Midterm Three Flashcards
What is the relationship of the ureters to the peritoneum?
ureters are retroperitoneal like the kidneys
How does urine move through the ureters?
peristalsis
Which arteries does the common ilac artery divide into? At which vertebral level does this happen?
Common iliac artery dives into the external iliac and internal iliac artery at the L4 vertebral level aka the common iliac bifurcation
What is the relationship of the ureters with the common iliac arteries?
ureters pass over the pelvic brim at the bifurcation of the common iliac arteries
What is the relationship of the ureters with the internal iliac arteries?
ureter lies anterior and parallel to the internal iliac artery
At the level of the ischial spine, what direction do the ureters take to enter the bladder?
anterior medially
What is the direction of the ureters through the muscular wall of the bladder?
inferior medially
Which blood vessels supply the pelvic part of the ureters? What is the most common variant of blood supply to the female ureter? What is the most common variant of blood supply to the male ureter?
- Pelvic ureter is supplied by branches of the common iliac and internal iliac arterys
- females = uterine (most of time) or vaginal artery
- males = inferior vesical artery
On a diagram of the blood supply of the ureters, label the arteries.
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List the plexuses which innervate the ureters.
- renal plexus
- aortic plexus
- superior hypogastric plexus
- inferior hypogastric plexus
On a diagram, label the plexuses which innervate the ureters. Which are mixed sympathetic and parasympathetic?
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What is the relationship of the urinary bladder to the pubic bone?
anterior portion of the bladder is directly superior to the pubic bone
What is in between the bladder and the pubic bone?
retropubic space
Which ligament holds the male bladder in place and what does it attach to?
- puboprostatic ligament
- attaches to the neck
Which ligament holds the female bladder in place and what does it attach to?
- pubovesical ligament
- attaches to the neck
Which muscle is the wall of the bladder composed of?
detrusor muscle
How high can a full bladder ascend?
all the way up to the level of the umbilicus
In the male bladder, what do the muscle fibers form at the neck?
- involuntary internal urethral sphincter
On a diagram of the bladder label the surfaces.
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Which ligament attaches tot he apex of the bladder?
median umbilical ligament
Which sphincter contracts during ejaculation? What does this prevent?
- internal urethral sphincter
- retrograde ejaculation of sperm into the bladder
Describe the trigone of the bladder. Where is the trigone located?
- Trigone is on the base/inferior part of the bladder
- it is where the ureters enter the inferior part of the bladder and the point where the urethra leaves under the side of the bladder
On a diagram of the male bladder identify the following structures: retropubic space, puboprostatic ligament, full urinary bladder, bladder, spongy urethra, prostatic urethra, intermediate urethra, detrusor muscle, ureter, internal urethral orifice, ejaculatory duct.
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On a diagram of the female bladder identify the following structures: ureter, retropubic space, pubovesical ligament, bladder, rectum, fundus of bladder, apex of bladder.
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On a diagram of the male bladder identify the following structures: retropubic space, puboprostatic ligament, full urinary bladder, bladder, spongy urethra, prostatic urethra, intermediate urethra, detrusor muscle, ureter, internal urethral orifice, ejaculatory duct.
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The arteries that supply the bladder are branches of which artery?
internal iliac artery
Which arteries supply the superior part of the bladder?
superior vesical
Which arteries supply the inferior part of the bladder in MALES?
inferior vesicle
Which arteries supply the inferior part of the bladder in FEMALES?
vaginal artery
List all of the arteries which supply the bladder.
- obturator artery
- inferior gluteal artery
- superior part = superior vesical
- inferior part = inferior vesicle (m), vaginal (f)
In the male, which veins drain the bladder and which structures do they drian into?
- Deep dorsal vein of penis drains into prostatic venous plexus and the prostatic venous plexus is continuous with the vesical venous plexus of the bladder which both drain into the internal iliac veins OR the sacral veins which drain into the internal vertebral plexus
In females, which veins drain the bladder and which structures do they drain into?
Dorsal vein of the clitorus drains into the vesical venous plexus which drains into the vaginal or uretovaginal venous plexus
On a diagram of arteries of the female bladder, identify the following arteries: common iliac, internal iliac, external iliac, obturator, superior vesical, inferior gluteal, vaginal and internal pudendal.
