Male Reproductive System Flashcards
Surrounded by a thick connective tissue layer (tunica albuginea)
Further surrounded incompletely by a peritoneal sac (tunica vaginalis)
Contents:
- seminiferous tubules
- straight tubules
- Rete testes
- efferent ductules
Blood supply: abdominal aorta via testicular artery
- rich collateral blood supply provided by:
1. Internal iliac artery via artery of the ductus deferens
2. Inferior epigastric artery via cremasteric artery
3. Femoral artery via external pudendal artery
Venous drainage:
- Pampiniform plexus unite to form testicular veins
- R testicular vein –> IVC
- L testicular vein –> L renal vein (L-sided testicular varicocele may indicate occlusion of L testicular vein or L renal vein by a malignant renal tumor
Lymph drainage:
- testes: deep lumbar nodes near the renal hilus (spread of testicular CA)
- scrotum: superficial inguinal nodes
Testes
Testes descends along an abnormal pathway
Ectopic tests
Small patency of processus vaginalis remain –> peritoneal fluid flows into tunica vaginalis surrounding the testes
Hydrocele
Abnormal dilatation of Pampiniform plexus & testicular vein (bag of worms)
More common on the left side (90%) - caused by compression of left testicular vein by sigmoid colon
Associated with infertility
Varicocele
Rotation of testes around the spermatic cord, usually toward the penis (eg. medially)
⬆️ in bell clapper deformity (testes is horizontal & tunica vaginalis is attached high on spermatic cord)
An emergency because it can cause ischemic necrosis within 6 hours
Torsion
MC form of testicular CA in men older than 60 year old
Occurs when malignant lymphoma metastasizes to the testes
Testicular lymphoma
MC form of testicular CA in infants & boys up to 3-year old
⬆️ a-fetal protein levels
Yolk sac tumor
MC type of germ cell neoplasm in 20-40% year old
Painless testicular mass, usually on the right side or diffuse nodularity
⬆️ b-hCG
Seminoma
Germ cell neoplasm
Early histology: resemble a blastocyst with 3 primary germ layers “male pregnancy”
Well differentiated cells from each primary germ layers (endoderm, mesoderm & ectodermh
Testicular teratoCA
Highly coiled duct, consists of head, body & tail
Sperm maturation & storage occur in the head & body
Tail is continuous with the vas deferens
Epididymis
Begins at the inferior pole of the testes –> enter spermatic cord –> inguinal canal –> deep inguinal ring
Joined by seminal vesicle to form the ejaculatory duct opens into the prostatic urethra
Ductus deferens (vas deferens)
Vasectomy cuts through the ff???
Skin –> COLLE’S fascia & dartos muscle –> external spermatic fascia –> cremasteric fascia & muscle –> internal spermatic fascia –> extraperitoneal fat
Tunica vaginalis is not cut
Contents of the spermatic cord
Ductus deferens
Artery of ductus deferens
Testicular artery
Cremasteric artery
Pampiniform venous plexus
Sympathetic & parasympathetic nerves
Genitofemoral nerve
Lymphatics
Function: produces seminal fluid, which fructose & choline
In forensic med: detection of choline crystals is the preferred method of determining the presence of sperm
Seminal vesicle
Location: between base of urinary bladder & urogenital diaphragm
- anterior surface: related to retropubic space
- posterior surface: related to the seminal vesicles & rectum
Collection of tubulo-alveolar glands
Prostate gland
5 lobes of prostate gland
R & L lateral
R & L posterior
Middle
3 zones of prostate gland
Peripheral (site of most cancers)
Central
Transitional (periurethral) -BPH
The lumen of the glands normally contain deposits
Corpora amylacea
Contains citric acid, phosphatase, prostaglandins, fibrinogen, & prostate-specific antigen (PSA)
Serine protease that liquefies semen after ejaculation
Serum acid phosphatase & PSA - diagnostic tools to detect prostatic CA
Prostatic fluid
Arterial supply prostate gland
INTERNAL ILIAC ARTERY via inferior vesical artery
Venous drainage of prostate gland
2 pathways
Prostatic venous plexus –> internal iliac veins –> IVC
Route of prostatic CA metastasis to the heart & lungs
Prostatic venous plexus –> vertebral venous plexus –> cranial dural sinuses
Route of prostatic CA metastatic to vertebral column & brain
Hypertrophy of transitional (periurethral) zone
MC location: lateral & middle lobes
Compresses prostatic urethra –> obstructs urine flow
May be caused by ⬆️ sensitivity of prostate to dihydrotestosterone (DTH)
Not premalignant
SSX: urinary frequency, nocturia, sense of incomplete emptying of the bladder
Tx: surgery, 5a-reductase inhibitor (finasteride) to block the conversion of testosterone & DHT; or a-adrenergic antagonists (e.g. Terazosin, Prazosin) to inhibit prostate gland secretion
Benign prostatic hypertrophy (BPH)
MC location: peripheral zone, which usually involves the posterior lobes
Dx: Serum PSA
Bone metastasis is common
Tx: surgery, radiation, Leuprolide (GnRH agonist that inhibits FSH & LH release, cyproterone or flutamide (androgen receptor antagonists)
Prostatic carcinoma
External genitalia
Scrotum
Penis
3 columns of erectile tissue
1 corpus Spongiosum
2 corpora cavernosa
Supported by suspensory ligament
Innervations: dorsal nerve of the penis
Penis
Blood supply of penis
INTERNAL PUDENDAL ARTERY via deep artery of the penis & dorsal artery of the penis
Venous drainage of the penis
DEEP DORSAL VEIN OF THE PENIS –> prostatic venous plexus –> internal iliac vein –> IVC
SUPERFICIAL DORSAL VEIN OF THE PENIS –> external pudendal vein –> great saphenous vein –> femoral vein –> external iliac vein –> IVC
Begins as bulb of the penis & ends as glans penis, ventrally located, transmits the urethra
Corpus Spongiosum
Begin as the cruris of the penis & end proximal to the glans, dorsally situated
Corpora cavernosa
Urethral folds do not fuse completely –> external urethral orifice opens onto the ventral surface
Associated with chordee (penis that curves ventrally)
Hypospadias
External urethral orifice opens onto the dorsal surface
Associate with bladder extrophy
Epispadias
Adult female
Gonads: ovary, follicles, Rete ovarii
Paramesonephric ducts: uterine tubes, uterus, cervix, upper part of vagina
Mesonephric ducts: duct of Gartner
Phallus: clitoris
Urogenital folds: labia minora
Labioscrotal swellings: labia majora
Adult male
Gonads: testes, seminiferous tubules, Rete testes
Paramesonephric ducts: appendix of testes
Mesonephric ducts: epididymis, ductus deferens, seminal vesicle, ejaculatory duct
Phallus: glands & body of penis
Urogenital folds: ventral aspect of penis
Labioscrotal swellings: scrotum
Testes descend along the normal pathway but do not reach the scrotum
If bilateral –> associated with sterility
⬆️ incidence of cancer & torsion
Cryptorchidism
