Notesale: Turn your study into money

Document Preview

Extracts from the notes are below, to see the PDF you'll receive please use the links above

---

Male internal genital organs


Includes the testes, epididymides, ductus deferetes, seminal glands,
ejaculatory ducts, prostate and bulbo-urethral glands

Spermatic cord, scrotum and testes
Spermatic cord


Contains structures running to and from the testes, suspends the testes in the
scrotum



Passes through the inguinal canal



Coverings of the cord
o
o

Cremasteric fascia

o


Internal spermatic fascia
External spermatic fascia

The cremasteric fascia contains loops of cremaster muscle
o

Striated muscle with somatic innervation (genitofemoral nerve, branch
of lumbar plexus)

o

Contracts to draw the testes superiorly in the scrotum in response to
e
...
cold

o


Relaxes to allow testes to descend deeply into the scrotum

Dartos muscle is smooth muscle (ANS innervation) in the testes that facilitates
the creamsteric



Spermatic cord contains three of each of the following:
o

Arteries



Artery of ductus deferens: arises from inferior vesical artery


o

Testicular artery: arises from aorta, supplies testes and epididymis
Cremasteric artery: arises from inferior epigastric artery

Veins



Vein to vas deferens


o

Pampiform venous plexus: converge at testicular veins
Cremasteric vein

Nerves


Ilio-inguinal nerve



SNS (arteries and ductus deferens) and PNS (ductus deferens)


o

Genital branch of genitofemoral nerve: innervates crimasteric

Other stuff


Ductus deferens: muscular tube conveying sperm from the
epididymis to the ejaculatory duct



Lymphatics: drain testes and associated structures to the lumbar
lymph nodes




Tunica vaginalis (processus vaginalis; should be gone)

Three fascial coverings – external, internal and cremasteric

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Scrotum


Cutaneous sac consisting of two layers
o
o



Pigmented skin
Dartos fascia

Smooth dartos muscle in the dartos fascia; attached loosely so skin, so
contraction in cold causes wrinkling of the skin, relaxes in the heat to form
smoother appearance



Dartos fascia continuous with membranous layer of subcutaneous tissue of
the abdomen anteriorly and of the peritoneum posteriorly



Septum of the scrotum is an internal continuation of the dartos fascia, dividing
into right and left compartments
o



Demarked externally by the scrotal raphae

Layers of the scrotum – skin, external fascia (continuous with external oblique
aponeurosis), cremasteric fascia (continuous with internal oblique
aponeurosis), internal spermatic fascia (continuous with transversalis fascia),
and tunica vaginalis (remnant of peritoneum; connection obliterates)

Arterial supply


Posterior scrotal branches of the perineal artery (branch of internal pudendal)



Anterior scrotal branches of deep external pudendal artery (branch of
femoral)



Cremasteric artery, a branch of the inferior epigastric artery

Venous supply


Follow the arteries

Lymphatic drainage


Drain to superficial inguinal lymph nodes

Nerve supply


Branches of lumbar plexus to anterolateral surface and branches of sacral
plexus to the posteroinferior surface
o

Genital branch of genitofemoral nerve (L1,2) – anterolateral

o

Anterior scrotal (branch of iliolingual; L1) – anterior

o

Posterior scrotal (branch of perineal branch of pudendal (S2-4) –
posterior

o

Perineal branches of posterior cutaneous nerve of the thigh –
posteroinferior

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Testes


Male gonads, producing spermatozoa and male hormones (testosterone)



Suspended in the scrotum by the spermatic cords



Surface covered by the visceral layer of the tunica vaginalis, apart from
where the testes attach to the epididymis and spermatic cord



Tunica vaginalis is a closed peritoneal sac
o

Visceral layer opposed to testes, epididymis and inferior vas deferens

o

Parietal layer extends more superiorly than the visceral layer to distal
part of spermatic cord



Sinus of the epididymis is the recess formed in the tunica vaginalis between
the testes and epididymis



Tunica albuginea is the tough, fibrous outer surface that thickens into a ridge
on the internal posterior side to form the mediastinum of the testes
o

