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Block 5 > Male Reproductive Anatomy > Flashcards

Male Reproductive Anatomy Flashcards

1
Q

How do the testes develop?

A

From intermediate mesoderm high on posterior abdominal wall in retroperitoneal position dragging the neurovascular supply and lymph vessels with it as they descend through inguinal canal along the gubernaculum to scrotum and anterior abdominal wall layers end up surrounding them and the spermatic cord - outpouching of parietal peritoneum forms the processus vaginalis which later forms the tunica vaginalis

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2
Q

What is the site of spermatogenesis?

A

Seminiferous tubules of the lobules of the testes in the scrotum

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3
Q

What is the lymph drainage of the testes?

A

Para-aortic lymph nodes (}L2)

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4
Q

What can be the consequence of a patent processus vaginalis?

A

Potential weak spot for indirect inguinal hernias

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5
Q

What is the scrotum?

A

A loose pouch of thin skin with layers derived from abdominal wall that testes lie within functioning to keep the testes at 3-4 degrees cooler than body temp. via altering their proximity to the body

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6
Q

What is the structure of the testes?

A
  1. Surrounded by tunica vaginalis that contain a visceral and parietal layer with small amount of fluid in between
  2. Tough fibrous coat called tunica albuginea gives rise to septa and divides into lobules
  3. Lobules contain seminiferous tubules which connect to rete testis, then to epididymis via efferent ductules (route of spermatozoa)
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7
Q

What is a hydrocele? How do you examine it?

A

Excessive fluid in the tunica vaginalis caused by inflammation, infection, developmental issues, trauma, neoplasm etc. - diagnose by transillumination ability

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8
Q

What is the epididymis?

A

Structure situated posteriorly and superiorly of testes with a head, body and tail:

  • Head receives numerous efferent ductules
  • Tail connects to ductus deferens (site of maturation and storage of spermatozoa) so sperm can move to the urethra to be ejaculated
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9
Q

What is a cause of epididymo-orchitis?

A

STIs

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10
Q

How can you clinically distinguish between hydrocele, spermatocele and testicular cancer?

A

Hydrocele: testes cannot be felt as the swelling covers the testes

Spermatocele/epididymal cyst: testes CAN be felt and inflamed epididymis will be felt superiorly (slightly posterior) of testes

Testicular cancer: multiple hard lumps can be felt within the testicle itself

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11
Q

What are the contents and coverings of the spermatic cord?

A

Rule of 3s:

  • 3 x coverings/layers = internal spermatic fascia, cremasteric fascia + external spermatic fascia
  • 3 x arteries = testicular, cremasteric + ductus deferens
  • 3 x nerves = genital br. of genitofemoral, autonomics + illioinguinal
  • 3 x other structures = ductus deferens, pampiniform plexus + lymphatics
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12
Q

What is the cremasteric reflex?

A

If you stroke and stimulate the anterior medial thigh, the muscular cremasteric fascia contacts and brings up the testicles

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13
Q

What are the layers of the spermatic cord derived from?

A

Internal spermatic fascia = transversalis fascia

Cremasteric fascia = internal oblique

External spermatic fascia = external oblique aponeurosis

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14
Q

Where can testicular pain refer to?

A

Abdomen

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15
Q

What is special about the vasculature of the testes?

A

Testicular arteries originate from aorta and pampiniform plexus from the testicular veins wrapped around testicular artery forming an arrangement that allows a counter-current heat exchange mechanism

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16
Q

What is the venous drainage of the testes?

A

R: testicular vein > IVC

L: testicular vein -> renal vein > IVC

(Similar to ovarian drainage)

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17
Q

What disorders occur of testicular vasculature?

A

Torsion (arterial): twisting of testis resulting in compromised blood supply - MEDICAL EMERGENCY

Varicocoeles (venous) most common on the L: abnormal dilations of pampiniform plexus

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18
Q

What is a vasectomy?

A

Male sterilisation performed by cutting and ligating (or cauterising) ductus vas deferens via a scrotal incision

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19
Q

What are the ductus vas deferens?

