Male Reproductive System Part 2 Flashcards
Arterial supply of seminal vesicles
Inferior vesical and middle rectal arteries
Venous drainage of seminal vesicles
into the vesical venous plexus
Lymphatic drainage seminal vesicles:
- Into the external iliac lymph nodes from the upper part
- Internal iliac nodes from the lower part.
Development seminal vesicles:
from mesonephric duct
Formation of Ejaculatory ducts:
Formation: near the neck of the bladder by the union of terminal part of vas deferens and duct of seminal vesicle.
Ejaculatory ducts Arterial supply:
Artery to the ductus deferens.
Ejaculatory ducts Venous drainage:
Into prostatic and vesical venous plexuses.
Ejaculatory ducts Lymphatic drainage:
Into external iliac nodes.
What are Bulbourethral glands (Cowper’s glands) :
- Are exocrine glands which form the part of the male reproductive system.
- located in the deep perineal pouch, at the base of the penis and are lateral and posterior to the urethra
- When sexually aroused, the glands produce a mucous-like fluid called pre- ejaculate, which is poured into the spongy urethra through its duct. The pre-ejaculate fluid is a viscous, clear, and salty liquid that neutralizes any residual acidity in the urethra. The now neutralized urethra is a more hospitable (as opposed to harmful) environment for the sperm to travel in.
Function of PROSTATE :
- Its secretion is added to the seminal fluid in the prostatic urethra.
- Prostatic secretion is rich in acid posphatase. Elevated prostatic acid phosphate levels may indicate the presence of prostate cancer.
Location of Prostate:
- Below the neck of urinary bladder
- Above the urogenital diaphragm
- Behind the lower part of pubic symphysis * In front of rectal ampulla.
Prostate: Capsules: 2 capsules
Inner True capsule and outer False capsule
* Betweenthe2capsulesistheprostaticvenousplexus.
* True capsule is the condensation of the connective tissue stroma of the prostate around it. It is adherent to prostate.
* False capsule lies outside the true capsule and is the condensation of the pelvic fascia. In front it is continuous with the puboprostatic ligaments, posteriorly it is continuous with true ligaments of bladder and rectovesicle fascia.
* In prostatectomy the gland is enucleated leaving behind both the capsules and the venous plexus.
Relations PRostate:
Base:
- Related to the neck of the urinary bladder.
- Is pierced by the urethra nearer the anterior aspect.
Relations PRostate:
Apex:
rests on the superior fascia of urogenital diaphragm.
Relations PRostate:
Anterior surface:
- Related to retropubic space which contains retropubic pad of fat and vesical venous plexus.
- Connected to pubic bones by puboprostatic ligaments.
Structures within the prostate
- Prostaticpartofurethra
- Two ejaculatory ducts
- Prostatic utricle
Relations PRostate:
Posterior surface:
- Related to ampulla of rectum.
- Separated from it by rectovesicle
fascia or fascia of Denonvilliers. - Pierced by 2 ejaculatory ducts.
Relations PRostate:
Infero-lateral surfaces:
related to levator ani muscles. The medial fibres of the levator ani muscles constitute levator prostatae.
Surgical lobes of the prostate:
ANTERIOR LOBE or isthmus: In front of prostatic urethra
-Connects the 2 lateral lobes
-Made up of fibro-muscular tissue
-Devoid of glandular tissue – hence, ADENOMA NEVER OCCURS in this lobe
-POSTERIOR LOBE: Behind the urethra and below the ejaculatory ducts. Connects the posterior ends of the lateral lobes.
* Contains glandular tissue
* Site of PRIMARY CARCINOMA
* This lobe is palpable by per rectal examination
MEDIAN LOBE: Behind the urethra and above the ejaculatory ducts. * Wedge shaped lobe, is in contact with the trigone of the bladder.
* Produces a bulge behind the internal urethral orifice - uvula vesicae
* Contains more glandular tissue than other lobes
* More susceptible to benign hypertrophy of the prostate (BHP) * Notpalpableperrectumbecauseitiscoveredbyposteriorlobe.
* RIGHT and LEFT LATERAL LOBES: on the respective sides of the urethra. They contain numerous glands, which may give rise to adenoma.
Prostatic urethra
Posterior wall presents:
a) A longitudinal ridge in the midline called urethral crest.
b) An elevation called colliculus seminalis (verumontanum). On this 3 openings –
* opening of prostratic utricle in the middle
* two openings of ejaculatory ducts on either side
of the previous opening.
c)Prostatic sinuses – two longitudinal grooves on either side of the urethral crest.
