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MRCS: Abdomen and Pelvis Anatomy > Male Pelvis and Perineum > Flashcards

Male Pelvis and Perineum Flashcards

1
Q

State some differences between the male pelvis and the female pelvis?

A

The pelvic inlet is more oval shaped and round in females, it is heart shaped and narrower in males
Females - ischial spines do NOT point medially, in males they do
Females - sub-pubic angle > 80 degrees, males 50-60 degrees
Females - ratio of distance between the pubic symphysis and the anterior margin of the acetabulum is 1 or > 1, in men it is < 1.
Females - true pelvis is shallow, wide and cyllindrical, males it is deep, narrow and tapers
Females - false pelvis is wide, males it is narrow

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2
Q

Describe the orientation of the pelvic girdle with reference to two bony landmarks that are in the same plane.

A

ASIS and pubic tubercle are in the same vertical plane

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3
Q

True or False: the parietal peritoneum reaches the pelvic floor.

A

False - the parietal peritoneum does NOT reach the pelvic floor

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4
Q

What is found in the space between parietal peritoneum and pelvic wall that is not occupied by viscera?

A

Pelvic fascia

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5
Q

What are the ligaments that support pelvic viscera made up of?

A

Pelvic fascial condensations

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6
Q

Describe the path of the ductus deferens from the epididymis to the urethra.

A

The ductus deferens goes in through the superficial inguinal ring, through the inguinal canal and out of the deep inguinal ring. It then goes superior to the bladder, crosses the ureter and goes posterior to the ureter and joins the urethra through the prostate. Before joining the urethra, the ductus deferens joins with the seminal vesicle to form the ejaculatory duct which then joins the urethra in the prostate.

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7
Q

What structures can be felt in a DRE of a healthy man?

A

Prostate and seminal vesicles. Probably not the bladder unless there is something abnormal.

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8
Q

What are the four parts of the urethra? State how long they are.

A 
Pre-prostatic - 1.5 cm
Prostatic - 2.5 cm 
Membranous - 2 cm
Spongy - 15 cm 
(sometimes the parts are: prostatic, bulbar, membranous and spongy)
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9
Q

What glands are found within the urogenital diaphragm and where do these glands open into?

A

Bulbourethral Gland (produces secretions that lubricate the urethra and provide nutrients

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10
Q

What is the ampulla of the ductus deferens?

A

This is a dilation that is found just before the joining of the ductus deferens with the seminal vesicle to form the ejaculatory duct.

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11
Q

What three components empty into the prostatic urethra?

A

Seminal vesicles
Prostate
Ductus deferens

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12
Q

How many ejaculatory ducts are there?

A

2 - there are two vas deferens’ as well because there are two testicles

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13
Q

What is the cul-de-sac in the prostatic urethra is a site where a catheter could get lodged?

A

Prostatic Utricle

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14
Q

Describe the internal urethral sphincter.

A

Made up of smooth muscle and is well organised in males (but not so well organised in females). It is under sympathetic control.

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15
Q

What happens to this sphincter during ejaculation?

A

It closes due to sympathetic stimulation. Parasympathetic stimulation makes it open.

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16
Q

State three areas of narrowing of the urethra for the navigation of a catheter.

A

External urethral orifice (narrowest part)
90 degree turning of the urethra in the membranous part
Prostatic utricle

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17
Q

What large blood vessel is involved in supplying the pelvis and its contents?

A

Internal iliac artery

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18
Q

What are the two main branches of this internal iliac artery?

A

Anterior and posterior branches

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19
Q

What are the main divisions of the anterior branch of the internal iliac artery?

A

Anterior branch is mainly concerned with supplying the pelvic viscera
Superior and Inferior vesical arteries (superior = bladder + ductus deferens/ inferior = PROSTATE + blader + ductus deferens)
Prostate is supplied by the prostatic branch of the inferior vesical artery.
Other branches include the obturatory artery and the internal pudendal artery

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20
Q

What does the posterior branch of the internal iliac artery supply?

A

Gluteal muscles (you get superior and inferior gluteal arteries)

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21
Q

Where do the testes receive their blood supply from?

A

Testicular arteries - branch off the abdominal aorta below the renal arteries

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22
Q

What are the borders/apices of the male perineum?

A

Pubic Symphysis
Ischial Tuberosities
Coccyx

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23
Q

What can the perineum be divided into?

A

Anterior - urogenital triangle

Posterior - anal triangle

24
Q

What are the fat-filled spaces that separate the anal canal and the levator ani from the pelvic walls?

A

Ischioanal Fossae

25
Q

How can the anterior triangle be further divided?

A

It is divided into SUPERFICIAL and DEEP POUCHES by the PERINEAL MEMBRANE

26
Q

What is the perineal membrane?

A

Thick triangular fascial structure attached to the pubic arch and extending between the ischiopubic rami. Posteriorly free margin

PERINEAL MEMBRANE FILLS THE UROGENITAL TRIANGLE - splits anterior perineum into superficial and deep perineal pouches.

27
Q

What are the two potential spaces related to the perineal membrane?