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On a diagram of arteries of the male bladder identify the following arteries: common iliac, internal iliac, external iliac, superior vesical, inferior gluteal, inferior vesical, internal pudendal and middle rectal.
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On a diagram of veins of the bladder identify the following veins: superior vesical, uterine venous plexus, vaginal venous plexus, vesical venous plexus, inferior vesical, prostatic venous plexus, deep dorsal vein of penis.
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Draw a diagram of the sympathetic innervations of the bladder and include the involved spinal segments, the appropriate plexuses. What are the sympathetic functions?
- T11-L2/L3
- hypogastric/pelvic plexus
- vesical plexus
- stimulates ejaculation and causes contraction of internal urethral sphincter
Draw a diagram of the parasympathetic innervations of the bladder and include the involved spinal segments, splanchnic nerve and the appropriate plexus. What are the parasympathetic motor functions?
- S2, S3, S4
- pelvic splanchnic nerve
- inferior hypogastric plexus
- motor to the detrusor so we can urinate
- inhibition of the internal sphincter of males to allow the sphincter to relax so that urine can pass through
In females, which blood vessels supply the urethra?
- internal pudendal
- vaginal
In males, which blood vessels supply the prostatic urethra? Which blood vessels supply the intermediate and spongy urethrae?
- prostatic urethra
- prostatic branches of inferior vesical and middle rectal arteries
- intermediate and spongy urethra
- internal pudendal artery
In females, what is the innervation of the urethra?
- vesical plexus
- pudendal nerve
- pelvic splanchnic nerves
In males, what is the innervation of the urethra?
prostatic nerve plexus which is an extension of the inferior hypogastric plexus
On a diagram of innervation of the urinary bladder and urethra, identify the following structures: pudendal nerve, prostate and prostatic nerve plexus, internal urethral sphincter, external urethral phincter, inferior hypogastric plexus, superior hypogastric plexus, pelvic splanchnic nerves, vesical nerve plexus.
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Label the blood supply of the ureters.
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In females, which artery most commonly supplies the ureter?
uterine artery
In males, which artery most commonly supplies the ureter?
inferior vesical artery
Which spinal segements are involved in the compostion of the pudendal nerve?
S2, S3, S4
Identify the similarities and differences in vasculature and innervation between the male and female bladder.
Identify similarities and differences in vasculature and innervation between the male and female ureter.
Identify similarities and differences in vasculature and innervations between the male and female urethra
Where are sperm made? Where are sperm stored?
- made = seminferous tubules
- stored = epididymis
Where does the ductus deferens begin?
at the tail of the epidydimis at the inferior pole of the testis
In which structure does the ductus deferens travel to reach the pelvis? Through which canal does this structure pass?
- tail of epiididymis –> spermatic cord –> inguinal canal –> external iliac vessels –> pelvis –> parietal peritoneum –> joins duct of seminal gland
- inguinal canal
Which structure does the ductus deferns join at its end?
the duct of the seminal gland to form the ejaculatory duct
What is the name of the enlargement of the ductus deferens?
ampulla
What is the relationship of the ductus deferens to the bladder?
the ductus deferns runs superior to the bladder and encircles it
Which arteries supply the ductus deferns and which artery do they anastomose with?
either superior vesical or inferior vesical artery eventually anastomosing with the testicular artery
Which veins drain the ductus deferens?
either superior vesical or inferior vesical vein eventually anastomosing with the testicular vein
Which lympathic nodes drain the ductus deferens?
external iliac lymph nodes
Where are the seminal glands located? What is their relationship to the prostate?
- located between the fundus of the bladder and the rectum
- superior to the prostate
What is the percentage of fluid from the seminal glands that make up semen?
65-75%
Which arteries supply the seminal glands?
arteries arise from the inferior vesical and middle rectal arteries
Which node does the superior seminal gland drain into?
external iliac nodes
Which node does the inferior seminal gland drain into?
internal iliac nodes
Which veins drain the seminal glands?
veins arise from inferior vesical and middle rectal veins
Where is the ejaculatory duct located?
near the neck of the bladder
What is the direction of passage through the prostate for the ejeaculatory ducts? In which part is the prostate found?
pass anterior inferiorly thorugh the posterior part of the prostate
Which artery supplies the ejaculatory duct? Which artery does it most typicall arise from? Which artery does it less typically arise from?