Prostate
Zones:
Glandular tissue – arranged in 3 zones.
- Peripheral zone: consists of long branching glands [prostatic follicles], whose ducts curve and open into the walls of the prostatic sinuses below the level of colliculus seminalis. Glands in this zone develop from endoderm and are prone to carcinoma.
- Internal (Transitional) zone: Consists of submucosal glands whose ducts open on the floor of prostatic sinuses at the level of colliculus seminalis. Glands in this zone are mesodermal in origin they are prone to benign hypertrophy of prostate (BHP)
- Innermost (Central) zone: Consists of mucosal glands surrounding the upper part of the prostatic urethra.
Supports of the prostate:
Urogenital diaphragm: The apex of the gland rests on it and the prostate sheath is continuous with its superior fascia.
Two pairs of pubo-prostatic ligaments: They extend from the prostatic sheath (false capsule) to the back of the pubic bones. The medial pair lies near the apex of the gland and the lateral pair close to the base.
Recto-vesical fascia of Denonvilliers: The posterior aspect of prostatic sheath adheres to this fascia posteriorly,
Blood supply PRostate:
Arterial supply:
- Inferior vesical artery.
- Middle rectal artery.
- Internal pudendal artery.
PRostate Lymphatic drainage:
Mainly into the internal iliac group of lymph nodes and also into the external iliac and sacral lymph nodes.
Blood supply PRostate:
Venous drainage:
- Prostatic venous plexus between true and false capsule.
- Receives deep dorsal vein of the penis in front.
- Joins vesical venous plexus and through it drains into internal iliac vein.
- Connected with internal vertebral venous plexus through valveless veins (Batson’s veins).
- In increased intra-abdominal pressure like in coughing and straining the malignant cells from the prostate spread to the vertebral column and skull through this route.
Nerve supply of Prostate:
- Parasympathetic from pelvic splanchnic nerves via inferior hypogastric plexus
- Parasympatheticnerves-forerection
- Sympathetic nerves – origin from L1 segment of spinal cord through hypogastric plexus reach the gland - Supply smooth muscle.
- Sympathetic supply of the prostate, seminal vesicles and vas deferens – responsible for ejaculation.
Development of Prostate:
- Glandular part of the prostate develop in the third month of foetal life as solid endodermal outgrowths from the pelvic part of the urogenital sinus
- The fibro-muscular part develops in the 4th month of foetal life from the splanchnic mesoderm which surrounds the urogenital sinus
Age changes in prostate:
- In newborn and childhood – contains only fibromuscular stroma and rudimentary duct system.
- At puberty – Testosterone level increase, duct system increase and there will be condensation of fibromuscular tissue and prostate becomes double the size. Prostatic follicles develop and proliferate and begin secretion of acid posphatase and prostate specific antigen (PSA) in addition to other constituents like prostaglandins.
- During third decade – Glandular epithelium of the follicles grow by irregular multiplication of epithelial infoldings in the lumen of follicles. Thereby the follicles increase in size.
- After third decade (during 30-45 years) – Size remains constant, but the infoldings are lost and become regular. The amyloid concretions start forming in the follicles.
- After 45 to 50 years – the gland may show gradual benign hypertrophy or progressive atrophy because of hormonal imbalance.
Benign hypertrophy of the prostate affects:
the median lobe which projects into the urinary bladder and obstructs the urinary outflow. As the patient strains to urinate, the median lobe blocks the internal urethral orifice more. This may give rise to chronic obstruction to bladder outflow leading to effects of backpressure on the bladder, ureter and renal pelvis and calyces.
Urethral obstruction leads to
nocturia (need to void during night), dysuria (difficulty and/or pain during micturition) and urgency (sudden desire to void)
What is Carcinoma of prostate:
- May spread locally involving bladder neck, seminal vesicle, ureters and rectum.
- Malignant prostate feels hard and often irregular.
- Spread by lymphatic route is common.
- External iliac and internal iliac nodes besides sacral nodes are enlarged.
- Spread by venous route occurs to the pelvic bones, lower lumbar vertebrae, femoral head, ribs and skull.
Surgical removal of the prostate – prostatectomy.
* 4 approaches –
- Retropubic approach – through the retropubic space – extraperitoneal approach.
- suprapubic transvesical approach – through the urinary bladder which is opened and prostate enucleated by a finger in the urethra.
