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Reproductive Anatomy > Male Pelvic Viscera > Flashcards

Male Pelvic Viscera Flashcards

1
Q

What is the primary sex organ?

A

testis

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2
Q

Name components of the reproductive tract?

A
  1. Epididymis
  2. Vas Deferens
  3. Spermatic cord
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3
Q

Name the accessory sex glands?

A
  1. Seminal vesicles
  2. Prostate gland
  3. Bulbourethral glands
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4
Q

What is the external genitalia?

A

penis

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5
Q

What is the scrotum?

A

An out pouching of loose skin & superficial fascia

  • It has thin skin with sparse hairs and sweat glands.
  • The Dartos muscle lies within the superficial fascia replaces Scarpa’s fascia
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6
Q

Describe the difference between the right and left scrotum?

A

the left scrotum is slightly lower than the right

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7
Q

What are the functions of the scrotum?

A
  1. Houses & Protects the testis
  2. Regulates testicular temperature
    • no superficial fat
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8
Q

What are the testes?

A

Paired almond-shape gonads that are suspended in the scrotum by the spermatic cord

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9
Q

State the measurements of the testes?

A
  • volume : 20 - 25 ml
  • length : 4 - 5 cm long
  • Weight : 10.5 - 14 g
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10
Q

What are the functions of the testes?

A
  1. Spermatogenesis
  2. Hormone production
    • Androgens - testosterone
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11
Q

Name the layers that cover the testes?

A
  1. tunica vaginalis

2. tunica albugenia

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12
Q

Describe the tunica vaginalis of the testes?

A
  • Peritoneal covering, formed of parietal and visceral layers
  • It surrounds testis & epididymis
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13
Q

Describe the function of the tunica vaginalis?

A

It allows free movement of testis within the scrotum

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14
Q

Describe the tunica albugenia of the testes?

A

It is a whitish fibrous capsule

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15
Q

Describe the internal structure of the testes?

A
  • Fibrous septae extend from the capsule, divide the testis into an average of 250 lobules
    (200-300)
  • Each lobule contains (1-3) seminiferous tubules
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16
Q

What are seminiferous tubules?

A
  • 60 cm coiled tubule

- They form the bulk of testicular tissue.

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17
Q

What is the function of seminiferous tubules?

A
  • They are the site of the spermatogenesis

- Interstitial cells of Leydig between the seminiferous tubules secrete Testosterone

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18
Q

What are rete testis?

A

A network of tubules

- It is the site of merging of the Seminiferous tubules

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19
Q

What is the blood supply of the testes?

A

Testicular artery

- It arises from the abdominal aorta at the level of L3

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20
Q

Describe the venous drainage of the testes?

A
  1. pampiniform plexus of veins
    • into testicular vein
  2. Right Vein drains into IVC
  3. Left Vein drains into left renal vein
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21
Q

Describe the testicular lymphatics?

A
  • Follow arteries, veins

- End in Lumbar (par aortic) nodes

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22
Q

Describe the lymphatics of the scrotum, penis and prepuce?

A

Terminate in Superficial inguinal nodes

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23
Q

What is the indication for performing a cremasteric reflex?

A

Evaluation of testicular pain in case of testicular torsion

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24
Q

What is the technique used in the cremasteric reflex?

A
  • Examiner strokes or pinches the skin in the upper medial thigh.
  • It causes cremasteric muscle contraction
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25
Q

What is seen as a normal observation in a cremasteric reflex procedure?

A

rise of the Testicle on same side

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26
Q

Describe the interpretation of the cremasteric reflex?

A
  1. Normal: It is present with Epididymitis

2. Absent: no Testicle rise is Suggestive of Testicular Torsion

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27
Q

What age group can the cremasteric test not be done on?

A

under 30 months

- cremasteric reflex absent in 50% of boys under age 30 months

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28
Q

Describe the efficacy of the cremasteric reflex?

A

Test Sensitivity for Testicular Torsion: 99%

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29
Q

What are the nerves involved in the cremasteric reflex?

A

Genitofemoral (GFN) ( L1, 2)

  1. Sensory: femoral branch of (GFN) and Ilioinguinal n.
  2. Motor: Genital branch of (GFN)
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30
Q

What is the epididymis and where is it located?

