Reporductive anatomy

Question 1

What are the branches of the internal iliac artery?

Answer 1

Branches in posterior (has iliolumbar, sacroilial and superior gluteal branch) and anterior (has umbilical, superior vesicle, vaginal, middle rectal, obturator, internal pudendal, inferior vesicle (uterine in female))

Question 2

Which ligament forms the greater and lesser sciatic foramen?

Answer 2

The sacrospinal ligament

Question 3

Which uterine related structure is intraperitoneal?

Answer 3

Fallopian tubes. All others are infraperitoneal as not completely surrounded by peritoneum

Question 4

What is the cardinal ligament?

Answer 4

Connects cervix to lateral pelvic wall. Carries uterine arteries.

Question 5

What is the round ligament?

Answer 5

Remnant of gubernaculum. Runs from near uterine horns to labia majora (through inguinal canal). Can become strained and painful during pregnancy.

Question 6

What is the suspensory ligament?

Answer 6

Peritoneal fold running from abdomainal wall (lateral) to ovary - has ovarian blood vessels.

Question 7

What is the ovarian ligament?

Answer 7

Runs between ovary and uterus

Question 8

What passes through the greater sciatic foreman?

Answer 8

Above piriformis: Superior gluteal A&N
Below piriformis: Internal pudendal N; inferior gluteal A,N,V; ob int. nerve; quad fem. nerve; post.fem.cut nerve; sciatic nerve

Question 9

What passes through the lesser sciatic foramen?

Answer 9

Internal pudendal artery, internal pudendal nerve, obturator internus tendon and nerve.

Question 10

Arterial supply to the scrotum

Answer 10

Anterior supplied by external pudendal artery (from femoral). Posterior supplied by internal pudendal artery

Question 11

Nerve supply to scrotum

Answer 11

Anterior scrotal nerves derived from the genital branch of genitofemoral (L1,L2 also gives upper anterior thigh) and ilioinguinal nerve (L1).Posterior scrotal nerves derived from the perineal branches of the pudendal nerve and posterior femoral cutaneous nerve.

Question 12

Scrotal layers

Answer 12

Some damn Englishman Called it The Testes
Tunica albuginea, tunica vaginalis (=peritoneum), Internal spermatic fascia (internal abdominal fascia), Cremasteric fascia (tranversus abdominus/internal oblique), external spermatic fascia (external abdominal fascia), dartos fascia (scarpas, colles in UG triangle), skin
Cremaster lifts testes, dartos wrinkles skin for temp control

Question 13

Spermatic cord has

Answer 13

-Testicular artery, ductus deferens artery and cremasteric artery
-Internal spermatic fascia, cremasteric fascia and external spermatic fascia
-Genital branch of genitofemoral nerve, sympathetic nerves and ilioinguinal nerve (runs outside)
-ductus deferens, lymphatics and pampiniform plexus
Spermatic cord twists in testicular torsion.

Question 14

Penis layers

Answer 14

-Skin
-Superficial dorsal vein, superficial lateral veins
-Dartos fascia (superficial fascia) - contains muscle helps to contract foreskin
Buck’s fascia (deep fascia)
-Dorsal artery, dorsal nerve, deep dorsal vein
-Tunica albuginea
Corpus spongeosum (with urethra), corpus cavernosum (with deep arteries in each) - corpus spongeosum separated from cavernosum compartment by intercavernous septum of deep fascia.

Question 15

Penis innervation

Answer 15

Neurovascular supply to the penis travels via deep perineal pouch and through pudendal (Alcock’s) canal.
Pudendal nerve (S2-S4) gives off perineal nerve (perineal skin and scrotum) and dorsal nerve of the penis.
Neurovascular bundle runs close to suspensory ligament of the penis.
Parasympathetic nerves enable erection (pelvic splanchnic S2,S3,S4) run to inferior hypogastric plexus, then prostatic plexus and then cavernus nerve,
Sympathetic nervous system for ejaculation - L1,L2, close off internal urethral sphincter, ductus deferens peristalsis, prostate contraction and seminal vesicles contraction as well as contraction of muscle (skeletal) over bulb of penis.

Question 16

Blood supply to penis

Answer 16

Arterial supply is from the internal pudendal artery - gives deep and dorsal penile arteries.
Penile venous drainage is from dorsal (superficial/deep) going to prostatic venous plexus and then internal iliac vein.
Erection involves straightening of helicine arteries - allows blood to fill corpus cavernosum.
Bulbospongiousus and ischiospongeosus muscles compress venous plexus to retain blood in penis.

Question 17

Bulbourethral glands

Answer 17

These are in the deep perineal pouch in the male (but superficial perineal pouch in the female).
Cowper’s glands in males, neutralises urethral for semen passage.
Batholins glands in women

Question 18

Prostate gland blood supply

Answer 18

middle rectal and inferior vesicle arteries (from anterior internal iliac).
Venous blood goes to prostatic venous plexus, then internal iliac veins.

