Pelvic floor and genital organs Flashcards
Which 3 muscles form the pelvic floor?
- Levator ani
- Ischiococcygeus / coccygeus
- External anal sphincter
What are the 3 parts of the levator ani?
iliococcygeus, pubococcygeus, puborectal
What innervates the levator ani?
Pudendal nerve, anterior rami of spinal nerves S2-S4
What are the 3 parts of the external anal sphincter?
subcutaneous, superficial, deep
What innervates the external anal sphincter?
pudendal nerve, anterior rami of spinal nerves S3-S4
Which umbilical ligament is a remnant of umbilical arteries?
The medial umbilical ligaments
What forms the perineal region?
the urogenital triangle anteriorly and the anal triangle posteriorly
What are the contents of the urogenital trigone in men? (5)
- Paired crus of penis
- Paired ischiocavernosus
- Unpaired bulb of penis
- Unpaired bulbospongiosus
- Paired bulbourethral glands of Cowper
What are the contents of urogenital trigone in women?
- Paired crus of clitoris
- Paired ischiocavernosus
- Paired bulb of vestibule
- Paired bulbospongiosis
- Paired vestibular glands of Bartholin
What is the peritoneal relation of the bladder?
sub peritoneal
What triggers the contraction of the detrusor muscle?
The sacral parasympathetic fibers, which are activated when there is increased tension in the bladder wall
Where is the apex of the bladder when empty / when full
When empty : right behind the pubic symphysis
When full : above pubic symphysis
What is the median umbilical ligament? What is it a remnant of?
ligament extending from the apex of the bladder to umbilicus. It’s a remnant of the urachus (allantois)
What is the trigone of the bladder?
triangle formed by the 2 ureteric orifices and urethral orifice. Its mucosa is not folded.
What is the trigonal area of Pawlik?
the projection of the trigone of the bladder on the anterior wall of the vagina
What is the fold between the ureteric orifices?
Interureteric crest
What is the retrotrigonal fossa?
hollow space between the interureteric crest
What is the retropubic space? What is another name for it?
Space between bladder (peritoneum) and pubic symphysis (transversalis fascia). It’s also called the space of Retzius
What is the vesicoumbilical fascia of Delbet?
A triangular fascia located between the medial umbilical ligaments and median umbilical ligament. It can contain the bladder in its full state.
What pouches does the peritoneum form nea rthe bladder in females and males?
Females : vesicouterine pouch
Males : rectovesical pouch of Proust
What structure can we find between the rectum / bladder or vagina / bladder?
- Retrovesical space of Denonvilliers in males (CT plate)
- Vesicovaginal septum in females (CT plate)
What is sphincter vesicae and its innervation?
single layer of smooth muscle around the neck of the bladder. Sympathetic innervation
What are the trigonal muscles?
Smooth muscle located in the vesical trigone that can control open / closure of the orifices
What are the muscles surrounding the urethra?
Internal urethral sphincter - smooth muscle
External urethral spincter - skeletal muscle
Which arteries supply the bladder? (3+)
- Superior vesical arteries (from umbilical)
- Inferior vesical arteries (from internal iliac)
- Vesical branches of obturator uterine, inferior gluteal and vaginal arteries
Which veins drain the bladder?
- Vesical plexus to vesical veins to iliac vein
- Connection to the pudendal plexus of Santorini
What is the parasympathetic, sensory, motor and sympathetic innervation of the bladder?
Sympathetic : vesical plexus
Parasympathetic, sensory, motor : sacra nerves L2 - S2
What are the parts of the female urethra? (3)
- Intramural
- Pelvic
- Perineal
What are the parts of the male urethra? (4)
- Intramural
- Prostatic (seminal collicle and ejaculatory ducts)
- Membranous / intermediate
- Spongy
What is the ampulla urethra?
dilated segment of spongy urethra for opening of bulbuurethral glands
What is the navicular fossa of urethra?
dilated final segment of the urethra
What is the ischioanal / ischiorectal fossa?
a paired space filled with adipose tissue surrounding the anus. They communicate dorsally.
