Session 6 Flashcards
Describe the anatomical structures of the epididymis
Head, body, tail
Efferent ductules –> rete testis –> seminiferous tubules
Describe the anatomical structures of the spermatic cord
Deep inguinal ring –> posterior border of testes (via inguinal canal, superficial inguinal ring)
Contents:
Testicular artery, artery to vas deferens, cremasteric artery
Veins - pampiniform plexus, cremasteric vein
Genital branch of genitofemoral nerve
Vas deferens, lymph, processes vaginalis
What are the fascial coverings of the spermatic cord?
External spermatic (external oblique) Cremaster muscle and fascia (internal oblique) Internal spermatic (transversalis)
Relate anatomy of the male reproductive tract to clinical problems
Hydrocoele, haematocoele, varicocoele, spermatocoele (epididymal cyst)
Indirect hernia - reopening of processes vaginalis (peritoneal cavity tunica vaginalis)
Testicular torsion - twisting just above upper pole, risk of necrosis of testis
BPH - increased in central zone, obstruction of urethra
Malignancies - often located in peripheral zone
During a DRE assess size and consistency
Describe the anatomical structures of the penis
Root, body, glans Corpora cavernosa (dorsal) x2 Corpus spongiosum (ventral) Arterial supply - internal pudendal artery
Describe the anatomical structures of the male urethra
Four parts:
Pre prostatic, prostatic, membranous, spongy
Membranous is least distensible
Describe the anatomical structures of the male perineum
Arterial supply - anterior division of the internal iliac artery (internal pudendal)
Bulbospongiosus - helps expel last drops of urine
Ischiocavernous - compresses veins
Both help maintain an erection
Describe the structure and function of the pelvic floor
Lower part of pelvic canal Muscular and fibrous tissue diaphragm Contributes to childbirth and continence Pierced by urethral, vagina and rectum Supports pelvic organs Defines upper border of perineum Closes abdominal cavity
List the muscles that make up levator ani
Puborectalis
Pubococcygeus
Iliococcygeus
Describe the neurovascular supply of the pelvic floor
Posterior trunk of internal iliac artery branches: Pudendal artery Vaginal artery Inferior rectal artery Pudendal nerve (S2-4)
List some risk factors of damage to the pelvic floor and the main types of pelvic floor dysfunction
Risk factors - age, menopause, obesity, chronic cough (brinchiectasis)
Childbirth:
Stretch of pudendal nerve –> neuropraxia
Stretch/damage of perineal muscles –> weakness
Stretch/rupture of ligaments –> ineffective muscle action
List the perineal muscles
Ischiocavernosus
Bulbospongiosus
Describe the consequences and treatments available for pelvic floor dysfunction
Consequences:
Prolapse of pelvic organs
Incontinence
Treatment:
Pelvic floor muscle exercise (Kegels)
Surgery for continence - colposuspension, tension free vaginal tape
Surgery for prolapse - remove prolapsed organs, restore CT supports
Explain the role of the perineal body
Connective tissue mass is centre of perineum: Anchors perineal muscles Anchors rectum Supports lower part of vagina Efficient bowel emptying
Describe the anatomical structures of the scrotum and testes
Surrounded by tunica vaginalis, enclosed by tunica albuginea
Lobules separated by fibrous septae
Develops in mesonephric ridge –> descend through abdomen –> cross inguinal canal –> exit anterolateral abdominal wall
Gonad is retroperitoneal, evagination of peritoneum, testes follows, processes vaginalis loses elasticity
Arterial supply - testicular artery (direct from AA)
Venous drainage - IVC (R), L renal vein (L)
Lymphatics - scrotum –> superficial inguinal nodes, testis –> paraaortic nodes
Innervation - lumbar plexus (anterior), sacral plexus (posterior, inferior)