Question 19

Prostate lymph drainage

Answer 19

Internal iliac nodes

Question 20

Prostate secretions

Answer 20

20% of seminal fluid; It contributes to semen production (e.g. zinc, proteolytic enzymes

Question 21

Prostate pathology

Answer 21

Prostate can be divided into zone (peripheral, central and transitional) - transitional zone associated with BPH, peripheral zone with cancer and can be palpated from the rectum.

Question 22

Seminal fluid

Answer 22

Seminal vesicles don’t store spermatazoa, but instead secrete an alkaline fluid (as vaginal pH is slightly acidic and this neutralises it as well as has nutrients (e.g. fructose). This makes up around 75% of semen.

Question 23

Seminal vesicles A,V,L

Answer 23

The blood supply is via the inferior vesical and middle rectal artery, while drainage is via the vesical and prostatic venous plexus.
The lymph drainage is via the internal and external iliac nodes, as well as the sacral nodes.

Question 24

Muscles assisting with erections

Answer 24

Ischiocavernosus (runs from ischium to corpus cavernosus) helps maintain penile and clitoral erections by compressing venous plexus and preventing venous drainage.
Bulbospongiosus covers the bulb of the penis so facilitates emptying urethra during ejaculation and urination (although in the female, the greater vestibular glands are emptied by bulbospongiosus). Also supports the perineal body.

Question 25

Female genitalia innervation

Answer 25

Clitoris is the pudendal nerve (dorsal nerve of the clitoris), anterior vulva (labia majora and mons pubis) is the ilioinguinal. Posterior vulva and inner labia is the pudendal branch (perineal nerve)

Question 26

Female reproductive innervation

Answer 26

Distal 1/5 of vagina of somatic pudendal S2-S4)

Above pelvic pain line, T12-L2 afferents.

Question 27

Levator ani innervation

ischiococcygeus innervation

Answer 27

Leavtor ani is S2-S4

Coccygeus is S4-S5

Question 28

Boundaries of inguinal canal

Answer 28

Roof is: Tranversalis fascia, internal olbique, tranversus abdominus
Posterior wall is transversalis fascia
Floor is lacunar ligament and inguinal ligament
Anterior wall is apeunorosis of internal oblique/external oblique

Question 29

Pelvic plexus

Answer 29

Superior hypogastric plexus has sympathetic L3-L4
Plexus splits into right and left hypogastric nerves
Parasympathetics (s2-S4) join the inferior hypogastric plexi, plus sacral part of sympthatic chain joins

Question 30

Uterine innervation

Answer 30

Sympathetic is T12-L2 (via superior, and then inferior hypogastric plexus)
Parasymathetic is S2-S4 pelvic splachnic, via inferior hypogastric plexus
Visceral afferents follow sympathetic efferent T10-L2

Question 31

Vaginal innervation

Answer 31

upper 2/3 efferent: inferior hyogastric plexus
upper 2/3 autonomic: pelvic splchanic through inferior hypogastric
Lower 1/3 somatic efferents: pudendal (S2-S4)

Question 32

Layers of ovary

Answer 32

Germinal epithelium, tunica albuginea, cortex, then medulla

Question 33

Breast lymphatic drainage

Answer 33

CHAAPS
C - central
H - humeral
A- apical
A-anterior
P-posterior
S-supraclavicular

Question 34

Genitofermoral nerve

Answer 34

Runs in spermatic cord in men, runs in inguinal canal in women

Question 35

Scrotal vs abdominal layers

Answer 35

1) skin - > skin
2) dartos - > scarpas (campers)
3) External spermatic fascia - > external oblique
4) Cremasteric - > internal oblique
5) ——— - > transversus abdominus
6) Internal spermatic fascia - > transversalis fascia
7) Tunica vaginalis - > peritoneum

Question 36

REgion of prostate for BPH?
Region of prostate for Pcancer?
Region of prostate around ejaculatory juct?

Answer 36

BPH is transitional zone
P cancer is in peripheral zone
Centrsal zone surrounds ejaculatory ducts

Question 37

Deep perineal pouch in men?

Answer 37

Has cowper’s glands (bulbourethral gland) - but these secrete into membranous urethra in superficial pouch) as well as external sphincter.

Question 38

Superficial perineal space (urethral damage)

Answer 38

Continuous with scrotum and abdominal wall, so if urethra is damaged then urine can end up in scrotum and abdo wall

Question 39

anatomical course of the ureters

Answer 39

Start retroperitoneal. Runs medial to L2-:5 transverse processes
Runs over psoas major and genitofemoral nerve.

Only structure to pass anterior in pelvic area is uterine artery/ductus deferens.

Question 40

Ischiocavernosus and bulbospongiosus innervation

Answer 40

S2-S4 somatic innervation (as skeletal muscle)

Question 41

Emission innervation

Answer 41

T11-L2 sympathetic.
Also somatic innervation of bulbospongiosus (S2-S4)

Resolution is by sympathetic