- arteries are the same as the ductus deferens (superior vesical or inferior vesical artery)
- usually arise from the superior vesical artery but sometimes the inferior vesical artery
Which structures drain the ejaculatory duct?
veins drain into the prostatic and vesical venous plexuses
Which lymph nodes drain the ejaculatory duct?
external iliac lymph nodes
Identify on a diagram the following structures: ductus deferens, scrotum, testis, ampulla of ductus deferens, ejaculatory duct.
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Identify on a diagram the following structures: ureteric artery, artery to ductus deferens, superior vesicle artery, inferior vesicle artery, prostatic artery, ductus deferens, seminal gland, ampulla of ductus deferens, ejaculatory duct.
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Which structure does the prostate surround?
prostatic urethra
What portion of the prostate is glandular? What portion is fibromuscular?
2/3 glandular
1/3 fibromuscular
What does the fibrous capsule of the prostate contain?
venus plexus and nervous plexus
Which structure is the base of the prostate related to?
neck of the bladder
Which structure is the apex of the prostate in contact with?
the fascia on the superior aspect of the urethral sphincter
What is the anterior surface of the prostate composed of and which structure does it form a apart of?
anterior surface is composed of muscle fibers forming a rhabdosphincter which is a part of the urethra sphincter
Which structure is the posterior surface of the prostate related to?
furrow, which is caused by the ampulla of the rectum
Where is the isthmus located and which structure is it a superior continuation of?
- located anterior to the prostatic urethra in the anterior muscle zone
- superior continuation of the urethral sphincter
How many lobes and lobules is the prostate divided into?
- 4 lobes
- lateral
- medial
- anterior
- posterior
- 4 lobules
- inferoposterior
- inferolateral
- superomedial
- anteromedial
How are the lobules defined?
by their relationship to the urethra and ejaculatory ducts
Which lobule is palpated on the digital rectal exam and therefore, screened for prostate cancer?
inferior posterior lobule
What is the relationship of the inferoposterior lobule to the urethra and the ejaculatory ducts?
- posterior to uretrha
- inferior to ejaculatory ducts
Which lobule forms the major part of the prostate?
inferolateral lobule
What is the relationship of the inferolateral lobule to the urethra?
lateral to the urethra
Which lobule surrounds the ejaculatory duct?
superior medial lobule
Which lobule is deep to the inferoposterior lobule?
superomedial
Which lobule is lateral to the proximal prostatic urethra?
anteromedial
Which lobule is deep to the inferolateral lobule?
anteromedial
Which lobules make up the median lobe?
- superior medial lobule
- anterior medial lobule
Which lobe undergoes hormone-induced hypertrophy in advanced age?
median lobe
Which lobe is reponsible for the uvula which projects into the internal urethral orifice?
median lobe
Where and into which structure do the prostatic ducts open into?
prostatic sinus recieves opening of prostatic ducts
Where is the seminal colliculus found?
ridge near the seminal vesicle
Which percent of semen comes from postatic fluid?
15-30%
Which arteries supply the prostate?
- inferior vesical arteries (most common variant)
- internal pudendal artery
- middle rectal artery
Prostatic arteries are branches of which artery?
internal iliac artery
What are the two possible pathways of venous drainage to the prostate?
- prostatic venous plexus draining into the internal iliac veins
- prostatic veous plexus draining into the internal vertebral venous plexus
What are the nodes that lymph from the prostate drains into?
- internal iliac lymph nodes (mostly)
- sacral lymph nodes (sometimes)
What is the landmark close to the seminal glands?
seminal colliculus
Identify the flowing on a diagram of the prostate gland: isthmus of prostate, inferolateral lobe, prostatic urethra, anteromedial lobule, superomedial lobule, inferoposterior lobuke, apex of prostate, external urethral sphincter, prostatic venous plexus, prostatic capsule, anterior muscular zone, prostatic urethra, seminal colliculus, prostatic sinus, peripheral zone, ejaculatory duct, prostatic utricle, central zone of prostate, anterior wall of rectum, rectum.