What are the contents of the ischiorectal / ischioanal fossa? (2)
- pudendal canal of alcock (internal pudendal av and pudendal nerve)
- fat body of ischioanal fossa
At which week is the sec of the fetus determined?
At week 7
What are the boundaries of the ischiorectal / ischioanal fossa?
Mediocranially : external anal sphincter
Laterally : ischial tuberosity and obturator fascia
Dorsally : gluteus maximus, sacrotuberous ligament
Caudally : anal triangle
What is the capsule of the testis?
tunica albuginea : dense CT, forms mediastinum of testis
What is the internal structure of the testis?
- Lobules separated by septa of testis (derived from tunica albuginea)
What is the mediastinum of the testis?
area close to the hilum filled with CT where the rete testis coalesce
What is the arterial supply of the testis?
- Testicular artery (from aorta)
- Artery to ductus deferens (from internal iliac)
- Cremasteric artery (from inferior epigastric)
What is the venous drainage of the testis?
- Pampiniform plexus to testicular veins
- Testicular veins to ICV (right) and to L renal vein i
At what month do testis start descending?
3rd month
How many efferent ductules are there in the epididymis?
8-12
Where do the spermatozoa mature?
duct of epididymis
What does ductus deferens connect?
duct of epididymis with prostatic urethra
What are the 6 parts of ductus deferens?
- Scrotal part
- Funicular part
- Inguinal part
- Pelvic part
- Ampulla
- Ejaculatory duct
What are the 7 contents of the spermatic cord?
- ductus deferens
- testicular artery
- pampiniform plexus
- testicular plexus
- deferential plexus (sensory nervous plexus of ductus deferens)
- Lymph vessels to lumbar lymph nodes
- vestige of processes vaginalis - remnant of peritoneal fold
What are the 3 coverings of the spermatic cord?
- External spermatic fascia
- Cremaster (sk muscle)
- Internal spermatic fascia
What does the scrotum contain?
testis, epididymis, part of ductus deferens
What are the 7 layers of the scrotum and their derivatives?
- Skin
- Dartos muscle - smooth muscle
- External spermatic fascia - external oblique muscle
- Cremaster - Internal oblique muscle
- Internal spermatic fascia - transversalis fascia
- Tunica vaginalis : parietal layer - parietal peritoneum
- Tunica vaginalis : visceral layer - visceral peritoneum
Innervation of scrotum
motor : genital branch of genitofemoral nerve
What joins to form the ejaculatory duct?
excretory duct of seminal gland and ductus deferens
What arteries (3) supply the seminal glands?
- Artery to ductus deferens
- Inferior vesical artery
- Middle rectal artery
What is the symp and parasymp innervation of the seminal glands?
prostatic plexus
Where do the bulbourethral glands empty?
In the ampulla of urethra
What produces the ejaculate fluid?
30% prostate 70% seminal glands
What is the prostatic capsule composed of? What can we find between the layers?
- Capsule (2 layers, fibromuscular)
- Periprostatic capsule - visceral pelvic fascia
- we can find the prostatic venous plexus in the layers
What are the 3 main zones of the prostate?
- Peripheral zone (inferoposterior)
- Central zone (superomedial)
- Transitional zone (anteromedial)
What is special with the peripheral zone of the prostate?
It is rich in glands
What is special about the central zone of the prostate?
it is around the openings of ejaculatory duct and prostatic utricle
What are the arteries that supply the prostate?
- Prostatic branches of inferior vesical artery
- Middle rectal
What is the root of the penis composed of?
2 crura : paired internal part of cavernous body
What is the bulb of the penis?
Unpaired dilated part of the spongy body
What is the raphe of the penis a remnant of?
Remnant of the genital / labioscrotal swellings
What attaches the penis to the pubic symphesis?
Suspensory ligament of penis
What is the corona of glans penis?
the dilated rim
What lines the cavities of the corpus cavernosum?
fenestrated endothelium
What separates the 2 corpus cavernosum?
septum penis
Which arteries supply the penis?