A
  • A Single coiled tubule
  • 6 Meters long
  • Located on the superior and posterior margins of the testis
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31
Q

What are the 3 parts of the epididymis?

A
  1. head - receives rete testis efferent ductules from the testis
  2. body
  3. tail - is continuous with Vas Deferens.
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32
Q

What are the functions of the epididymis?

A
  1. Secretes/absorbs the nourishing fluid.
  2. Recycles damaged spermatozoa.
  3. Stores spermatozoa Up to 2 weeks to allow for maturation
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33
Q

What is the vas deferens?

A
  • A muscular tube 45 cm long
  • Carries sperms from the epididymis to pelvic cavity
  • passes through the inguinal canal and crosses the ureter
  • the terminal part is dilated to form the ampulla of the vas
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34
Q

What components makes up the ejaculatory duct?

A

vas deferens + seminal vesicle

- opens in the prostatic urethra

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35
Q

What are the functions of the accessory glands?

A
  1. Secretion of seminal fluid
  2. Nourishing, activation of sperms
  3. Protection of sperms
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36
Q

What are the seminal vesicles?

A
  • Paired elongated glands
  • Located posterior & inferior to the urinary bladder
  • Secrete (60% of Semen)
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37
Q

Describe the structure of the ejaculatory ducts?

A
  • Formed by the union of the lower end of the vas deferens and the duct of the seminal vesicle
  • Its length is about 2.5cm
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38
Q

What is the function of the ejaculatory ducts?

A

They drain the seminal fluid into the prostatic urethra

- The 2 ejaculatory ducts open into the prostatic urethra on both sides of the seminal colliculus

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39
Q

What is the prostate gland?

A
  • The Largest male accessory gland.
  • It is a fibromuscular glandular tissue.
  • Walnut sized
  • Secretes (20-30% of semen)
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40
Q

Where is the prostate gland located?

A

Located at the neck of bladder.

- Traversed by the prostatic urethra

41
Q

Describe the shape of the prostate gland?

A

conical

  1. Base (Superior): Attached to neck of urinary bladder
  2. Apex (Inferior): rests on the Urogenital diaphragm.
  3. Four Surfaces: Anterior, posterior and 2 lateral (Right & Left)
42
Q

What are the functions of the enzymes secreted by the prostate gland?

A
  1. Aid in activating sperm motility
  2. Mucus degradation
  3. Neutralize female reproductive tract (Alkaline fluid)
43
Q

Describe the capsule of the prostate gland?

A
  1. Internally - dense fibrous capsule (prostatic capsule)
  2. externally- fibrous prostatic sheath
    • continuous with the puboprostatic part of the
      levator ani muscle (levator prostate).
44
Q

Describe the capsule of the prostate gland?

A
  1. Internally - dense fibrous capsule (prostatic capsule)
  2. externally- fibrous prostatic sheath
    • continuous with the puboprostatic part of the
      levator ani muscle (levator prostate).
45
Q

Where does the prostatic venous plexus lie?

A

between the prostatic capsule and the prostatic facial sheath

46
Q

What are the relations of the prostate gland?

A
  1. Anterior - Symphysis pubis
  2. Superior - Neck of the bladder
  3. Posterior - Rectum (important for PR examination)
  4. Inferior - Urogenital diaphragm
  5. Lateral - Medial margins of levator ani muscles (levator prostate)
47
Q

How are the prostate gland divided anatomically?

A

It is divided into 5 lobes according to their relation to the urethra

48
Q

State the lobes of the prostate gland?

A
  1. anterior
  2. posterior
  3. 2 lateral
  4. middle
49
Q

Describe the anterior lobe?

A
  • Lies anterior to the urethra,

- It is fibromuscular

50
Q

Describe the posterior lobe?

A
  • Posterior to the urethra

- inferior to the ejaculatory ducts

51
Q

Describe the lateral lobes of the prostate gland?

A
  • on each side of the urethra

- made of glandular tissue

52
Q

Describe the middle lobe of the prostate gland?