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What structure are the bulbo-urethral glands close to and what is their relationship?
- intermediate urethra
- lies posterior lateral to the intermediate urethra
The bulbo-urethral glands are embedded within which structure?
external urethral sphincter
The ducts of the bulbo-urethral glands open into which structure?
proximal part of the spongy urethra
Which proportion of semen comes from the bulo-urethral glands?
1%
Identify on a diagram the following structures: uvula, internal urethral orifice, internal urethral sphincter, opening of prostatic utricle, opening of ejaculatory duct, seminal colliculus, openings of prostatic ducts, urethral crest, bulbo-urethral gland, intermediate part of urethra.
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Describe the sympathetic innervation of the male reproductive organs.
sympathetic trunk (L1, L2) –> lumbar splanchnic nerves –> superior/inferior hypogastric plexuses
Describe the parasympathetic innervations of the male reproductive organs
S2, S3, S4 –> pelvic splanchnic nerve –> inferior hypogastric and prostate plexus
What is the sympathetic function? What is the parasympathetic function of the male reproductive organs?
sympathetic = ejaculation
parasympathetic = erection
Identify on a diagram the following structures: sympathetic ganglion and trunk, aortic (intermesenteric plexus), lumbar splanchnic nerves, superior hypogastric plexus, sacral splanchnic nerves, left hypogastric nerve, pelvic splanchnic nerves, inferior hypogastric plexus, prostatic (pelvic) plexus, testicular plexus.
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Label the diagram.
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List 2 structures associated with the intermediate urethra.
- external urethral sphincter
- bulbo-urethral glannds
Which lobule forms the major part of the prostate?
inferior lateral lobule
Which lobule surrounds the ejaculatory duct?
superiomedial lobule
Which lobe is responsible for the uvula?
median lobe
Which node does the inferior seminal gland drain into?
internal iliac lymph node
Which structures does the vagina extend to and from?
from the posterior fornix (horn) to the vestibule of the vagina (entrance)
What does the vestibule contain?
both vagina and external urethral orfices and the opening of the two greater vestibular glands
Which structure is found at the superior end of the vagina?
cervix
What is the term for the recess around the protruding cervix?
vaginal fornix
What are the parts of the fornix? Which is the deepest and related to the recto-uterine pouch?
- anterior
- posterior –> deepeset and related to recto-uterine pouch
- lateral
What are the four muscles which compress the vagina and act like sphincters?
- pubovaginallis
- external urethral sphincter
- urethrovaginal sphincter
- bulbospongiosus
Which vessels supply which parts of the vagina?
- superior part is supplied by branches of the uterine arteries
- middle/inferior part is supplied by the vaginal artery and the internal pudendal artery
Describe the venous drainage of the vagina.
vaginal venous plexus –> uterine venous plexus –> uterovaginal plexus –> uterine vein –> internal iliac vein
Which parts of the vagina drain into which lymph nodes?
- superior = internal and external iliac lymph nodes
- middle = internal iliacy lymph nodes
- inferior = sacral and common iliac lymph nodes
- external orfice = superficial inguinal lymph nodes
What is the normal position of the uterus?
anteverted and anteflexed
What is the rounded part of the uterus called?
fundus
What are the two parts of the cervis and where are they found?
- supravaginal part between isthmus and the vagina
- vaginal part that protrudes into the vagina and surrounds the external os of the uterus
What are the three layers of the wall of the uterus? Which one is the outer serous coat? Which one is the muscular coat? Which one is the inner mucous coat? Which one contains blood vessels and nerves?
- Three layers
- perimetrium = outer serous coat
- myometrium = muscular coat
- contains blood vessels and nerves
- endometrium = inner mucous coat
What is the attachment of the ligament of the ovary?
posterior inferior to the utero-tubal junction
What is the attachment of the round ligament of the uterus?
anterior inferior to the utero-tubal junction
Describe the broad ligament of the uterus and where it extends to and from. What is the superolateral projection of the broad ligament?
