Repro: The Male Reproductive Tract

Question 1

What are the contents of the scrotum?

Answer 1

The testis, epididymis and first part of the spermatic cord

Question 2

What is the tunica vaginalis?

Answer 2

A double layer of peritoneum surrounding the testis. It is derived from the processus vaginalis

Question 3

What is the blood supply of the testis?

Answer 3

The testicular artery which branches directly off the abdominal aorta

Drained by the right testicular vein which drains into the IVC, and the left testicular vein which drains into the renal vein

Question 4

What is the anatomical course of the spermatic cord?

Answer 4

The spermatic cord is formed at the deep inguinal ring, passes through the inguinal canal and enters the scrotum through the superficial inguinal ring.

In the scrotum it ends at the posterior border and disperses to supply the various structures of the testis

Question 5

What are the fascial coverings of the spermatic cord?

What are they derived from?

Answer 5

External spermatic fascia (derived from the aponeurosis of the external oblique)

Cremaster muscle and fascia (derived from internal oblique and its fascia)

Internal spermatic fascia (derived from tranversalis fascia)

Question 6

What are the contents of the spermatic cord?

Answer 6

• testicular artery
• cremasteric artery and vein
• artery to vas deferens
• pampiniform plexus
• genital branch of genitofemoral nerve
• vas deferens
• lymph vessels
• processus vaginalis
• autonomic nerves

Question 7

What is the configuration of the pampiniform plexus?

Why is this important?

Answer 7

The pampiniform plexus is wrapped around the testicular artery

This acts as a heat exchanger by absorbing some of the heat from the testicular artery before it enters the testis - so they keep cool

Question 8

What is hydrocoele?

Answer 8

A collection of serous fluid in the tunica vaginalis - most commonly caused by failure of the processus vaginalis to close

Question 9

What is haematocoele?

Answer 9

A collection of blood in the tunica vaginalis - most commonly caused by trauma

Question 10

How can you differentiate between hydrocoele and haematocoele?

Answer 10

Transillumination - light is shone onto the scrotal swelling, if its blood then the light will be unable to pass through.

Question 11

What is varicocoele?

Answer 11

Dilation of the testicular veins - the left testicle is most likely to be affected as the left testicular vein is draining into a smaller vein than the right

Question 12

What is testicular torsion?

Answer 12

A medical emergency where the spermatic cord twists on itself - this can occlude the testicular artery and cause necrosis of the testis.

Question 13

What are the 2 types of erectile tissue in the penis?

Answer 13

Anteriorly there are 2 masses of corpus cavernosa and posteriorly there is a band of corpus spongiosum (which the urethra runs through)

Question 14

What are the muscles at the root of the penis?

Answer 14

2 x bulbospongiosus muscles which are associated with the bulb of the penis.

• contract to empty the spongy urethra of residual urine and semen
• anterior fibres aid maintaining an erection

2 x ischiocavernosus muscles which surround the left and right crura
- contract to force blood from the cavernous spaces to the corpus cavernosum to maintain an erection

Question 15

What are the 2 coverings of the testis?

Answer 15

The tunica vaginalis covers the anterior surface of each testicle

The tunica albuginea is a fibrous capsule that encloses the testis and penetrates into the parenchyma to diving the testicle into lobules

Question 16

Which will present first, benign prostatic hyperplasia or prostatic carcinoma?

Answer 16

Benign prostatic hyperplasia because this occurs in the transitional zone which surrounds the urethra - therefore will present earlier with urinary symptoms.
Prostatic carcinoma however usually occurs on the periphery so does not produce symptoms until more advanced

Question 17

What is the function of the bulbourethral / cowpers glands?

Answer 17

They secrete a mucus which lubricates and neutralises the urethra for ejaculation

Question 18

Where are the bulbourethral / cowpers glands?

Answer 18

They are located posterolateral to the membranous urethra and superior to the bulb of the penis

Question 19

Where are the seminal vesicles located?

Answer 19

Between the bladder fundus and the rectum

They combine with the vas deferens to form the ejaculatory duct which drains into the prostatic urethra

Question 20

What is the function of the seminal vesicles?

Answer 20

Secrete 70% of the volume of semen

They secrete:

• alkaline fluid to neutralise the urethra and vagina to aid survival of sperm
• fructose to provide energy to sperm
• prostaglandins which suppress the female immune response to foreign semen
• clotting factors to keep in the fame or repro tract post-ejaculation

Question 21

What is the lymphatic drainage of the testis and the scrotum?

Answer 21

The testis drain into paired lumbar and para-aortic nodes at the L1 level (from when they were in the abdomen)

The scrotum drains into nearby superficial inguinal nodes

Question 22

What is the lymphatic drainage of the bulbourethral glands?

Answer 22

The inernal and external iliac lymph nodes

Question 23

What is the lymphatic drainage of the seminal vesicles?

Answer 23

The internal and external iliac lymph nodes

Question 24

What is the cremasteric reflex?

Answer 24

Stroking the superior medial thigh causes contraction of the cremaster muscle which elevates the testis on the same side.

The stroking stimulates the ilioiguinal nerve which activates the genital branch of the genitofemoral nerve.

Question 25

What is the function of the dartos muscle?

Answer 25

It is a smooth muscle layer that causes the scrotal skin to wrinkle when exposed to cold temperatures - this reduces heat loss.

Question 26

Why do carcinomas of the prostate spread readily to the pelvis and vertebrae?

Answer 26

The prostrate drains into the batson venous plexus which connect the deep pelvic veins to the internal vertebral venous plexuses. The veins are valveless so are a route of sread of malignancy.