Week 4.0 - Male Reproductive tract

Question 1

What is the scrotum?

Answer 1

-A cutaneous sac developed from labioscrotal folds which contains the testis, epididymis and spermatic cord (first part)

Question 2

Describe the layers of the testis

Answer 2

• Tunica Albuginea
• Tunica Vaginalis
• Internal spermatic fascia
• Cremastic muscle and fascia
• External spermatic fascia
• Dartos
• Skin

Question 3

How are the testis organised?

Answer 3

-Lobules of seminiferous tubules divided by fibrous septae

Question 4

Describe the descent of the testis

Answer 4

• Gonads develop on urogenital ridge on posterior abdominal wall
• Descend behind the peritoneum through the abdomen
• Take an oblique passageway across anterior abdominal wall, following processes vaginalis, forming inguinal canal

Question 5

Describe the arterial supply and venous drainage of the testis

Answer 5

• Arterial supply is directly from abdominal aorta

- Venous drainage R testicular vein to IVC, L testicular vein to L renal vein then L IVC

Question 6

What connects the lobules of seminiferous tubules and the epididymis?

Answer 6

-Rete testis and efferent ductules

Question 7

What does the spermatic cord contain?

Answer 7

• Testicular A, cremasteric A, artery to vas deferens,
• Pampiniform plexus
• Genital nerve (from genitofemoral nerve)
• Lymphatics
• Ductus deferens
• Processus Vaginalis

Question 8

Where is the spermatic cord?

Answer 8

-From the deep inguinal ring to posterior border of testis via inguinal canal and superficial inguinal ring

Question 9

What is the pampiniform plexus?

Answer 9

• Sophisticated venous drainage of the testis
• > acts as a heat exchanger as arterial blood passes into testis at core body temp but spermatogenesis is optimal at a few degrees lower -> venous drainage wraps arouns artery to allow heat to dissipate

Question 10

Where is the internal spermatic fascia derived from?

Answer 10

-Transversalis fascia

Question 11

Where is the cremasteric muscle and fascia derived from?

Answer 11

-Internal oblique and transversalis fascia

Question 12

Where is the external spermatic fascia derived from?

Answer 12

-Aponeurosis of external oblique

Question 13

Define hydrocoele

Answer 13

-Swelling in the scrotum caused by serous fluid in tunica vaginalis

Question 14

Define Haematocoele

Answer 14

-Swelling in the scrotum causes by blood in tunica vaginalis

Question 15

Define varicocoele

Answer 15

-Varicosities of pampiniform plexus

Question 16

Define spematocoele

Answer 16

-Epididymal cyst

Question 17

What is epididymitis?

Answer 17

-Inflammation of the epididymis often caused by STI

Question 18

How do you determine between hydrocoele and haematocoele?

Answer 18

• Transillumination
• White light = hydrocoele
• Pink light = haematocoele

Question 19

What is an inguinal hernia?

Answer 19

• Outpocketing of bowel which has pushed through the anterior abdominal wall
• Direct through hesselbachs triangle
• Indirect through deep inguinal ring -> inguinal canal

Question 20

What is the predisposing developmental factor to an indirect hernia?

Answer 20

-Reopening of processus vaginalis allowing communication between peritoneal cavity and scrotum

Question 21

What is testicular torsion?

Answer 21

-Twisting of the testicles usually above the upper pole -> risk of necrosis

Question 22

Describe the innervation to the testis

Answer 22

• Anterior = lumbar plexus

- Posterior/inferior = sacral plexus

Question 23

Describe the lymphatic drainage of the testis and scrotum

Answer 23

• Testis drains to paraaortic nodes

- Scrotum drains to superficial inguinal nodes

Question 24

Describe the course of the ductus deferens

Answer 24

• Ascends from the testes in spermatic cord
• Traverses inguinal canal
• Tracks around pelvic side wall
• Passes between ureter and bladder
• Forms dilated ampulla
• Opens into ejaculatory duct

Question 25

What are the seminal vesicles?

Answer 25

-Outpuching of ductus deferens forming a glandular structure which secretes important ejaculate components

Question 26

What forms the ejaculatory ducts?

Answer 26

-seminal vesicles combining with ductus deferens on both sides form one duct within prostate

Question 27

What is the prostate?

Answer 27

-A fibromuscular gland which secretes components of ejaculate

Question 28

Describe the anatomical relationships at the base of the prostate

Answer 28

-combines with neck of bladder

Question 29

Describe the anatomical relationships at the apex of the prostate

Answer 29

-Attaches to urethral sphincter and perineal muscles

Question 30

Describe the anatomical relationships at the anterior of the prostate

Answer 30

-Attaches to urethral sphincter

Question 31

Describe the anatomical relationships at the posterior of the prostate

Answer 31

-Attaches to ampulla of rectum

Question 32

Describe the structural organisation of the prostate

Answer 32

-Organised into central, transitional and peripheral zones

Question 33

Describe the origins of the zones of the prostate

Answer 33

- Central zone from wolffian ducts | - Peripheral zone from UGS

Question 34

Describe Benign Prostate Hyperplasia and its symptoms

Answer 34

- Proliferation of the central zone of prostate, often causing obstruction of the internal urethral orifice - Dysuria, nocturia and urgency

Question 35

Which part of the prostate do malignancies often affect? Why is this clinially significant?

Answer 35

- Peripheral zones | - Present later as has to get very large before it affects micturition

Question 36

How does prostatic malignancy often spread?

Answer 36

- Lymphatics via internal iliac and sacral nodes | - Venous routes via internal vertebral plexus to vertebrae and brain

Question 37

What two characteristics are assessed during DRE?

Answer 37

-Size and consistency of prostate

Question 38

Describe the internal structure of the penis

Answer 38

- Pair of corpora cavernosa dorsally | - Single corpus spongiosum ventrally

Question 39

Through which part of the penis does the urethra pass?

Answer 39

-Corpus spongiosum

Question 40

Which arteries supply the penis and perineum?

Answer 40

-Branches of internal pudendal (which is branch of anterior internal iliac)

Question 41

Which muscles are the main contributors to the male perineum?

Answer 41

- Bulbospongiosus | - Ischiocavernosus

Question 42

What is the function of bulbospongiosus in males?

Answer 42

-Wraps around root of penis to help expel last drops of urine and maintain erection

Question 43

What is the function of ischiocavernosus in males?

Answer 43

-Compress the veins and therefore help maintain the erection

Question 44

Which is the least distensible part of the male urethra? Why? Why is this clinically significant?

Answer 44

- Membranous - Confined by peritoneum and perineal floor - Likely to meet resistance here during passage of catheter

Question 45

Name the peritoneal pouch in the male

Answer 45

-Rectovesical pouch