- “vacuum sealing” the reproductive organs
- double layer of peritoneum
- extends from sides of uterus to the lateral walls and floor of the pelvis
In which ligament are the ovarian vessels found?
broad ligament
In which part of the broad ligament is the ovary suspended?
mesovarium
In which part of the broad ligament is the mesentery of the uterine tube found?
mesosalpinx
In which part of the broad ligament is the mesentery for the uterus found?
mesometrium
Which arteries drain the uterus?
uterine arteries
ovarian arteries
Which veins drain the uterine venous plexus and into which vein do they drain into?
- uterine veins run in the broad ligament into the uterine venous plexus
- uterine venous plexus drains into the internal iliac veins
Which parts of the uterus drain into which lymph nodes?
- fundus = lumbar aortic lymph nodes
- body = external iliac lymph nodes
- cervix = internal iliac lymph nodes
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Describe the innervation of the inferior vagina.
- somatic innervation
- deep perineal nerve which is a branch of the pudendal nerve
Describe the innervation of the rest of the vagina and uterus
visceral innervation
uterovaginal plexus which travels along the uterine artery
Describe the sympathetic innervations of the superior vagina and uterus
inferior thoracic spinal segments –> lumbar splanchnic nerve –> intermesenteric-hypogastric-pelvic plexus
Describe the parasympathetic innervations of the vagina and uterus.
S2, S3, S4 –> pelvic splanchnic nerve –> inferior hypogastric/uterovaginal plexus
Identify on a diagram the following structures: cervix, labium minus, internal os, cervical canal, external os, fornix of vagina, vaginal orifice, vestibule of vagina.
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Identify on a diagram the following structures: bulbospongiosus, uretrhovaginal sphincter, pubovaginalis, bulbospongiosus, urethrovaginal sphincter.
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What is the name of the funnel-shaped distal end of the uterine tube?
infundibulum
What is the name of the finger-like process of the infundibulum?
fimbriae
What is attached to the superior aspect of the ovary?
one large ovarian fimbriae
What is the widest and longest part of the uterine tube?
ampulla
Which three structures hold the ovary in place?
- mesovarium
- ligament of the ovary
- suspensory ligament of the ovary
What is the posterosuperior aspect of the broad ligament?
mesovarium
Where does the suspensory ligament attach?
pelvic wall
Which ligament conveys the ovarian vessels, lymphatics and nerves.
suspensory ligament
Which ligament attaches the ovary to the uterus?
ligament of the ovary
What is the blood supply of the ovaries?
ovarian arteries
What is the course of ovarian arteries?
the ovarian artery gives a branch to the ovary and a branch to the uterine tube before ending up in the suspensory ligament and supplying the ovary
Prior to entering the suspensory ligament, which recieve branches from the ovarian artery?
the ovarian artery gives a branch to the ovary and a branch to the uterine tube before ending up in the suspensory ligament and supplying the ovary
Describe the venous drainage of veins including where the right and left veins drain.
pampiniform plexus of veins within broad ligament –> ovarian veins –> (right) ovarian vein to the ICV or (left) ovarian vein to the renal vein
Where is the pampiniform plexus of veins located?
broad ligament
Describe the drainage of the uterine tubes.
paminiform plexus of veins within broad ligament –> ovarian veins –> (right) ovarian ven to the ICV or (left) ovarian vein to the renal vein
Describe the innervation of the uterine tubes
- retrograde
- sympathetic fibers of the ovairan plexus –> lumbar splanchnic nerve –> T11, L1
- parasympathetic fibers –> uterine/inferior hypogastric plexus –> pelvic splachnic nerve –> S2, S3, S4
Identify on a diagram the following structures: ampulla, infundibulum, fimbriae, uterine artery, vaginal artery, pudendal artery, uterine venous plexus, vaginal venous plexus, pudendal vein.
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Identify on a diagram the following structures: fundus, uterine horn, body, isthmus, cervix and its parts, uterine tube, uterine cavity, myometrium, endometrium, internal os, cervical canal, fornix of vagina, external os, vagina.
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Identify on a diagram the following structures: suspensory ligament, round ligament, broad ligament, ampulla, indundibulum, fimbriae, mesosalpinx, ovary, mesovarium, mesometrium, uterine artery, ovarian artery.
