Urinary Tract and Pelvis Flashcards
How is the urethra oriented for catheterization?
Oriented anteriorly
The true and false pelvis is separated by what?
The pelvic inlet
If you damage S2 to S4 you will have trouble with what?
Trouble with urethral m and sphincters
What nerve roots is the skeletal muscle in perineum and pelvic floor including urethral and anal sphincters controlled by?
S2 to S4
Somatic motor and sensory innervation of the perineum is via what nerve and roots?
S2 to S4
Where is a pudendal nerve block performed?
Medial to the ischial tuberosity
What artery supplies the pelvis?
Internal iliac artery and branches
Anterior iliac artery (supplies bladder)
Posterior iliac artery (supplies posterior structures and anus)
The deep pelvic structures drain into what? (bladder, rectum, pelvic genital organs and terminal part of the urethra)
Internal and external iliac chains
The deep perineal structures drain into what? (urethra, external urethral sphincter, and the vagina in the female.)
Internal iliac chain
The superficial perineal structures (penis, scrotum, clitoris and labia) drain into what?
Superficial inguinal nodes
Other superficial perineal structures such as the glans penis, glans clitoris, labia minora and inferior end of the vagina drain into what two areas?
Deep inguinal nodes and external ililac chain
The ovaries and related uterine structures and the testes drain into where?
Lateral and pre-aortic nodes
The gluteal nodes drain into the
Internal iliac chain
Drainage from the lower extremities is into where?
Superficial and deep inguinal nodes
How are the deep parts of the perineum drained?
Internal pudendal-> internal iliac-> aortic nodes
How are the superficial and external genitalia parts of the perineum drained?
Superficial inguinal nodes-> deep inguinal nodes-> external iliac nodes
Ovaries and testes drain straight into which nodes?
Periaortic
Why is a womans urethra more disposed to cystitis?
Because its shorter
What are the boundaries of the perineum?
Well the urogenital triangle is located here and so is the anal triangle. Boundaries include:
- Pubic symphysis
- ischium
- sacrotuberous ligament
What is the nerve supply to the perineum?
Pudendal nerve
What is the arterial supply to the perineum?
internal pudendal artery
The pelvic diaphragm consists of what two important strucutes?
levator ani and coccygeus
What is the levator ani comprised of?
Pubococcygeus, puborectalis, iliococcygeus
The levator ani and the urogenital diaphragm together do what?
Holt up the uterus, rectum and bladder
What is the significance of the ischiorectal fossa?
AKA the deep perineal space (abscesses can form here because they have decrease vascular supply)
The levator ani and the perineal membrane come together at the _________ ______
perineal body
What is the clinical significance of the perineal body?
It is where the vagina and rectum meet and you don’t want to cut this area in an episiotomy
What systemic system is involved in external hemorrhoids?
Systemic venous system
What systemic system do internal hemorrhoids to into?
Hepatic portal veins
You can drain the bladder through the _________area
suprapubic
In development, the bladder is connected to the _________
median umbilical ligament
What female structure is analagous to the male vas deferens?
The round ligament
What are the supporting structures of the uterus and what are the true supporting structures of the uterus?
Supporting structures: pelvic diaphragm, UG diaphragm and perineal body
Are the round ligament, broad ligament or suspensatory ligaments supporting structures of the ovary?
No
What are the MAJOR TRUE supporting structures of the uterus?
CUA
Cardinal, uterosacral, anterior pubocervical ligaments
The pouch of douglas is part of what supporting structure of the uterus?
Uterosacral ligaments
The uterine artery and vaginal arteries are in the __________ ________
broad ligament
Significance of the uracus?
a canal that drains the urinary bladder of the fetus that joins and runs within the umbilical cord.
Where is the vesicouterine pouch? where is the pouch of douglas?
Vesicouterine pouch is in front of the uterus
Pouch of douglas or rectouterine pouch is behind the uterus in between the rectum
What are the supporting structures of the ovary?
Major Suspensatory Ligament
Mesovarium
Suspensatory ligament of ovary
Ligament of ovary
What are the four parts of the male urethra?
- Preprostatic part of urethra
- Prostatic part of urethra
- Membranous part of urethra
- Spongy part of urethra
This part of the urethra is surrounded by erectile tissue of the penis just below the deep perineal pouch and is thin, angled, and vulnerable to injury
spongy urethra
The prostatic urethra is curved how?
Slightly anterior
The external urethral sphincter is located where?
Deep perineal pouch
Most prostate cancer is in the _________ zone
peripheral zone
BPH is in the _________ zone
transitional zone (periurethral area)
The sympathetic and visceral nerves of the spermatic cord descend through what?
Superficial inguinal canal and deep inguinal canal
What n innervates the cremasteric muscle?
genitofemoral n
Arterial supply of the penis?
IPDPD
Internal pudendal-> dorsal -> perineal->Deep A of penis
Venous supply of the penis?
DPV IPI
Dorsal V-> prostatic plexus-> vesicle plexus -> internal pudendal -> internal iliac
Where does the testicular artery come from?
Arises from the abdominal aorta to scrotum via inguinal canal
Scrotum gets arterial supply from what?
Perineal AA
How does the scrotum venous drainage go?
testicular veins, internal iliac and internal saphenous (TIISing out the blood)
What artery is responsible for vasodilating for an erection?
Internal pudendal artery
What nerves are responsible for the contraction of the internal urethral sphincter in men?
SNS fibers carried by sacral splanchnic nerves and the superior hypogastric plexus
What nerves help stimulate an erection?
PSNS fibers from the pelvic splanchnic nerves to the inferior hypogastric plexus
Somatic afferents (sensation) from the penis is via what two nerves?
Pudendal and perineal nerves
What is the significance of the space of retzius aka retropubic space)?
The space of rezius is the area right above the pubic symphysis and this is an area in which you can insert a catheter. You don’t want to go any higher or you will go through the peritoneum which is BAD
Where would fluid from a torn urethra collect?
Anterior to the anterior abdominal wall.
Not down the legs because the colle’s fascia is continuous with the abdominal fascia but gets tacked down at the inguinal ligament and anterior to the anal triangle.