A

Superficial and deep perineal spaces

28
Q

What regions of erectile tissue that make up the penis?

A 
Corpora cavernosae (paired) 
Corpus spongiosus

REMEMBER: erectile tissue within the perineum is surrounded by skeletal muscles.
What muscle is associated with the corpus cavernosum? Where does it attach?
Ischiocarvernosus - attaches to the ischiopubic ramus

29
Q

What muscle is associated with the bulb of the penis/corpus spongiosum?

A

Bulbospongiosus - this is midline and attached to the perineal membrane

30
Q

What are the two ligaments of the penis and where are they attached?

A

Suspensory ligament
Fundiform ligament
These are attached to the pubic symphysis

31
Q

How is the bulbospongiosus different in females?

A

The bulb divides around the vestibule to form the vestibular bulbs

32
Q

Where do the bulbourethral glands open into?

A

Urethra below the perineal membrane

33
Q

Where does the rectum receive arteries from?

A

One pair of arteries from the inferior mesenteric (superior rectal artery)
Two pairs from the internal iliac artery (middle and inferior rectal arteries)
The venous drainage is similar

34
Q

The rectum is an important site of portal-systemic anastomosis. Which veins are systemic and which are portal?

A

The venous drainage is similar to the arterial supply. Superior drains into the inferior mesenteric vein and goes to the liver via the portal system. Middle and inferior veins are systemic, and drain into the internal iliac vein.

35
Q

What is the role of the ischio-anal fossae?

A

Allows recto-anal and vaginal expansion.

36
Q

Where is the pudendal neurovascular bundle found?

A

In the lateral border of the ischio-anal fossa.

37
Q

Which mass of erectile tissue does the urethra travel through?

A

Corpus Spongiosum

38
Q

Describe the passage of sperm from the seminiferous tubules to the vas deferens.

A

Seminiferous tubules - rete testis - vasa efferentia (efferent ductules) - head of epididymis - tail of epididymis - ductus deferens

39
Q

What is another term for foreskin?

A

Prepuce

40
Q

What is the term for the ridge of the glans?

A

Corona of the glans

41
Q

What is the main branch of the internal iliac artery that supplies the penis?

A

Internal pudendal artery

42
Q

What are the arteries and veins that run along the top of the corpora cavernosae and supply the skin and connective tissue?

A

Dorsal artery of the penis

43
Q

Where in the tip of the penis can catheters get caught?

A

Fossa terminalis (navicular fossa)

44
Q

Which artery supplies the corpora cavernosae?

A

Deep artery

45
Q

What makes the penis erect?

A

Branches supplying the cavernous spaces are usually coiled - helicine arteries
PARASYMPATHETIC stimulation causes dilation of the helicine arteries allowing blood to flow into the penis and cause erection

46
Q

What nerves supply the pelvic contents? Where do the sympathetic and parasympathetic nerves arise from?

A

AUTONOMIC NERVES
Sympathetic - lower thoracic and upper lumbar - T10-L2 (via the hypogastric plexus)
Parasympathetic - S2-S4

47
Q

Where is pelvic sensation referred to?

A

Suprapubic region + perineum

48
Q

What nerve gives somatic control of some sphincters in the pelvis?

A

Pudendal nerve (S2-S4)

49
Q

What does the pudendal nerve provide sensory innervation to and which smaller branch of the pudendal nerve is involved in this?

A

Sensory - penile skin and glans (via the dorsal nerve of the penis)

50
Q

What does the pudendal nerve provide motor innervation to?

A

Perineal muscles - bulbospongiosus and ischiocavernosus
Leads to ejaculation
External urethral sphincter

51
Q

What are the effects of parasympathetic nerves in the pelvis?

A

Vasodilation of arterioles in erectile tissue (male and female) leading to erection.
Secretion in prostate and bulbourethral glands

52
Q

What are the effects of sympathetic nerves in the pelvis?

A

Contraction of smooth muscles in epididymis, vas deferens, seminal vesicles, prostate during ejaculation
Contraction of internal urethral sphincter (prevents reflux of semen)

53
Q

What does the pudendal nerve supply?

A

All the perineal muscles

54
Q

Which plexus do the somatic nerves leave the pelvis from?

A

Lumbosacral plexus

55
Q

Which arteries relax to allow blood flow into the penis?

A

Internal pudendal artery

56
Q

What muscle is associated with the corpus cavernosum? Where does it attach?

A

Ischiocarvernosus - attaches to the ischiopubic ramus

57
Q

Process of ejaculation

A
  1. Parasympathetic activation causes pudendal arteries and arterioles to relax and allow blood flow into corpora cavernosae = ERECTION.
    It also stimulates secretion from prostate, seminal vesicles and bulbourethral glands.
  2. Sympathetic activation causes smooth muscle contraction of vas deferens, prostate and seminal vesicles as well as internal urethral sphincter and inhibition of bladder muscle contraction to prevent urine flow.
  3. Entry of semen into urethra triggers somatic reflex via pudendal nerve which causes contraction of bulbospongiosus muscle = EJACULATION.

MRCS: Abdomen and Pelvis Anatomy (11 decks)

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