S1) The Man Flashcards by Nick Harding

Label the following structures in the male reproductive system:

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What are Sertoli cells?

Sertoli cells are the somatic cells of the testis that are essential for testis formation and spermatogenesis

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Where are Sertoli cells found?

Found in the seminiferous tubule

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What are Leydig cells and what do they do?

Leydig cells are interstitial cells of Leydig, are found adjacent to the seminiferous tubules in the testicle.
Produce testosterone in the presence of LH

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In three steps, explain what happens during testicular torsion

⇒ The spermatic cord twist upon itself

⇒ This occludes the blood supply (testicular artery)

⇒ Pressure builds up and necrosis of testis results

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Can testicles swap sides?

No, as a scrotal septum separates the two testicles

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Describe the process in which the testes push through the abdominal wall

The testes evaginate the abdominal wall as they are pulled through by the gubernaculum
This forms the spermatic fascia (made of layers of abdominal muscle)

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What are the three fascial layers in the spermatic cord?

Internal fascia
Cremasteric fascia
External fascia

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Identify the three arteries supplying the spermatic cord

Testicular artery
Artery to vas
Cremasteric artery

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Identify the three veins draining the spermatic cord

Testicular vein
Vein to vas
Cremasteric vein

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Identify the three nerves innervating the spermatic cord

Ilioinguinal nerve
Nerve to cremaster (genital branch of genitofemoral nerve)
Sympathetic

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What happens during a vasectomy?

Vas deferens are sectioned
Sealed/tied to prevent sperm from entering into the urethra
Prevents fertilisation

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What are the consequences to the sperm count after a vasectomy?

Sperm count reduces

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What are the consequences to the composition of the ejaculate after a vasectomy?

No visible difference
Semen is made in accesory glands and sperm only composes 2-5%

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Which nerve is responsible for the cremasteric reflex?

Muscular reflex of genitofemoral nerve in males

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What does the prostate do?

Maintains urinary continence (surrounds urethra)
Creates an alkali secretion
Propels seminal fluid into urethra during ejaculation

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Which zones in the prostate does cancer and BPH affect?

- Benign prostatic hyperplasia affects transitional zone

Prostate cancers tend to be in peripheral zone

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What are the functions of the penis?

Expulsion of urine via urethra
Deposition of sperm in female genital tract

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Describe the processes that guide erection

Vasodilatation in penile arterioles, and compression of veins results in erection (parasympathetic)
Erection is terminated by vasoconstriction (sympathetic)

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Which nervous system orchestrates ejaculation?

Ejaculation is a complex process primarily orchestrated by the sympathetic system

Which artery is the main blood supply to the penis?

Pudendal artery

On the following figure of the testis, identify:

Pampiniform plexus of veins
Testicular artery
Vas deferens
Epididymis
Seminiferous tubules

Where is the origin of the testicular arteries?

Branch of abdominal aorta, inferior to renal arteries

Describe the venous drainage of the right and left testis

Right testis: inferior vena cava
Left testis: renal vein

Discriminate between the lymphatic drainage of the scrotum and that of the testis

- **Scrotum** – drains into inguinal lymph nodes - **Testes** – drains into para-aortic lymph nodes

What is the cremasteric reflex?

- The **cremasteric reflex** can be stimulated by stroking the superior and medial part of the thigh - Produces immediate contraction of the cremaster muscle, elevating the testis to the side that has been stimulated

From which layers of the anterior abdominal wall are the fascial coverings of the spermatic cord derived?

- External oblique muscle - Internal oblique muscle - Transversus abdominis muscle

On the diagram below, label: - The vas deferens - The spermatic cord - External spermatic fascia - Cremaster muscle - Cremasteric fascia - Internal spermatic fascia - Tunica vaginalis

What are the contents of the spermatic cord?

- **N**erve to cremaster (genital branch of genitofemoral nerve) - **A**rtery & vein to vas deferens - **P**ampiniform plexus of testicular veins - **S**ympathetic nerve - **C**remasteric artery and vein - **I**lioinguinal (on the outside, in superficial to external spermatic fascia) - **T**unica vaginalis - **T**esticular artery & vein - **L**ymph vessels - **V**as deferens ***Mnemonic: Not All People Steal Cookies In The Teacher's Lovely Van***

Which structures of the male reproductive system have smooth muscle that contract in peristaltic waves during emission?

- Seminal vesicles - Prostate - Vas deferens

Identify the three accessory glands of the male reproductive system

- Seminal vesicles - Bulbourethral gland - Prostate gland

Describe the contents of the seminal vesicle secretions as well as its overall contribution to the seminal fluid

- Secretions contain alkali, fructose, prostaglandins and clotting factors - Compose 70% of total semen volume

Describe the contents of the bulbourethral gland secretions and its overall function

- Produces an alkali-rich mucous fluid - Neutralises residual acidity in male urethra

Describe the contents of prostate gland secretions and its contribution to the overall volume of seminal fluid

- Secretions contain proteolytic enzymes - Contributes to 25% of seminal fluid

What is the usual size of the prostate?

- Walnut - 2-4 cm

Which part of the prostate gland is felt on rectal examination?

Peripheral zone

Enlargement of which part of the prostate causes urethral obstruction?

Transitional zone

Describe the venous drainage of the prostate gland

- Blood drains via prostatic venous plexus which drains into the internal iliac veins - This connects posteriorly to the vertebral venous plexus

Which part of the urethra is least distensible?

Membranous urethra

Name the erectile tissue in the penis

- Corpora cavernosa - Corpus spongiosum

Identify possible causes of scrotal swelling

- Orchitis - Infections - Hernia - Hydrocoele

Generally, how can one discriminate between a hernia and a testicular swelling?

Hernias change with position

What is a hydrocoele?

**Hydrocoele** is a collection of serous fluid in the tunica vaginalis

What is a haematocoele?

**Haematocoele** is a collection of blood in the tunica vaginalis

How can one distinguish between a haematocoele and a hydrocoele?

- Transillumination (light is applied to testicular swelling) - Due to dense nature of blood, light is unable to pass through

What is a varicocoele?

**Varicocoele** is the gross dilation of veins draining the testes

Why is the left testicle commonly affected in varicocoele?

- Left testicular vein drains into the left renal vein at a 90^o angle - Renal vein is smaller than IVC and there is no valve, building up pressure

What does a varicocoele look and feel like upon palpation?

A bag of worms