Male Pelvis and Perineum Flashcards
What is the shape of the male pelvis? and sub pubic angle ?
heart shapes
50-60 sub pubic angle (women are 80-85)
label what is contained in the male repro system
what are seminal vesicles?
Secretions contribute to the volume of ejaculatory semen
what are bulbourethral glands function
Lubrication of the urethra
how do testes descend
- Testes develop high up in the abdominal cavity between the parietal peritoneum and transversalis fascia
- Gubernaculum will pull it down which is made of mesenchymal tissue
- Through the anterior abdominal wall passing through inguinal canal
what is cryptochidism ?
undescended testes
Process of descent can be arrested at any age
If left within the the abdominal cavity - risk of becoming malignant/high risk of subfertility
What does the scrotum contain?
testes, epididymis, and spermatic cord, tunica vaginalis
what is tunica vaginalis
Tunica vaginalis lies within spermatic fascia and is a
closed off sac (remnant of processus vaginalis)
processus vaginalis which is the indentation of the parietal peritoneum which obliterates soon after birth and closes from superior to inferior but the inferior portion remains open
what smooth muscle replaces absominal wall
dartos
function of cremasteric muscle
to raise the testes and scrotum upwards for warmth and protection
where is scarpas fascia (colles) attatched
attached to perineal body & membrane and the ischiopubic rami
what are the layers of the testes and spermatocord?
Peritoneal diverticulum called processus vaginalis from L1 through abdominal wall acquiring a tubular sheath from each layer
Through external oblique aponeurosis - creates superficial inguinal ring = external spermatic fascia
Passes through internal oblique = cremaster muscle (fascia)
Under transversus abdominis = no covering from this layer
Passes through deep inguinal ring (transversalis fascia) = internal spermatic fascia
What is the spermatic cord?
collection of vessels, nerves and ducts running to and from the testes - relatively short connecting the scrotum and abdomen
What are the contents of the spermatic cord?
- vas deferns = cord-like structure which transports sperm to and from epididymis to urethra
- testicular artery = L2 branch of aorta supplying testes and epididymis
- testicular veins = pampiniform plexus from the border of testis to form a single vein at level of deep inguinal ring
- lymph vessels = para-aortic nodes at root of testicular artery
- autonomic nerves
- cremasteric artery
- artery of vas deferns
- genital branch of genitofemoral nerve
- tunica vaginalis
where is sperm made
testes
label what u can
What is the vas deferens?
large muscular tube transporting sperm from tail of epididymis to ejaculatory duct
What forms the ejaculatory duct?
vas deferens and duct of seminal vesicle
How does the vas deferens pass the urethra?
vas deferens pass over the top of ureter
where does most amount of sperm come from ? 70%
seminal vesicles
paired tubular glands which are postero-inferior to urinary bladder = provide a huge proportion of total volume of semen
label what you can
What is the prostate gland?
fibromuscular glandular organ producing secretions making up 30% of ejaculate
- smooth and rounded
- within capsule with venous plexus on outside surface
What ligaments support the prostate gland?
puboprostatic ligament anterioly and levator prostatae of inferiorly
What is the male equivalent of the uterus?
prostatic utricle
What are the 4 anatomical lobes of prostate gland?
- median lobe = smallest
- posterior lobe = posterior to median
- inferolateral lobe
- anterior lobe
What happens in prostatic enlargement?
how is it assesed
ENLARGED PROSTATIC MEDIAN LOBE - PUSHES INTO BLADDER, prevent urine leaving neck
BPH - could be benign/malignant
- common in 50+ men
-sphincter vesicae can’t close the neck of the bladder therefore urinary symptoms such as frequent urination and leaking
Assessed with ultrasound by a trans-rectal approach and by trans-rectal biopsy of the prostate gland
An enlargement of the prostate gland compresses the prostatic urethra as it
passes through - consequences in terms of continence
What is testicular torsion?
What are the causes of testicular torsion?
What are the symptoms of testicular torsion?
What is the diagnosis of testicular torsion?
What are the complications of testicular torsion?
rotation of testes around the spermatic cord within scrotum
- inadequate fixture of testis to scrotum
- excessively large tunica vaginalis
- severe pain in the scrotum extending through the inguinal region (thigh pain)
- testis higher up than usual
- fever
- absence of cremasteric reflex
- presenting symptoms and signs
- doppler ultrasound if not clear
if not treated quickly then testicular artery may become occluded and could lead to necrosis of testes
What is an indirect inguinal hernia?