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Identify on a diagram the following structures: sympathetic ganglion and trunk, lumbar splanchnic nerve, superior mesenteric plexus, left hypogastric nerve, sacral splanchnic nerve, pelvic splanchnic nerve, inferior hypogastric plexus, uterine plexus, vaginal plexus, aortic (intermesenteric) plexus, ovarian plexus.
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Label
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What is the renal artery a branch of?
abdominal aorta
What is the ovarian artery a branch of?
abdominal aorta, just below the renal artery
List the branches of the ovarian artery and indicate what they supply.
- branch through the mesovarium to the ovary
- branch through the mesosalpinx to the uterine tube
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List the branches of the internal iliac artery.
- uterine artery
- superior vesical artery
- inferior vesical artery
- internal pudendal artery
- middle rectal artery
List the structures supplied by the uterine artery.
uterus
ureter in females
List the structures supplied by the superior vesicle artery
superior bladder
ureter
List the structures supplied by the inferior vesical artery
inferior bladder
ductus deferens
prostate
ureter in males
seminal glands
ejaculatory duct
prostatic urethra
List the structures supplied by the internal pudendal artery
prostate
intermediate urethra
spongy urethra
List the structures supplied by the middle rectal artery
rectum
seminal vesicle
vagina
prostate
prostatic urethra
List the structures supplied by the vaginal artery
- lower part of vagina
- vestibular bulb
- rectum
- fundus of bladder
Draw a diagram of the lumbar splanchnic nerve. Indicate the vertebral levels which provide the presynaptic fibers as well as the ganglia that it supplies and finally, the structures supplied by the ganglia.
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Which ganglia are supplied by the lumbar splanchnic nerve?
inferior mesenteric ganglia
The postsynaptic fibers of the inferior hypogastric plexus run along which artery?
internal iliac artery
Which structures are supplied by the prostate plexus?
- prostate
- seminal glands
- penis
- urethra
Draw a diagram of the pelvic splanchnic nerves. Indicate the vertebral levels which provide the presynaptic fibers as well as the ganglia that it supplies and finally, the structures supplied by the ganglia.
Do the pelvic splanchnic nerves carry parasympathetic or sympathetic fibers?
parasympathetic
Draw a diagram of the plexuses supplied by the inferior hypogastric plexus and indicate the structures that are supplied.
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List the plexuses supplied by the inferior hypogastric plexus and list the structures that are supplied.
- vesicle plexus
- fundus
- bladder
- prostatic plexus
- seminal glands
- prostate
- penis
- urethra
- uterovaginal plexus
- uterus
- vagina
- uterine artery
- ovarian plexus
- ovaries
- uterus
The position of the ureter in relation to the internal iliac artery
anterior and parallel
The direction of the ureters move through the muscular wall of the bladder
inferiomedially
The blood vessel which most commonly supplies the ureter in females
uterine artery
The blood vessel which most commonly supplies the ureter in males
inferior vesicle artery
The ligament which attaches to the apex of the bladder
median umbilical ligament
The sphincter in males which contracts to prevent retrograde ejaculation of semen into the bladder
internal urethral sphincter
The part of the bladder where the ureteric orfices and the internal urethral orfice are located
trigone
In males, the inferior part of the bladder is supplied by this artery
inferior vesicle artery
In females, the inferior part of the bladder is supplied by this artery
vaginal artery
This blood vessel supplies the intermediate and spongy urethra in males
internal pudendal artery
This is where sperm are made
seminiferous tubules
This is where sperm is stored
epididymis
The lymph from the ductus deferns drains into
external iliac lymph nodes
THe lymph from the superior seminal gland drains here
external iliac lymph nodes
The lymph from the inferior seminal glands drains into the
internal iliac lymph nodes
Lymph from the middle part of the vagina drains here
internal iliac lymph nodes
These blood vessels supply the superior part of the vagina
branches of the uterine arteries
Venous drainage of the uterus ultimately ends here
internal iliac vein
Venous drainage of the ovary begins here
pampiniform plexus
The part of the broad ligament forming the mesentery of the uterine tube
mesosalpinx