)

Question 20

Where does the prostate gland lie in relation to the bladder?

Answer 20

Inferiorly

Question 21

What is the relationship of the peritoneum and bladder?

Answer 21

Peritoneum only ever covers the superior surface of the bladder (regardless of whether it is empty or full)

Question 22

What are the 2 routes of catheterisation?

Answer 22

Urethral

Suprapubic

Question 23

What is the danger with suprapubic catheterisation?

Answer 23

If bladder is empty, there is a risk that you pierce the peritoneum

Question 24

How long is the female urethra?

Answer 24

approx 4cm

Question 25

What is the external urethral sphincter?

Answer 25

Voluntary, skeletal muscle arranged around the urethra

Question 26

Is there an internal urethral sphincter in females?

Answer 26

No

Question 27

Is there an internal urethral sphincter in males?

Answer 27

Yes

Question 28

How long is the male urethra?

Answer 28

approx 20cm

Question 29

What is the prostatic urethra?

Answer 29

Portion of urethra passing through the prostate gland

Question 30

Where is the external urethral sphincter located in males?

Answer 30

Below the prostate gland

Question 31

What is the route of sperm in the male reproductive tract?

Answer 31

``` Testes - produced Epididymis - stored Vas Deferens Seminal gland - semen added Ejaculatory duct Prostatic urethra Spongy urethra External urethral orifice ```

Question 32

What is the route of testes descent?

Answer 32

Posterior abdomen Through inguinal canal Scrotum

Question 33

What is contained within the spermatic cord?

Answer 33

``` Testicular artery Pampiniform plexus Vas deferens Lymphatic vessels Autonomic nerves (smooth muscle of vas) Somatic nerves (cremaster muscle) ```

Question 34

What is the tunica vaginalis?

Answer 34

Sac within the scrotum containing the testes

Question 35

What are the two "layers" of the tunica vaginalis?

Answer 35

Parietal layer = In contact with scrotum | Visceral layer = In contact with testes

Question 36

What is excess fluid within the tunica vaginalis known as?

Answer 36

Hydrocele

Question 37

Why are the testes at risk of twisting?

Answer 37

Testis and epididymis attached to spermatic cord superiorly (quite mobile within scrotum) Risk of torsion of spermatic cord

Question 38

What is the clinical outcome of testicular torsion?

Answer 38

Blood supply disruption: Severe pain Danger of testicular necrosis

Question 39

What is contained within the deep inguinal ring?

Answer 39

``` Testicular artery Testicular vein Vas deferens Lymphatics Nerves ```

Question 40

Where does the pampiniform plexus drain to?

Answer 40

Testicular vein

Question 41

Where do the right and left testicular veins drain to?

Answer 41

``` Right = IVC Left = Left renal vein ```

Question 42

Where is the epididymis palpated/located?

Answer 42

Palpated at the posterior aspect of the testis | Its head is acted at the superior pole of the testis

Question 43

Where are the vas deferens palpated/located?

Answer 43

Palpated within the spermatic cord, superior to testis | Begins at inferior pole of the testis

Question 44

What is the route of the vas deferens?

Answer 44

Start at inferior pole of the testes Pass superiorly within spermatic cord to deep inguinal ring Turn medially into the pelvis

Question 45

What are the prostatic ducts?

Answer 45

Openings through which the glandular secretions from the prostate drain into the prostatic urethra

Question 46

What is the ejaculatory duct a combination of and where does it open?

Answer 46

Vas deferens and seminal gland ducts | Prostatic urethra

Question 47

What are the two zones of the prostate?

Answer 47

Peripheral zone | Central zone

Question 48

Which prostatic zone is palpated on rectal exam and why is this clinically significant?

Answer 48

Peripheral zone | This is where most prostate cancers arise

Question 49

What are the three cylinders of erectile tissue within the penis?

Answer 49

Corpus spongiosum | Right and left corpus cavernosum

Question 50

What is transmitted in the corpus spongiosum?

Answer 50

Spongy urethra | Expands distally to form the glans

Question 51

What is transmitted int he corpus cavernosum?

Answer 51

Deep arteries of the penis

Question 52

What happens to the erectile tissue during erection?

Answer 52

They become engorged with blood

Question 53

What surface structure does the corpus spongiosum lie deep to?

Answer 53

Penile raphe

Question 54

What surface structure does the testes lie deep to?

Answer 54

Scrotal raphe

Question 55

What is the anatomical name for foreskin?

Answer 55

Prepuce

Question 56

What is the clinical consequence of retraction of the prepuce?

Answer 56

Constriction of the neck of the glans, causing swelling (paraphimosis) Circumsicion can be performed

Question 57

What is the blood supply to the penis?

Answer 57

Deep arteries of the penis | Branches of internal pudendal artery (from iliac artery)

Question 58

What is the blood supply to the scrotum?

Answer 58

Internal pudendal artery and branches from external iliac artery

Question 59

Where does lymph from the scrotum and most of the penis (except the glans) drain to?

Answer 59

Superficial inguinal nodes (superficial fascia in the groin)

Question 60

Where does lymph from the testis drain to?

Answer 60

Lumbar nodes (abdominal aorta)