A
  • Between the urethra and ejaculatory ducts & closely related to neck of urinary bladder.
  • Usually it projects into lumen of the bladder distorting the internal urethral sphincter, after the age of 40 years
  • rich in glandular tissue
53
Q

How is the prostate divided physiologically?

A

divide the prostate into central (internal) & peripheral zones
- Within each lobe are four lobules, which are defined by the ducts and connective tissue

54
Q

Name the 3 physiological prostate zones?

A
  1. central
  2. transitional
  3. peripheral
55
Q

Describe the central zone?

A
  • 20% of prostate volume
  • Benign hypertrophy
  • 25% of malignancies
56
Q

Describe the transitional zone?

A

5% of prostate volume

57
Q

Describe the peripheral zone?

A
  • 70% of prostate volume

- 70% of malignancies

58
Q

What is the arterial supply of the prostate?

A

Inferior vesical artery from internal iliac artery

59
Q

Describe the prostatic venous plexus and its course?

A
  • Lies between the prostatic fibrous capsule and the prostatic sheath.
  • It drains into the internal iliac veins.
  • It is continuous superiorly with the vesical venous plexus and posteriorly to the internal vertebral venous plexus
60
Q

Describe the importance of the structure of the prostatic venous plexus?

A

metastases

61
Q

What is the lymph drainage of the prostate?

A

internal iliac lymph nodes

62
Q

Consequences of benign hypertrophy of the prostate?

A
  • The middle lobe often enlarges and obstructs the internal urethral orifice
  • this leads to:
    1. nocturia
    2. dysuria
    3. urgency
63
Q

Describe the occurrence of benign hypertrophy of the prostate and its consequence?

A
  • Common after middle age

- An enlarged prostate projects into the urinary bladder and distorts the prostatic urethra

64
Q

Describe occurrence of malignant hypertrophy of the prostate and how it is detected?

A
  • It is common after the age of 55

- The malignant prostate is felt hard & irregular in Per rectal examination (PR) .

65
Q

Describe the course of the matasteses of malignant hypertrophy of the prostate?

A
  • The malignant cells metastasize first to internal iliac & sacral lymph nodes (lymphatic spread)
  • Later to distant nodes , bone & brain through venous spread (IVVP)
66
Q

Consequences of malignant hypertrophy of the prostate?

A

can cause obstruction to urine flow because of its close relationship to the prostatic urethra

67
Q

What are the structures seen on the posterior wall of the prostatic urethra?

A
  1. urethral crest
  2. prostatic sinus
  3. seminal colliculus
  4. prostatic utricle
68
Q

Describe the urethral crest of the prostatic urethra?

A

A longitudinal elevated ridge

69
Q

Describe the prostatic sinus?

A
  • A groove on each side of the crest.

- The prostatic gland opens into the sinuses

70
Q

Describe the seminal colliculus of the prostatic urethra?

A

a rounded eminence that opens into the prostatic utricle.

71
Q

Describe the prostatic utricle of the prostatic urethra?

A
  • A depression on the summit of the urethral crest.

- The ejaculatory ducts open on the sides of the utricle

72
Q

What are bulbourethral of Coopers glands?

A
  • Small paired glands

- Located at the base of the penis

73
Q

What are the functions of the bulbourethral glands?

A

Secrete alkaline mucus for:

  1. Neutralization of urinary acids
  2. Lubrication
74
Q

Describe the corpora cavernosa of the penis?

A
  • Two superior (right & left) masses of
    Primary erectile tissue
  • They Provide the majority of rigidity & length of penis.
  • Their posterior expansions, forms the 2
    Crurae (anchor tissue) against pelvic bone
75
Q

Describe the corpus spongiosum of the penis?

A
  • The single inferior mass : Secondary erectile tissue
  • It is traversed by the penile urethra.
  • Its Anterior expansion forms the Glans penis.
  • Its posterior expansion forms the bulb of the penis
76
Q

Describe the prepuce/foreskin?

A

Fold of skin covering glans penis (before circumcision)

77
Q

What is the rectum?

A
  • The inferior part of the large bowel.
  • About 12 cm long
  • It is retroperitoneal or infra peritoneal
78
Q

Describe course of the rectum?