A

Muscular smooth muscle tube derived capable of peristaltic action via sympathetic innervation running from the tail of the epididymis to the ejaculatory duct (superior to ureter in pelvic cavity) which also meets the seminal vesicles at the widened ampulla - blood supply from local vessels on its course

20
Q

What are seminal vesicles?

A

Paired accessory sex glands located behind the bladder and related posteriorly to rectovesical pouch (palpable in some people) that produce alkaline fluid to contribute to seminal fluid uniting with the ductus deferens to form the ejaculatory ducts which open into prostatic urethra raised central area called the seminal colliculus/veramontanum (useful landmark during TURP)

21
Q

What is the prostate gland?

A

1/3 fibromuscular and 2/3 glandular tissue superior to perineal membrane between the bladder and levator ani surrounding the urethra (prostatic urethra/urethral crest) contributing volume to the seminal fluid via openings within prostatic sinus - blood supply from ILA branches vesical and rectal a.’s

22
Q

How can you examine the prostate?

A

Lies directly anterior to lower rectum so posterior aspect is palpable via DRE

23
Q

What sympathetically innervated structure prevents retrograde ejaculation?

A

Internal Urethral Sphincter (IUS)

24
Q

What are the lobes and zones of the prostate?

A

Lobes based on positional relationship of prostate tissue to urethra and ejaculatory duct:

  • Anterior
  • Median - BPE
  • Posterior

Zones from closest to furthest from urethra:

  • Transitional (TZ) - BPE
  • Central (CZ)
  • Peripheral (PZ) - cancer
25
Q

What is the venous drainage of the prostate gland?

A

Prostatic venous plexus > internal illiac veins BUT can pass to vertebral valveless venous plexus too which runs length of vertebral column and into bodies so cancer can spread to here from the prostate causing a back pain presentation

26
Q

What is the penis?

A

Tissue formed from 3 cylindrical vascular structures covered and bound by various connective tissue layers:

  • 2 x corpora cavernosa (root = 2 crus/crura) forming the body that is suspended by suspensory and fundiform ligaments and covered in relatively thin, hairless skin
  • 1 x corpus spongiosum (root = bulb) containing urethra and expanding at distal end to form glans which have the foreskin (prepuce) anchored to them by frenulum - damaged by perineal trauma
27
Q

What covers the crura and bulb of the penis?

A

Somatically innervated muscles by pudendal nerve (S2-4) ischiocavernosus and bulbospongiosus

28
Q

Where are the neurovascular structures of the penis?

A

Dorsal aspect (anatomical position) where open channels allow blood to enter and engorge the corpora (mainly cavernosa) - position of neurovasculature structures and urethra important for anaesthesia and treatment of priapism

29
Q

What are the 4 different parts of the urethra?

A
  1. Pre-prostatic at exit from bladder
  2. Prostatic
  3. Membranous (non-distensible) in perineal membrane
  4. Spongy (penile) urethra

When catheterising, straighten penis and push it into legs

30
Q

What is the bulbourethral (Cowper’s) glands and where is it?

A

Accessory sex gland that is located deep to perineal membrane opening into the urethra superficial to it producing and secreting lubricating fluid

31
Q

What pathologies can occur in the penis?

A
  1. Fracture of penis from traumatic rupture of corpus cavernosum
  2. Prepuce can get stuck around glands and cannot be retracted over glans = phimosis
  3. Foreskin stuck in retracted position behind glands = paraphimosis (can be caused by catheterization) - will compromise blood supply w/o treatment
  4. Persistent painful non-stimulated erection lasting > 4 hrs and unrelieved be ejaculation = priapism - requires prompt treatment
  5. Hypospadias (ventral) and epispadis (dorsal) abnormalities of male urethral development - hypospadias MORE COMMON
32
Q

What is the ischioanal fossae?

A

Fat-filled spaces below the pelvic floor and communicate across the midline that support the pelvic floor and aid passage of faeces - anterior recesses on either side project towards the pubic bone (superior to perineal membrane) that be classed as a division of the deep perineal pouch - common region of infection spread due to lack of blood supply

33
Q

What are perineal pouches?

