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.
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?
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.
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.
On a diagram of the female bladder identify the following structures: ureter, retropubic space, pubovesical ligament, bladder, rectum, fundus of bladder, apex of 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.
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.
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.
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.
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.
Label the blood supply of the ureters.
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.
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.
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