What is a direct inguinal hernia?
What is a varicocele?
What are the symptoms of the varicocele?
What is the diagnosis for varicocele?
What is the treatment for varicocele?
what is this?
venogram showing varicocele
label the male external genitalia. what does it consist of?
penis = corpora cavernosa and corpora spongiosum
root = 2 crura with proximal part of corpora cavernosa attached to pubic arch
bulb = proximal part of corpus spongiosum anchored to perineal membrane
galns penis = distal expansion of corpus spongiosum
What is the fundiform ligament?
condensation of deep fascia exteding from linea alba and pubic symphysis
What is the ischiocavernosus muscle?
surrounds erectile tissue of crura which are proximal parts of corpora cavernosa
How does an erection happen?
blood rush into corpora cavernosa and corpora spongiosum
What is the puboporstatic ligament?
wraps around the prostate and attached to pubic symphysis
what are the spaces
what is this ligament?
Puboprostatic ligament
* Wraps around prostate
* Attached to pubic symphysis
is the bladder the same in males and females?
yes, apart from in venous drainage:
inferior prostatic plexus in men
utero vaginal plexus in females
label alllll that u can (bends, sphincters, parts)
What are parts of the male urethra?
- preprostatic = voluntary control
- prostatic = opening of ejaculatory duct and prostatic duct
- membranous = least dilated and most likely to be damaged during catherization
- spongy = through the corpora spongiosum with 2 bends
Which muscles are replaced in the pelvic diaphragm between males and females?
Female = pubourethralis and pubovaginalis
Males = levator prostatae (anterior fibres passing around prostate gland)
What is the nerve supply to the levator prostatae?
pudendal nerve (S2 - S4)
What is the deep and superficial perineal pouch separated by?
separated by 3 layers of fascia:
1. superior fascia
2. camper’s = loses its fat as it comes in through the side of scrotum
3. scarpas
What is Colle’s fascia?
continuation of scarpa’s fascia from anterior abdominal wall
What are the boundaries of uro-genital triangle?
anterior margin = ischio-pubic rami
posterior margin = sacro-tuberous ligament
What is the make up of the uro-genital diaphragm?
- superior layer of fascia - deep
- sphincter urethrae and deep transverse perineal muscle
- inferior layer of fascia - superficial
What are the borders of deep perineal pouch in male?
Superiorly by the superior fascia of the urogenital diaphragm (above this is the pelvic diaphragm)
Inferiorly by the perineal membrane
What is the contents of the deep perineal pouch?
- Deep transverse perineal muscles (support base of penis and perineal floor)
- External/voluntary urethral sphincter
- Membranous urethra
- Perineal branch of the internal pudendal vessels
- Perineal nerve (branch of pudendal)
- Dorsal nerve of the penis (1 of the 2 terminal branches of pudendal nerve)
- Bulbo-urethral Glands
What are the contents of superficial perineal pouch?
- erectile tissue = 2 crura and corpora spongiosum
- muscle = ischiocavernosus, bulbospongiosus and superficial transverse perineal muscle
- spongy urethra
- penis
- perineal branch of pudendal nerve and internal pudendal artery
What are the branches of pudendal nerve?
inferior rectal => dorsal nerve of penis and perineal nerve (supplies muscle of perineum) => posterior scrotal
What does the ilioinguinal nerve supply?
anterior scrotal skin
What does the genitofemoral nerve innervate?
cremaster muscle - runs in front of psoas muscle
What does the obturator nerve supply?
Medial compartment of the thigh
What is the parasympathetic innervation?
Pelvic splanchnic nerves (S2 - S4) pass through inferior hypogastric plexus.
Fibres passing around the Prostate - brought in by cavernous nerves from the prostatic nerve plexus causing vasodilation of arteries for erection
label all that u can
function of umbillical artery in male supply
- Carries blood to placenta
- Becomes Medial umbilical fold
- Gives the superior vesical artery
function of superiror and inferior vesicla arteires
Superior vesical artery - Branch of umbilical artery: which supplies the superior aspect of the bladder
Inferior vesical artery - Supplies the inferior aspect of the bladder and the prostate gland (via prostatic branches) and seminal vesicles - Also gives => artery of vas deferens
function of internal peudendal artery
- All the structures of the perineum
- Gives Dorsal artery of the penis + deep artery of penis
what does Inferior gluteal artery innervate
Levator ani, coccygeus and piriformis (also gluteal muscles)
Which muscle does internal pudendal pass inferior to?
Piriformis muscle
