Session 1

Question 1

1. What is the internal & external genitalia in the male?
2. Secondary sexual characteristics e.g. in men

Answer 1

1. Internal:

Testes

Epididymis

vas deferens

seminal vesicles

prostate

bulbo-urethral glands

External:

Penis

Scrotum

2. • Larger body size

• Body composition and fat distribution
• Hair and skin
• Facial hair, male pattern baldness
• Central nervous system effects

Question 2

1. Function of the penis
2. Route sperm travel

Answer 2

1. Sexual intercourse:

- Erection (penis engorged with blood)

• Emission (mixing of the components of semen in the prostatic urethra)
• Ejaculation
• Remission (flaccid)

Micturition (males have an IUS & EUS)

2. seminiferous tubules -> straight tubes -> rete testes -> efferent ductules -> epididymis (mature) -> vas deferens -> ejaculatory duct

Question 3

Root

1. How is anatomically related to the pelvic floor?
2. What does it contain?
3. Is it visible externally?

Answer 3

1. located in the superficial perineal pouch of the pelvic floor
2. Three erectile tissues (two crura and bulb of the penis), and two muscles (ischiocavernosus and bulbospongiosus)
3. No

Question 4

1. There are four muscles located in the root of the penis: (name them)
2. What is the function of the bulbospongiosus muscles?
3. What is the fucntion of the Ischiocavernosus?

Answer 4

1. Bulbospongiosus (x2) – associated with the bulb of the penis.
   * *Ischiocavernosus** (x2) – surrounds the left and right crura of the penis.
2. • contracts to empty the spongy urethra of any residual semen and urine
     - anterior fibres also aid in maintaining erection by increasing the pressure in the bulb of the penis
3. It contracts to force blood from the cavernous spaces in the crura into the corpus cavernosa – this helps maintain erection

Question 5

1. State the fascia that covers all three erectile tissues?
2. State the fascia that is deep to the deep fascia and state what is surrounds
3. What part of the NS initiates erection, termination of erection and ejaculation?

Answer 5

1. Deep fascia
2. Tunica albuginea, forming an individual capsule around each cavernous body
3. • Vasodilatation (parasympathetic) in penile arterioles, & compression of veins results in erection
     - Erection is terminated by vasoconstriction (sympathetic)
     - Ejaculation is a complex process primarily orchestrated by the sympathetic system

Question 6

1. How are the collagen fibres of the tunica albuginea of the penis arranged?
2. As the penis changes from a flaccid to an erect state, what happens to the tunica albuginea? Clinical significance.
3. State the layers of fascia of the penis (deep to superficial)

Answer 6

1. right angles to each other (one circumferential, one parallel to the penile long axis)
2. thins, loses elasticity & becomes vulnerable to rupture

Acute bend (i.e. intercourse) -> haematoma -> confined to bucks fascia (penile shaft)

3. Tunica albuginea-> Bucks -> colles

Question 7

1. What two ligaments support the root of the penis
2. What is the prepuce
3. What’s the blood supply to the penis

Answer 7

1. Suspensory ligament – a condensation of deep fascia. It connects the erectile bodies of the penis to the pubic symphysis

Fundiform ligament – a condensation of abdominal subcutaneous tissue. It runs down from the linea alba, surrounding the penis like a sling, and attaching to the pubic symphysis.

2. Foreskin - double layer of skin and fascia, located at the neck of the glans. The prepuce is connected to the skin of the glans by the frenulum, a median fold of skin on the ventral surface of the penis. The potential space between the glans and prepuce is termed the preputial sac.
3. Anterior division of the internal iliac artery
   - > internal pudendal artery
   - > Dorsal arteries of the penis, Deep arteries of the penis & Bulbourethral artery

Question 8

1. What is the venous drainage of the penis?

Answer 8

1. -> cavernous spaces
   - > deep dorsal vein of the penis
   - > prostatic venous plexus

(superficial dorsal veins supply the skin and cutaneous tissues)

Question 9

Answer 9

Question 10

Describe and identify the main anatomical structures of the male reproductive system LO
Testes

1. Located within?
2. Where is the epididymis located in relation to the testes?
3. Which testicle hangs lower?
4. What suspends the testes

Answer 10

1. Scrotum
2. Epididymis situated on the posterolateral aspect.
3. Left
4. Spermatic cord – collection of vessels, nerves and ducts that supply the testes.

Question 11

Testes are located on the posterior abdominal wall. What happens in embryonic development for them to be located in the scrotum?

Answer 11

• Descend down the abdomen
• Through the inguinal canal to reach the scrotum (carry their neurovascular and lymphatic supply)

Question 12

The spermatic cord has three facial layers:

It contains 3 arteries :

It has 3 veins:

It has 3 nerves:

Answer 12

3 facial layers:

1. Internal spermatic fascia 2. Cremasteric fascia 3. External spermatic fascia

3 arteries:

1. Testicular artery 2. Artery to ductus deferens 3. Cremasteric artery

3 veins:

1. pampiniform plexus/testicular vein 2. Vein to the vas 3. Cremasteric vein

3 nerves:

1. Ilioinguinal nerve (outside but alongside the spermatic cord)
2. Nerve to cremasta - responsible for pulling the testes up regulates height of testes (genital branch of genitofemoral)
3. Sympathetic nerves which supply the vas - responsible for ejaculation + Parasympathetic nervous system responsible for an erection

Question 13

1. What are the two coverings of the testes?
2. State the arteriole to the testes
3. State the venous drainage from the testes? Function?
4. How does the drainage of the left and right testicles differ?

