Pelvic Viscera I Flashcards
Where is the retropubic space in males?
Rectovesicular pouch/fossa?
Retrorectal space?
Between the pubis and bladder
Between bladder and rectum
Between rectum and sacrum
The male parietal peritoneum does not reach the pelvic floor. Where is the lowest point of male parietal peritoneum?
What collects there?
2cm above the seminal vesicles
Abdominal fluid collects there; abscess likely to form
Where is the endopelvic fascia?
What do the thickened areas of the fascia form?
Beneath the peritoneum and covering viscera, pelvic wall and floor; continuous with endoabdominal fascia
Puboprostatic L (male; supports the bladder and prostate) and pubovesical and pubocervical (female)
Lateral ligament of bladder and rectum
What is the cardinal ligament (transverse cervical L)?
What is the paracolpium?
Ligament supporting the cervix
Thickened fascia from lateral vagina to tendinous arch; supports the vagina
Where is the ureter in a male?
Bladder?
Seminal vesicles?
Bulbourethral gland?
Prostate?
Ureter travels under the vas deferens
Bladder is superior to prostate
Seminal vesicles lie on the posterior surface of the bladder
Bulbourethral gland located within UG membrane
Prostate is below bladder but superior to UG membrane
What and where are the ureters?
Where do the ureters run in males vs females?
Connect the kidney to the urinary bladder; retroperitoneal
Pass over the pelvic brim and enter the lesser pelvis
Pass obliquely through urinary bladder wall in an inferomedial direction
Males: run inferior to vas deferens
Females: run inferior to uterine artery
What is the artery and nerve supply to the ureters?
Multiple artery supply: renal, gonadal, aortic, internal iliac branches
Nerves: preaortic plexus, hypogastric plexus (sympathetics), pelvic splanchnics N (parasympathetics)
Where is the bladder and what ligaments support it?
What does the superior surface of the bladder look like?
When does the bladder rise above the pelvic brim?
Apex points toward the pubic symphysis; fundus is opposite; body lies between; neck lies at bottom
Supported by median umbilical L (urachus) which continues to umbilicus
Supported by lateral L (part of endopelvic fascia)
Superior surface is triangular and bounded by a line connecting the ureters
Bladder only rises above pelvic brim when it is full
What are the two male urethral sphincters?
Internal urethral sphincter: circular fibers continuous with detrusor M (smooth m)
External urethral sphincter: skeletal m; located primarily at level of membranous urethra and extends superiorly around prostatic urethra
What lines the interior bladder?
What senses when the area begins to fill with urine?
Detrusor M (smooth m) lines the bladder walls and is continuous with internal urethral sphincter and ureteric sphincters
Sensory stretch receptors in bladder wall and posterior urethra sense when the area begins to fill with urine
What innervates the male urethral sphincters?
Internal urethral sphincter: smooth m (inferior hypogastric plexus); involuntary
External urethral sphincter: skeletal m (deep perineal branch of pudendal N); voluntary
Posterior ridge on the urethra as it passes through the prostate?
Enlarged area on the crest that opens into two ejaculatory ducts?
Remnant of paramesonephric system?
Depressions on either side of the ridge where prostatic glands open and secrete an alkaline prostatic fluid?
Urethral crest
Seminal colliculus: Brings the sperm from the vas deferens and fluid from the seminal vesicle into the urethra
Prostatic utricle
Prostatic sinuses
Where is the prostate? Base? Apex?
What is the prostate made up of?
Where do prostatic ducts open?
Surrounds the prosthetic urethra
Base close to neck of bladder
Apex in contact with fascia on superior aspect of urethral sphincter and deep perineal muscles
2/3 gland; 1/3 fibromuscular tissue (smooth m. so it can contract during ejaculation)
Prostatic ducts open into prostatic sinuses
What is benign hypertrophy of the prostate?
What symptoms does it cause?
How do you detect enlargement and tumors?
Enlargement of the prostate; projects into the urinary bladder and impedes urination by distorting prostatic urethra
Urethral obstruction, nocturia, dysuria, urgency, bladder infections, kidney damage
Digital rectal exam; prostate feels hard and irregular in shape if malignant
Where does the vas deferens enter the abdomen and where does it go?
Comes from the epididymus and enters the abdomen by deep inguinal ring
Passes superior to all structures including ureters and iliac vessels
Passes superiorly and medially to ureter, expanding into an ampulla, before narrowing and joining the duct of the seminal vesicle
Where are the seminal vesicles?
What forms the ejaculatory duct?
What is the vascular supply of the seminal vesicles?
Bilateral, lobulated sacs lying lateral to the ampulla of the vas deferens
Duct of the seminal vesicle and vas deferens join on each side to form ejaculatory duct and enter the prostate
Umbilical and inferior vesicular arteries
What is the innervation of the male reproductive organs?
What is the exception and why?
Sympathetic: T10-L2 inferior hypogastric plexus (similar route as bladder)
Parasympathetic: from pelvic splanchnic nerves
Visceral afferent fibers: travel with parasympathetic fibers from S2-S4
Exception is testis because they started superior and descended -> sympathetic from T10; parasympathetic from vagus N
Where is the lymphatic drainage in the male reproductive system?
Vas deferens and inferior portion of seminal vesicles -> internal iliac nodes
Scrotal portion of vas deferens -> external iliac nodes
Testis -> lumbar LN
Prostate -> internal iliac nodes with some to sacral nodes
Bladder drains into -> external (superiolateral portion) and internal iliac nodes (fundus and neck)
What makes the trigone in the interior bladder?
Outlined by the two openings of the ureters and the exit of the internal urethral orofice
Contains thin, smooth mucosa
What are the parts of the male urethra?
Intramural
Prostatic
Membranous
Spongy
Penile
