Station 6

Question 1

Pubic tubercle

Answer 1

1. Inguinal ligament extends from pubic tubercle and ASIS
2. In normal anatomical position, ASIS and pubic tubercle are on the same plane

Question 2

ASIS

Answer 2

1. In normal anatomical position, ASIS and pubic tubercle are on the same plane
2. Inguinal ligament extends from pubic tubercle and ASIS
3. Mcburney’s point: 2⁄3 of the way from umbilicus and ASIS
   
   1. Site of maximum tenderness in acute appendicitis

Question 3

Ischial spine

Answer 3

1. Pudendal nerve curls around the ischial spine

Question 4

Iliac crest

Answer 4

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Question 5

Testis

Answer 5

1. suspended in the scrotal sac (scrotum) by the spermatic cord and covered by scrotal layers
2. covered by (from outside to inside) tunica vaginalis, tunica albuginea and tunica vasculosa
   
   1. tunica vaginalis covers the testis except at the posterior border
3. Sinus of Epididymis: extension of cavity of tunica vaginalis between the lateral part of the epididymis
   
   1. (fluid tends to accumulate between two layers of tunica vaginalis/hydrocele).
4. mediastinum testis: thickened tunica albuginea along the posterior border of the testis
5. posterior border is related to body of the epididymis on postero-lateral aspect and vas deferens on postero-medial aspect
6. Supplied by testicular arteries (branch from the aorta), drained through pampiniform plexus of vein to testicular veins (right side to IVC, on left side to left renal vein)
7. LN: ascend with testicular artery and drain in lumbar [aortic] LN

Question 6

Epididymis

Answer 6

1. Stores sperm in their last stage of maturation
2. maturation and storage of spermatozoa in the head and body as well as propulsion of the spermatozoa into the ductus deferens.
3. Has three parts:
   
   1. Head:
      
      1. Enlarged upper end and is connected to the upper pole of the testis by efferent ductules.
      2. Made up of highly coiled efferent ductules.
      3. Upper end of testis overlaps the head of epididymis and are connected by efferent ductules
   2. Body and Tail
      
      1. Single duct of epididymis, which is highly coiled, on itself, [~ 6 meters when uncoiled]
      2. Body: related to posterior border of testis
      3. Tail: continues to form the vas deferens

Question 7

Vas deferens

Answer 7

1. Continuation of the distal part of the tail/duct of epididymis
2. Content of the inguinal canal
3. Descends to base of prostate and joins duct of seminal vesicle to form ejaculatory duct
4. Crosses superior to the ureter close to the urinary bladder
5. Terminal end= ampulla
6. Related to the posterior border of testis

Question 8

Spermatic cord

Answer 8

1. Collection of structures that transverses the inguinal canal and extends from the upper pole of the testes to the deep inguinal ring.
2. Content: Vas deferens, Testicular artery, cremasteric artery & artery to the vas, Pampiniform plexus of veins, Genital branch of the genitofemoral nerve and lymphatic plexuses.
3. Covered by (from within outwards) - Internal spermatic fascia, Cremasteric muscle and fascia and External spermatic fascia (covering begins from superficial inguinal ring).
4. Recall the cremasteric reflex (involves the L1 & L2 segments of the spinal cord), the afferent limb of the reflex is ilioinguinal nerve carrying fibers from upper medial part of the thigh and the efferent limb by genitofemoral nerve (supplying cremaster muscle).

Question 9

Ejaculatory duct

Answer 9

1. formed by the union of ductus deferens with duct of the seminal vesicle.
2. open into the prostatic urethra on the seminal colliculus just lateral to the blind prostatic utricle.
3. Peristaltic contractions of the muscular layer of the ductus deferens and the ejaculatory ducts propel spermatozoa with the seminal fluid into the urethra
4. Pierce the posterior surface of the prostate

Question 10

Seminal vesicle

Answer 10

1. two sacculated contorted tubes placed between the bladder and rectum.
2. Narrow end forms duct of the seminal vesicle, which joins the ductus deferens, to form the ejaculatory duct.
3. It is located posterior to the base of the bladder and in front of the rectum.
4. Supplied by branches of inferior vesical and middle rectal arteries
5. do not store spermatozoa.
6. secretion rich in fructose, citrate, prostaglandins and several proteins. Their secretion makes up approximately 70% of the human ejaculate

Question 11

Prostate

Answer 11

1. Functional activity of gland starts after puberty
2. Located at lesser pelvis below neck of urinary bladder
3. Relations:
   
   1. A: Retropubic space separates anterior surface of prostate from the pubic symphysis
   2. P: rectovesical fascia of Denovillier separates the posterior surface from the rectum
4. prostatic venous plexus is between true and false capsule (during prostatectomy both capsule should be left behind)
5. Anatomically divided into 3 lobes
6. Urethra and two ejaculatory ducts pierces the prostate and divide it into 5 surgical lobes [Anterior, posterior, medial, and 2 lateral]
   
   1. Anterior: lies in front of the urethra and is devoid of glandular substance
   2. Median: lies between the urethra and the ejaculatory ducts and is prone to benign hypertrophy obstructing the internal urethral orifice
      
      1. Lobe is mainly fibro-muscular with few mucous glands. Hence benign hypertrophy of prostate (BPH) is common in the median lobe.
      2. It projects into the trigone of the urinary bladder and this projection is called ‘uvula vesicae’.
   3. Posterior: lies behind the urethra and below the ejaculatory ducts, contains glandular tissue and is prone to carcinomatous transformation
   4. Lateral lobes: situated on either side of the urethra and form the main mass of the gland. It secretes a fluid that produces the characteristic odor of the semen
7. Prostate has ducts (20-30) that open into the prostatic sinus, a groove on either side of the urethral crest.
8. Prostatic arteries are mainly branches of the internal iliac artery, especially the inferior vesical arteries, but also the internal pudendal and middle rectal arteries.
9. Prostatic plexus of veins drains into the internal iliac veins

Question 12

Inferior rectal nerve

Answer 12

1. Branch of the pudendal nerve [S2-S4]
2. Part of the ischiorectal fossa
3. Supplies the voluntary external anal sphincter, which surrounds the anal canal

Question 13

Ischiocavernosus

Answer 13

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Question 14

Bulbospongiosus

Answer 14

1. Found in the superficial perineal pouch
2. Attached to the perineal body

Question 15

Lobes of the Prostate

Answer 15

1. Anatomically divided into 3 lobes
2. Urethra and two ejaculatory ducts pierces the prostate and divide it into 5 surgical lobes [Anterior, posterior, medial, and 2 lateral]
   
   1. Anterior: lies in front of the urethra and is devoid of glandular substance
   2. Median: lies between the urethra and the ejaculatory ducts and is prone to benign hypertrophy obstructing the internal urethral orifice
      
      1. Lobe is mainly fibro-muscular with few mucous glands. Hence benign hypertrophy of prostate (BPH) is common in the median lobe.
      2. It projects into the trigone of the urinary bladder and this projection is called ‘uvula vesicae’.
   3. Posterior: lies behind the urethra and below the ejaculatory ducts, contains glandular tissue and is prone to carcinomatous transformation
   4. Lateral lobes: situated on either side of the urethra and form the main mass of the gland. It secretes a fluid that produces the characteristic odor of the semen