From this ridge extend fibrous septa between lobules of seminiferous
tubules



Seminiferous tubules are joined by straight tubules to the rete testes, a
network of canals in the mediastinum of the testes

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Arterial supply


Testicular arteries arise from the abdominal aorta, inferior to the renal arteries



Testicular artery or one of its branches anastomose with the artery of the
ductus deferens

Venous drainage


Veins emerging from the testes and epididymis form the pampiniform venous
plexus



Pampiniform venous plexus is part of the thermoregulatory system of the
testes, along with cremasteric and dartos muscles, helping to keep the gland
at a constant temperature



Veins of each plexus converge superiorly, forming testicular veins
o

Right testicular vein drain into IVC

o

Left testicular vein drains into the left renal vein

Lymphatic drainage


Follow the testicular artery and vein to the lumbar (caval/aortic) and preaortic lymph nodes



ANS nerves arise as the testicular plexus of nerves on the testicular artery
o

Vagal PNS, visceral afferent and SNS fibres from T10-11

Epididymis


Elongated structure on the posterior surface of the testis



Efferent ductules of the testes transport newly developed sperm to the
epididymis from the rete testes



Formed of tightly compacted ductules (minute convolutions)
o

Duct becomes smaller as it passes from head to tail



At its tail, it becomes the vas deferens



Structures
o

Head – superior expanded part, composed of lobules formed by
coiled ends of multiple efferent ductules

o

Body – tightly convoluted duct

o

Tail – tapering to the vas deferens

Medical application
Inguinal hernias












Most abdominal hernias occur in the inguinal region
Can occur in both sexes, but mostly male due to passage of
spermatic cord via the inguinal canal
Inguinal hernia is a protrusion of the parietal peritoneum and viscera
(e
...
small intestine) through a normal or abnormal opening from the
cavity they belong in
Most are reducible (can be returned by manipulation)
Two types – direct and indirect (see table)
Normally most of the processus vaginalis obliterates before birth
apart from a small distal residual segment which forms the tunica
vaginalis of the testes
In an indirect hernia, the peritoneal part of the herniation sac is
formed from the residual processus vaginalis; if this extends to the
scrotum, a complete indirect inguinal hernia can occur
Indirect hernia goes via both deep and superficial inguinal rings,
while direct only via the superficial one

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Characteristic

Direct (acquired)

Indirect (congenital)

Predisposing factors

Weakness of anterior

Patency of processus

abdominal wall

vaginalis

Frequency

Uncommon

Common

Exit from abdominal cavity

Peritoneum plus transversalis

Peritoneum of processus

fascia (outside inner one or

vaginalis plus all three

two fascial coverings of

fascial coverings of cord

cord)
Course

Through or around inguinal

Through inguinal canal

canal, external and parallel

within processus vaginalis

to vestige of processus
vaginalis
Exit from abdominal wall

Superficial ring, lateral to

Via superficial ring inside

cord, rarely enters scrotum

cord, commonly into
scrotum

Cremasteric reflex




Light stroke on medial part of superior thigh causes contraction of
thee cremasteric muscle
Causes rapid elevation of the testes
Hyperactive reflex may cause undescended testes in children

Hydrocele of spermatic cord and testes






Hydrocele is excess fluid in a persistent processus vaginalis
May be associated with an indirect inguinal hernia
Fluid accumulates from secretions of the tunica vaginalis
Size of hydrocele depends on size of remnant
Transillumination can be used to detect excess fluid

Haematocele of testes



Collection of blood in the tunica vaginalis from trauma (rupture of
testicular artery)
Transillumination can differentiate from hydrocele (blood doesn’t
transilluminate)

Torsion




Surgical emergency as necrosis of testes may occur
Obstructs venous drainage, leads to oedema and haemorrhage
Surgical fix to scrotal septum

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Spermatocele and epididymal cyst



Spermatocele is a retention cyst in the epididymis; milky fluid, usually
asymptomatic
Epididymal cyst is collection of fluid anywhere in the epididymis

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Varicocele





Can get dilation and torture (varicose) of the pampiniform plexus
Usually only seen on standing or straining
Can result from defective values in the testicular vein, also kidney and renal
problems
Occurs mainly on left side likely as acute angle for right testicular vein to
drain into IVC is more favourable than 90 degree angle for left testicular
vein to enter the left renal vein