- Internal pudendal artery
- Dorsal artery of penis : skin, glans of penis, foreskin
- Deep artery of penis (corpus cavernosum, helicine arteries)
- Artery of bulb of penis
- Urethral artery (corpus spongiosum)
Somatosensory innervation of penis
ilioinguinal nerve + dorsal nerve of penis (from pudendal)
What system triggers ejaculation?
Sympathetic system
What system triggers erection?
Parasympathetic system
Which muscles contract to eject semen out of the urethra?
bulbospongiosus and ischiocavernosus
What is mesovarium?
peritoneal fold of the ovary, attaches to posterior aspect of broad ligament of uterus at Farre’s line
What is the suspensory ligament of ovary?
Its attachment to lateral pelvic wall
What does the suspensory ligament of ovary contain?
- Ovarian artery and veins
- Ovarian nerve plexus
- Lymphatic vessels
What is the role of the ovarian ligament proper?
attach ovary to uterine horns
What does the ovarian ligament proper contain?
- ovarian branch of uterine artery and vein
- lymphatic vessels
What is the arterial supply of the ovary?
- Ovarian artery
2. Ovarian branch of uterine artery
What is the venous drainage of the ovary?
- Left ovarian vein -> left renal vein
2. Right ovarian vein -> IVC
What is the mesosalpinx?
peritoneal fold of the uterine tube, cranial part of broad ligament of uterus
What does the mesosalpinx contain?
it contains arterial anastomosis (ovarian arcade) between tubal branch of ovarian artery and ovarian branch of uterine artery
What is the lining of the mucosa of the uterine tube?
simple columnar ciliated epithelium
How is the muscular layer of the uterine tube organized?
Inner circular, outer longitudinal
What is the arterial supply of the uterine tube?
Lateral 1/3 : tubal branch of ovarian artery
Medial 2/3 : tubal branch of uterine artery
What are the 4 layers of the uterus?
- Endometrium
- Myometrium (4 layers)
- Perimetrium
- Parametrium
What is the lining of the endometrium?
simple columnar epithelium with goblet cells and ciliated cells
What are the 3 layers of the endometrium?
Basal layer (deepest layer)
Functional layer
Compact (superficial) layer
What does the basal layer of the endometrium contain?
It contains the basal parts of endometrial glands. It doesn’t change during the cycle
What does the functional layer of the endometrium contain?
Uterine glands, widest layer, undergoes cyclic changes
What does the compact layer of the endometrium contain?
contains the duct of the uterine glands
What is the perimetrium?
serous coat of uterus continuous with peritoneum of broad ligament of uterus
What are the angles of the uterus?
- Anti flexion : cervical axis and body axis are at 160-170°
- Anteversion : body of uterus and axis of vagina form an angle of 70-100°
What are the 3 parts of the broad ligament of the uterus?
- Mesovarium
- Mesosalpinx
- Mesometrium
What is the arterial supply of the uterus?
Uterine artery from internal iliac
What is the arterial supply of the vagina?
- vaginal artery from internal iliac or from uterine artery
- vaginal branches from uterine, middle rectal and internal pudendal arteries
What does the vestibule contain?
external openings of vagina, urethra, and paired accessory glands
What is Bartholin’s gland?
greater vestibular gland, paired mucous gland in the perineal membrane
What is the bulb of the vestibule?
pair of female erectile bodies located around vestibule
What is the vascular supply of the external female genitalia?
- Anterior labial branches from external pudendal (from femoral)
- Posterior labial branches, deep artery of clitoris, artery of bulb of vestibule, from internal pudendal (from internal iliac)
What innervates the external female genitalia?
Ilioinguinal nerve, genitofemoral nerve, pudendal nerve
Which of the following parts contribute to the development of the penis?
a. genital folds
b. perineal body
c. genital tubercle
d. Cowper’s glands
e. Labioscrotal swelling
genital folds and genital tubercle