A
  1. Is continuous above with the sigmoid colon at the level of vertebra S3
    - the muscle of the tenia of the sigmoid colon becomes a continuous outer longitudinal layer of the rectum
  2. The rectum is continuous with the anal canal the junction being where the rectum pierces the perineal floor/ the levator ani muscles
79
Q

Describe the appearance of the rectum?

A

has a uniform smooth external appearance/ surface

80
Q

Describe the orientation of the recutum?

A

It makes a sudden change of angle/direction as it penetrates the levator ani = the pelvic diaphragm [anteroinferior to the coccyx], to become the anus, turning posteriorly

81
Q

What is the puborectalis?

A

a sling of muscle that is part of the levator ani which surrounds the rectum on it’s posterior and lateral sides

82
Q

What is the function of the puborectalis?

A

This has a major effect on enhancing faecal continence, as it creates a valve
- So relaxation of puborectalis is an important
part of defecation

83
Q

What is the rectovesical pouch?

A

In males the peritoneum passes from the rectum to the bladder to form the rectovesical pouch which in a woman would be the recto uterine pouch or pouch of Douglas.
These pouches can collect pus and you can examine for this by performing a digital rectal exam as the structures are so closely related.

84
Q

What is the rectovesical septum?

A

In males the rectovesical septum lies between the fundus of the bladder and the ampulla of the rectum and is closely associated with the seminal vesicles and the prostate which hence are easily examined during digital rectal examination. It is a useful plane for rectal cancer surgery

85
Q

What is the rectovaginal septum?

A

In females inferior to the pouch of douglas, the weak rectovaginal septum separates the superior half of the posterior wall of the vagina from the rectum

86
Q

Describe the lymphatic drainage of the rectum?

A
  1. The superior half of the rectum drains to pararectal lymph nodes then to nodes in the mesentery of the sigmoid colon and then inferior mesenteric and lumbar lymph nodes
  2. Inferior half drain to the internal iliac nodes
    - Rarely by lymphatic spread or by direct invasion of the lower half of the anus, a rectal cancer can spread to the superficial inguinal lymph nodes
87
Q

Why is lymphatic drainage of the rectum important?

A

cancer

88
Q

What is the anal canal?

A

Terminates as the anus as it passes through the perineum

89
Q

Describe the structure of the anal canal?

A

As it passes through the perineal floor it is surrounded along it’s whole length by the internal and external sphincters that normally keep it closed
- Below this is a transitional area the anal pecten which is lined by non keratinised stratified squamous epithelium

90
Q

Describe the structure of the anus?

A

The upper part of the anus has mucosa like the rectum, which forms longitudinal folds called anal columns , which are united inferiorly by crescentis folds called anal valves .

Above each valve is a depression called an anal sinus , these form a circle called the pectinate line.

Below this is a transitional area the anal pecten which is lined by non keratinised stratified squamous epithelium

91
Q

What are the columns of the Morgagni?

A

consist of 8-14 longitudinal mucosal folds just above dentate line and forming the anal crypts at their distal end.
Small glands empty into these crypts. The ducts of some of these glands penetrate the internal sphincter, the body of the gland resides in the intersphincteric plane.

92
Q

What is the internal sphincter?

A

is a specialized continuation of the circular smooth muscle layer of the rectum. It is involuntary, and contracted at rest

93
Q

What is the intersphincteric plane?

A

is a fibrous continuation of the longitudinal smooth muscle layer of the rectum

94
Q

What is the intersphincteric plane

A

is a fibrous continuation of the longitudinal smooth muscle layer of the rectum

95
Q

What is the external sphincter?

A

a voluntary, striated muscle divided into three u-shaped loops (subcutaneous, superficial, and deep). Acts as a single functional unit.
- It is a continuation of the levator ani muscle, specifically of the puborectalis muscle.

96
Q

What is a pilondial sinus?

A

Sinus which contain tuft of hairs, mainly in skin covering the sacrum and coccyx but can occur between fingers, in hair dressers, and the umbilicus.

97
Q

Describe the function of the tunica vaginalis?

A

It allows free movement of testis within the scrotum

98
Q

Describe the function of the tunica vaginalis?

A

It allows free movement of testis within the scrotum

Reproductive Anatomy (16 decks)

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