- Perineal approach – almost outdated technique – through the rectovesicle fascia.
- Transurethral approach – most accepted approach nowadays. Known as TURP – Transurethral resection of prostate.
Blood supply of scortum:
- Superficial external pudendal artery
- Deep external pudendal artery
- Scrotal branches of the internal pudendal artery
- Cremasteric artery, a branch of the inferior epigastric artery
Nerve supply of Scrotum:
- Anterior one-third is supplied by L1 segment through ilioinguinal nerve and genital branch of genitofemoral nerve
- Posterior two-third is supplied by S3 through posterior scrotal branches of perineal nerve and perennial branch of posterior cutaneous nerve of the thigh
- Dartos is supplied by sympathetic fibres through genital branch of genitofemoral nerve
The areas supplied by L1 and S3 spinal segments are separated by the ventral axial line
Lymphatics of Scrotum:
drain into superficial inguinal group of lymph nodes
Development of Scrotum:
Develops from two labioscrotal swellings and urogenital folds, which fuse in the midline to form the scrotum.
What is Scrotal edema (A):
is a common site due to laxity of the skin and its dependent position
What is Sebaceous cyst (B) :
often occurs in the scrotum due to the presence of a
large number of sebaceous glands in the scrotum
What is Scrotal elephantiasis (C):
is a clinical condition characterized by massive swelling and enlargement of the scrotum due to accumulation of interstitial fluid in the scrotal wall following blockage of lymph vessels by slender worms of filariasis (Wuchereria bancrofti)
Ligaments of the penis:
- Fundiform ligament – springs from the lower part of linea alba and splits into two lamellae, which enclose the proximal part of the body of penis and then unite on its urethral aspect with the septum of scrotum
- Suspensory ligament – It is deep to fundiform ligament and triangular in shape. Its narrow upper end is attached in front of the pubic symphysis and broad lower part blends with Buck’s fascia on either side of the body of penis.
Arterial supply of penis
Supplied by:
Deep arteries of the penis – branch of internal pudendal A (branch of internal iliac A)
Dorsal arteries of the penis - branch of internal pudendal A
Arteries of the bulb - branch of internal pudendal A
Superficial external pudendal arteries – femoral A
Venous drainage of penis:
The superficial dorsal vein of the penis drains the prepuce and skin of the penis, and, running backward to open into the corresponding superficial external pudendal vein (tributary of great saphenous vein)
The deep dorsal vein of the penis lies beneath the Buck’s fascia; it receives the blood from the glans penis and corpora cavernosa penis and courses backward and divides into two branches, which enter the vesical and prostatic plexuses.
Lymphatic drainage of penis:
- Lymphatic from the glans penis drain into the lymph node of Cloquet (deep inguinal
- From the rest of the penis lymphatics drain into superficial inguinal lymph nodes
Nerve supply of penis:
- Sensory nerve supply to penis is by dorsal nerve of the penis and ilioinguinal nerve
- Motor innervation is by perineal branch of pudendal nerve
- Autonomic nerve supply is derived from inferior hypogastric via the prostatic plexus; they reach penis through the pudendal nerve
- The sympathetic nerves are vasoconstrictor while the parasympathetic fibres are vasodilator.
- The parasympathetic fibers (nervi erigentes) are derived from S2,S3,S4 spinal segments
The mechanism of erection is purely a vascular phenomenon and occurs in response to parasympathetic stimulation
What is Impotence:
the failure to achieve tumescence erection is called impotence. The commonest cause of erectile dysfunction are: a. Psychological disturbance with failure to relax the smooth muscle in the corpora. b. arterial insufficiency because of atheromatous disease. c. involvement of nervi erigentes secondary to diabetes.
WHat is Priapism:
failure of erection to detumesce (tumescence - readiness for sexual activity marked especially by vascular congestion of the sex organs)
What is Phimosis:
is narrowing of the distal end of the prepuce, which prevents its retraction over the glans penis and may interfere with the micturition
What is Paraphimosis:
in which narrowing of the prepuce is insufficient to interfere with the micturition, but just sufficiently tight to get struck on the glans posteriorly on erection and thus interfere with copulation
WHat is Circumcision
is surgical removal of foreskin (prepuce) of the penis. In children and adults, the circumcision is somewhat required to relieve the patient from a lightly consulting prepuce (Phimosis). The ritual circumcision for religious reasons is one of the oldest operative procedures in the world.
