The Male Reproductive System Flashcards
What is hydrocoele?
Excess fluid in tunica vaginalis
How do you diagnose a hydrocoele?
Trans illuminate testi > will glow if filled with fluid
Outline the arterial blood supply to the testis
- Testicular arteries from the abdominal aorta at
L1 - symmetrical on both sides
Outline the venous drainage of the testis
- via the pampiniform plexus
- right testicular vein > IVC
- left testicular vein > left renal vein > IVC
Outline the lymphatic drainage of the testis
Via the para-aortic lymph nodes
Outline the lymphatic drainage of the scrotum
Inguinal lymph nodes
What is Bell-clapper deformity?
What can happen in boys with this deformity?
Tunica vaginalis lacks a normal attachment to testis > hangs freely
Testicular torsion
Outline the rule of three of spermatic cord
- 3 fascial layers
- 3 arteries/veins
- 3 nerves
- 3 others
Name the 3 fascial layers of the spermatic cord
- internal spermatic fascia
- cremasteric fascia
- external spermatic fascia
3 arteries and accompanying vein of spermatic cord
- testicular artery/vein (pampiniform plexus)
- arteries + veins from the vas
- cremasteric vein + artery
3 nerves of the spermatic cord
- autonomic - sympathics to vas
- genital branch of genitofemornal nerve - motor to cremaster
- ilioinguinal nerve - sensory to part of external genitals + upper inner thigh on top of
Why does the pampiniform plexus surround the testicular artery?
- artery pump helps venous return
- cooling effect of the blood
3 others of the spermatic cord
- vas/ductus deferens
- lymphatics
- patent processes vaginalis
What does ‘point and shoot’ refer to?
Parasympathic > erection
Sympathetic > ejaculation
What does ‘water under the bridge refer to’ in men?
The ureter passes under the vas
Briefly outline the process of a vasectomy
- under general anaesthetic
- Small cut in scrotal skin
- vas deferens is cut
What accessory glands contribute to the volume of semen?
- seminal vesicles
- prostate gland
- bulbourethral glands
What are the accessory glands which secrete semen?
What is their percentage composition?
- seminal vesicles ~65%
- prostate gland ~25%
- bulbourethrel glands ~1%
Function of fluid produced by seminal vesicles
- nutrition for sperm
- alkaline > neutralises acidic environment of vagina
Describe the ejaculatory fluid produced by the prostate gland
- contains proteolysis enzymes
- mildly acidic
Function of fluid produced by bulbourethral glands
Reduces friction
Pre-ejaculate
Outline the process of an erection
- initiated by parasympathetic stimulation
- release of NO causes GTP > cGMP
- vasodilation > increase blood flow to corpus cavernosum
. - ischocavernosus + bulbospongiosus contract > helps blood stay in erect penis > rigidity
What is the cremasteric reflex?
Stroking of the inner thigh causes the cremaster muscle to contract > ipsilateral testicle moves up
Outline the route of sperm from the testicles to the penis
- sperm develop in the Sertoli cells of the seminiferous tubules of the testicles
- sperm ‘learn how to swim’ in the epididymis
- exit in the vas deferens of the spermatic cord
- spermatic cord enters the body via the inguinal canal + splits into the vas and the blood supply
- vas deferens meets the seminal vesicle > ejaculatory duct
- pass through the prostate gland
- prostatic urethra > membranous urethra > bulbous urethra > penile urethra
What are the male urethral divisions?
Pre prostatic > prostatic > membranous > bulbous > penile
What cells make up seminiferous tubules?
What are their function?
- Sertoli cells - spermatogenesis
- Leydig cells - produce testosterone
Function of the Sertoli cells
Spermatogenesis
Function of leydig cells
Produce testosterone
What are the two tissue types of the penis?
Corpus spongiosum
Corpus cavernosum
Differentiate between benign prostatic hyperplasia and prostate cancers in terms of the zone affected?
- BPH: transitional zone
- prostatic cancers: peripheral zone
What part of the prostate is affected in benign prostatic hyperplasia?
Transitional zone
What part of the prostate tends to be affected in prostate cancers?
Peripheral zone
Describe the cross sectional structure of the penis
‘Like ET’
- Corpus cavernosum: larger double circles surrounded by tunica albuginea
- Corpus spongiosum: smaller singular circle containing the urethra
What is the tunica albuginea and what is its function?
- a ring around the corpus cavernous
- gives penis cylindrical shape
What is a fractured penis?
Rupture of the tunica albuginea
Where do the testicular arteries branch off the abdominal aorta?
L1
What pulls the testes through the abdominal wall muscles?
Gubernaculum
‘Like a finger in cling film’
What do leydig cells contain a lot of?
Smooth endoplasmic reticulum
Where do the testes initially develop i the embryonic period?
Posterior abdominal wall
What is a varicocele?
Swelling of the scrotum due to increased hydrostatic pressure in pampiniform plexus
Which testicle is more likely to form a varicocele and why?
Left
Pampiniform plexus drains into left renal vein then IVC
Urinary symptoms of benign prostatic hyperplasia
- frequent urination
- urgency of urination
- incontinence
What is the blood supply to the penis?
- internal pudendal artery
- a branch of the internal iliac artery
What prevents semen from entering the bladder during ejaculation?
Internal urethral sphincter
What needs to be considered in a transgender man?
They may still have a cervix so may need cervical screening
An absence of the cremasteric reflex is suggestive of…
Testicular torsion
What enzyme is secreted by the prostate gland?
What is the clinical use of the enzyme?
PSA - prostate specific antigen
If high, suspicion of prostate cancer