A

Fascia bound regions in the urogenital triangle:

  1. Deep: above perineal membrane and below the pelvic floor
  2. Superficial: below the perineal membrane and Colles’ fascia (continuous with Scarpa’s fascia > dartos > colles’)
34
Q

What do the superficial abdominal wall fascia become in the perineum?

A

Campers: dartos muscle in scrotum

Scarpa’s: dartos fascia in penis and scrotum > Colles’ fascia in urogenital triangle (why fluid/infection can extend up anterior ab. wall) - binds to fascia lata of thigh below inguinal ligament

35
Q

What is in the superficial perineal pouch in the male?

A

Penis
Urethra
Scrotal contents
Superficial perineal muscles

36
Q

What clinical problems can occur in the perineum?

A

Fournier gangrene (necrotizing fasciitis of the perineal region)

Perianal fistula (from anal canal, tracking through ischioanal fossa and going onto the skin near the anus)

37
Q

What is the main arterial supply to the penis?

A

Internal illiac artery travels through greater and lesser sciatic foramen inferior to pelvic floor into deep perineal pouch and turns into the internal pudendal artery travelling through the pudendal (Aclock’s) canal which lives over obturator internus - arterial disease can lead to erectile dysfunction

38
Q

What is the venous drainage of the penis?

A

Dorsal veins (superficial and deep) drain to prostatic venous plexus and then to internal illiac veins (also can go via the vertebral plexus alike the prostate)

39
Q

What is the lymphatic drainage of the penis?

A

Different routes taken:

  1. Superficial inguinal nodes scrotal, penis, perineal skin and distal anal canal
  2. Deep inguinal nodes: glans of penis and distal spongy urethra
  3. Para-aortic (L2) nodes: testicles
  4. Internal illiac nodes: most other parts of male RS inc. proximal urethra
40
Q

What is the somatic innervation of the male reproductive tract?

A

Neurovascular bundle is on dorsum of penis which is useful for anaesthesia. Nerve supply comes from pudendal nerve (S2-4) running in the pudendal canal and passes close to ischial spine which is a landmark where it can be anaesthetized - branches off to supply anal sphincters, perineal skin and penis (via dorsal nerve of penis which also supplies distal spongy urethra). Urethritis causes a lot of pain to somatically innervated tissues.

41
Q

What is the autonomic innervation to the male reproductive tract?

A

PS: pelvic splanchnic nerves (S2-4)

S: hypogastric nerves + sacral splanchnic nerves from sympathetic chain

PS + S fibres unite to form INFERIOR HYPOGASTIC PLEXUS on lateral pelvic wall travel medially to form plexi ass. with pelvic organs (e.g. rectum, prostate) -> rectal plexus -> prostatic plexus -> cavernous n.’s move into penis

42
Q

How could autonomic nerves be damaged? What is the result?

A

During surgery on the colorectal, pelvic and prostatic region - may result in impotence i.e. inability to become erect as PS cavernous n. would be affected which is important in erection

43
Q

What types of nerves are responsible for the 3 key functions of the penis?

A

Erection = Point = PS (mediated by NO causing SM relaxation of helicine arteries which is why some drugs to treat erectile dysfunction increase NO)

Emission = Secrete = Sym (L1-2)

Ejaculation = Score - Som

44
Q

What does erection involve?

A

Smooth muscle in helicine arteries relaxes allowing them to go from coiled to straight position allowing blood to fill the corpora cavernosa and the ischiocavernosus and bulbospongiosis muscles compress the venous plexus to prevent blood drainage from the penis - in a flaccid paralysis the arteriovenous (AV) anastomoses allows blood to bypass the corpora cavernosa

45
Q

What does emission involve?

A

Secretion from glands, peristalsis of ductus deferens and closure of internal urethral sphincter occurs to prevent retrograde emissions resulting in seminal fluid and spermatozoa open onto seminal colliculus (verumontanum) move through prostatic urethra to bulb of penis

46
Q

What does ejaculation involve?

A

Semen results from rhythmic contractions of bulbospongiosus that squeezes the penile bulb and urethra - this muscle also helps urethral emptying in male following urination

47
Q

What can surgery around the prevertebral plexus damage?

A

Sympathetics involved in mediating emission

Block 5 (29 decks)

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