Urogenital Anatomy

Question 1

How do primary sexual characteristics develop in males and females?

Answer 1

• all of the primary sexual characteristics (internal and external organs of reproduction) develop from the same starting point in males and females
• all of these organs have homologs in both sexes
• renal and reproductive development are intertwined

Question 2

Describe development of XX genotype

Answer 2

• cortex (pink) of the indifferent gonad develops
• perimesonephric duct stays attached to it and descends into the pelvis to become the ovary
• mesonephric kidney and mesonephric duct system mainly disappears

Question 3

Describe the development of the XX genotype with the kidney

Answer 3

• the cortex of the indifferent gonad develops and stays attached to the perimesonephric tube, mesonephric kidney and duct mostly disappear
• develop a metanephric kidney; a branch off of the mesonephric duct connects to the developing metanephric kidney which ascends in the body wall while the gonad descends

Question 4

What are the homologs between males and females?

Answer 4

• ovary and testes
• clitoris and erectile tissue of corpus cavernosum
• glans of penis is homologous to glans of clitoris
• round ligament and remains of the gubernaculum
• scrotum and labium majora

Question 5

Identify structures

Answer 5

Question 6

Describe the path of the ureter

Answer 6

• travels along the posterior body wall behind the peritoneum
• ureteropelvic junction is the first narrowing of the ureter
• crosses over the psoas and iliacus muscles and external iliac artery
• ureterovesicular junction is narrowing as the ureter enters the bladder
• kidney can make stones in the pelvis and they get trapped at these points along the path

Question 7

What occurs if the ureter gets blocked at the ureteropelvic junction?

Answer 7

• hydronephrosis
• build up fluid and pressure back into kidney causing renal pelvis to expand
• influences the ability of the kidney to make urine

Question 8

What could occur with a blockage of the ureter at the iliacus/psoas muscles and external carotid?

Answer 8

• hydronephrosis and hydroureter
• greatly expanded ureter
• urine is produced so the ureter is expanded

Question 9

Describe the muscle of the ureter

Answer 9

• longitudinal layer of muscle closest to the lumen of the ureter
• circular layer of smooth muscle on the outside

Question 10

What function does the mucosal lining of the ureter serve?

Answer 10

• mucus makes it harder for bacteria to adhere to the epithelium
• protects from ascending bacteria/viruses from the bladder infecting the ureter

Question 11

Answer 11

Question 12

Answer 12

Question 13

Answer 13

• sacroiliac is a gliding joint
• sacrococcygeal joint doesn’t move much except in childbirth it moves coccyx out of the way

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Question 14

How do the pelvic joints change during gestation?

Answer 14

• in the last 3 months of gestation, the joints relax remarkably
• movement of the SI joint when the woman is in dorsal lithotomy position may increase pelvic diamter 1.5-2cm
• not necessarily the best position to labour in as it compresses blood vessels around pelvis and can compromise venous return

Question 15

Contrast the gynecoid and android pelvis

Answer 15

• gynecoid is light and thin, android is thick and heavy
• gynecoid has shallow false pelvis (area bound between ischiums and towards pubic symphysis), android has deep cup shaped false pelvis
• gynecoid true pelvis is large and slightly oval pelvic brim, android is small heart shaped pelvic brim
• pubic arch is greater than 90 degrees in gynecoid, android pubic arch is less than 90 degrees
• coccyx angled toward anterior in gynecoid, angled strongly toward anterior in android
• anterior area in male pelvis is much larger which is indicative of its not round shape

Question 16

What is the antero-posterior and transverse diameter of the gynecoid pelvic inlet?

Answer 16

-10cm

Question 17

Describe the differences in primate pelvis structure

Answer 17

Question 18

How do the male and female lumbar spine differ?

Answer 18

-in females, L3,4,5 are all wedge shaped

Question 19

What benefit does the structure of the lumbar spine provide to females?

Answer 19

• during pregnancy, the curvature of the spine can balance out the centre of mass to what it would be if you were not pregnant
• in non-pregnant state the COM is above the head of the femur
• pregnant abdomen will unbalance the pelvis by moving the COM forward if there is no compensation
• the pregnant abdomen does not alter the COM because of the increase in lumbar lordosis
• “pregnancy walk” can develop later in pregnancy with more mass/inadequate changes in the spine; COM will move forward causing difficult gait

Question 20

Answer 20

• suspensory ligament of the ovary is really a neurovascular bundle
• uterus is able to move during pregnancy
• cervix has its own attachment and doesn’t need to move during pregnancy

Question 21

Answer 21

• everything is covered in peritoneum
• comes together where the broad ligament is indicated
• peritoneum provides some support particularly since it folds over the side of the uterus and uterine tubes to make a double thick layer of parietal peritoneum called the broad ligament

Question 22

What occurs with a prolapsed uterus? How can it be treated?

Answer 22

• uterus descends down the vagina
• puts pressure on the bladder
• females don’t have an internal sphincter so causes urinary incontinence
• if you don’t treat anything, cervix will continue down and come out of vagina
• put in a pessary which will push the uterus back up
• hysterectomy to remove the uterus
• colpopexy: pull uterus up and tie to posterior body wall
• uterine inversion: inverted uterus can happen from pulling on umbilical cord (instead of cervix coming out the uterus will come out inverted)
• uterus is getting a lot of blood but venous return is poor

Question 23

Answer 23

• labium majora; stratified squamous epithelium
• labium minora; delicate mucous membrane
• inside of vaginal wall have rugae/bumps but these are lost and walls get thinner as you get older
• this uterus is antiverted and retroflexed
• when uterus becomes pregnant, it will become more retroverted and retroflexed

Question 24

Answer 24

• muscles of the pelvic floor support and maintain the pelvic viscera
• can help with urinary continence and guard to some degree against prolapse

Question 25

Answer 25

• incontinence can happen if bladder is put under different pressure sometimes from movement of the uterus
• physiological internal sphincter exists in females as the bladder kinks when it fills up

Question 26

Answer 26

• muscles are thin
• illustrations make them seem large

Question 27

Describe the normal pH of the vagina and a related pathology

Answer 27

• cells stain pink and are covered by bacteria (lactobacilli) which create a low vaginal pH (<4.5) so most organisms can’t live here
• cuts down on number of pathogens
• under influence of estrogen, we put glucose into the epithelial cells which gets put into the lumen for lactobacilli to make lactic acid
• bacterial vaginosis; cell surrounded by different organisms (not lactobacilli)

Question 28

Where do you tend to get infections in the female anatomy?

Answer 28

• stratified squamous vaginal epithelium are dead cells
• if you are going to get an infection it will generally infect the cells higher up in the uterine cervix which are simple columnar epithelial cells (alive)
• tend to get infections in the transition zone
• gonorrhea/chlamydia also tend to appear in the transition zone

Question 29

Answer 29

• prostate is hypertrophied
• prostatic urethra attaches to penile urethra

Question 30

Answer 30

-important for males to have internal urethral sphincter so that urine and semen don’t mix

Question 31

Answer 31

• semen has prostatic and seminal secretions and sperm
• ejaculatory duct is where mixture of seminal and prostatic fluid and sperm make semen