Answer 13

1. tunica vaginalis (more superficial), fibrous capsule (penetrates into the parenchyma)
2. Arteriole: AA -> testicular arteries
3. Venous: pampiniform plexus -> testicular artery

cools the testicular artery

4. Left testicular vein -> left renal vein

Right testicular vein -> inferior vena cava

Question 14

1. Embryologically, the scrotum is derived from?
2. What muscle lies within the scrotum & what is its purpose?
3. What does water under the bridge mean in men and women?

Answer 14

1. Genital swelling (labia majora)
2. Except the cremasteric muscle

Dartos muscle: SM, situated immediately underneath the skin.

Scrotal raphe -> regulates temperature

3. Men: the ureter goes under the vas deferens

Women: the ureter moves under the uterine artery

Question 15

1. What supplies the scrotum
2. What drains the scrotum
3. Describe the anatomical course of the spermatic cord

Answer 15

1. Anterior (external pudendal artery) & posterior (internal pudendal artery) scrotal arteries
2. External pudendal vein
3. • Begins in the inferior abdomen -> opening of the inguinal canal i.e. DEEP INGUINAL RING (lateral to inferior epigastric vessels)
     - Ends in the scrotum (enters via the superficial inguinal ring)
     - ends at the posterior border of the testes

Question 16

1. State the fascial layers of the spermatic cord
2. Function of the prostate

Answer 16

1. External spermatic fascia – aponeurosis of the external oblique.

Cremaster muscle and fascia – internal oblique & its fascial coverings.

Internal spermatic fascia – transversalis fascia.

The three fascial layers themselves are covered by a layer of superficial fascia, which lies directly below the scrotal skin.

2. Proteolytic enzymes (breakdown clotting factors - fluid state)

Question 17

The prostate is divided into anatomical lobes (inferoposterior, inferolateral, superomedial, & anteromedial) by the urethra and the ejaculatory ducts as they pass through the organ. However, more important clinically is histological division of the prostate into zones:

Answer 17

Central zone – surrounds the ejaculatory ducts (Derived from wolffian duct)

Transitional zone – located centrally and surrounds the urethra (derived from the urogenital sinus), BPHT

Peripheral zone – located posteriorly (derived from the Urogenital Sinus), prostate cancer

The fibromuscular stroma is situated anteriorly in the gland. It merges with the tissue of the urogenital diaphragm. The zones of the prostate are important in BPH and prostatic carcinoma

Question 18

Relate male reproductive tract anatomy to common clinical problems LO

1. What is hypospadias
2. What is Phimosis & Paraphimosis and problems that can arise from these conditions

Answer 18

1. • congenital condition
     - opening to their urethra on the ventral aspect of the penis]
2. Phimosis: prepuce cannot be retracted.
   It can cause irritation when smegma (oily secretions) accumulate in the preputial sac.

Paraphimosis (severe): retraction of the prepuce over the glans constricts the neck of the glans, interfering with venous and lymphatic drainage. This may cause the glans to enlarge to the extent that the prepuce cannot be drawn over it.

Question 19

1. What is ED? Causes?
2. What is priapism? Cause? Complications?

Answer 19

1. Inability to maintain an erection

vascular e.g. hypertension, hypercholesterolaemia or diabetes (most common)

Psychological e.g. anxiety & depression

2. erection > 4hrs despite a lack of sexual stimulation

often painful & results from blood becoming trapped in the erectile bodies

Untreated, it may lead to scarring and erectile dysfunction

Question 20

Enlargement of the scrotum. Give examples of causes of scrotal swelling:

Answer 20

Inguinal hernia – where the contents of the abdominal cavity protrude into the scrotum, via the inguinal canal.

Hydrocoele – serous fluid in the tunica vaginalis, most commonly due to a failure of the processus vaginalis to close.

Haematocoele – blood in the tunica vaginalis, distinguished from a hydrocoele by transillumination. Due to the dense nature of blood, light is unable to pass through.

Varicocoele – gross dilation of the veins draining the testes. The left testicle is more commonly affected, as the left testicular vein drains into a smaller vessel, the left renal vein, at a perpendicular angle. A large varicocoele can look and feel like a bag of worms within the scrotum.

Epididymitis – usually caused by bacterial or viral infection

Question 21

1. What is the function of the pampiniform plexus?
2. What is Testicular torsion? Complications? How do we diagnose? Main symptom?

Answer 21

1. • venous drainage of the testes
     - cools the arterial blood before it reaches the testes (testes function best at a temperature just below that of the body)
2. • Spermatic cord twists upon itself
     - occlusion of the testicular artery, resulting in necrosis of the testes
     - INFERTILITY
     - Ultrasound & colour doppler scanning
     - Severe, sudden pain in one or both of the testes, where the onset is often during exercise or physical activity

Question 22

1. What is Benign Prostatic Hyperplasia (BPH)?

Risk factor?

Structures it effects?

Signs/symptoms

Answer 22

1. • Increase in size of the prostate, without the presence of malignancy
     - Age
     - compresses on both the bladder and the urethra
     - urinary frequency, urinary urgency, & difficulty in initiating micturition. BPH is usually caused by enlargement from the transitional zone of the prostate

Question 23

Prostatic carcinoma will present with similar symptoms as BPH (frequency, urgency, difficulty initiating micturition).

Commonly originate from the peripheral zones, resulting in symptoms presenting late during advanced stages of the disease. A DRE may reveal a hard irregular prostate gland. Malignant cells will commonly spread via ?

Answer 23

Batson venous plexus to the vertebral bodies and cause metastases.