Cancer of testes and scrotum






Lymph metastases common with testicular tumours
As testes relocate from the anterior abdominal wall to the testes during
development, their lymphatic drainage differs to that of the scrotum
(outpouching of anterolateral abdominal skin)
Cancer of the testes usually metastasises to retroperitoneal lumbar lymph
nodes, then mediastinal and supraclavicular nodes
Cancer of scrotum metastasises to superficial inguinal nodes

Male internal genital organs
Ductus deferens


Ductus/ vas deferens is continuation of the duct of the epididymis



Features
o
o



Primary component of the spermatic cord
Thick muscular walls and small lumen

Course
o

Begins at tail of epididymis

o

Ascends posterior to testis, medial to epididymis

o

Penetrates anterior abdominal wall via the inguinal canal

o

Crosses internal iliac vessels to enter pelvis

o

Passes over lateral walls of pelvis, external to peritoneum

o

Ends by joining the duct of the seminal gland (ejaculatory duct)



Lies in contact with the peritoneum when passing over it



Crosses the ureter near the posterolateral angle of the bladder, before joining
the duct of the seminal gland; enlarges at this point to form the ampulla of
the ductus deferens

Arterial supply and venous drainage


Artery of the ductus deferens arises from the superior (sometimes inferior)
vesical artery; terminates by anastomosing with the testicular artery



Veins from the ductus drain into the testicular vein

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Seminal glands


Elongated structure lying between fundus of the bladder and the rectum,
superior to the prostate



Do not store sperm



Secrete a thick alkaline fluid containing fructose (energy source) and
coagulating agent – mixes with sperms as they pass into ejaculatory ducts



Superior aspect covered with peritoneum, rectovesicular pouch separates
from the rectum



Inferior ends closely related to the rectum, separated by the rectovesicular
septum



Seminal gland duct joins the ductus deferens to form the ejaculatory duct

Arterial supply and venous drainage


Arteries derive from the inferior vesical and middle rectal arteries



Veins accompany with similar names

Ejaculatory ducts


Tubes arising from union of the ductus deferentes with ducts of the seminal
gland



Arise near neck of the bladder, pass anteroinferiorly through the prostate



Ducts converge to open on the seminal colliculus by small apertures onto the
opening of the prostatic utricle



Prostatic secretions do not join the seminal fluid until the ejaculatory ducts
terminate at the prostatic urethra

Arterial supply and venous drainage


Arteries to the ductus deferens (branches of superior or inferior vesical
arteries) usually branch to supply the ejaculatory ducts



Veins join the prostatic and vesical venous plexus



Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Prostate


Largest accessory gland



Firm and walnut shaped, surrounding the prostatic urethra



2/3 is glandular, 1/3 is fibromuscular



Fibrous capsule is dense and neurovascular, containing plexi of veins and
nerves



Surrounded by the pelvic fascia
o
o



Forms a prostatic sheath
Blends with the puboprostatic ligaments and rectovesical septum

Features
o

Base related to neck of bladder

o

Apex contacts fascia on superior part of urethral sphincter and deep
perineal muscles

o

Muscular anterior surface; transversely orientated to form a
hemisphincter, forming part of the urethral sphincter

o
o


Posterior surface close to rectum
Inferolateral surfaces related to levator ani

Several lobes
o

Isthmus – mostly muscular

o

Right and left lobes, divided further



Inferolateral lobule – major part



Superomedial lobule


o

Inferoposterior lobule – palpable by rectal exam

Anteromedial lobule

the superomedial and anteromedial lobes tend to undergo
hypertrophy with age, forming a middle lobule



The prostatic ducts open into the prostatic sinuses on posterior wall of the
prostatic urethra, either side of the seminal colliculus



Prostatic fluid is thin and milky, provides 20% volume of semen and role in
activating sperms



Semen is a mixture of secretions produced by the testes seminal glands,
prostate and bulbourethral glands) providing transport for sperms

Arteries and venous drainage


Prostatic arteries are branches of the internal iliac arteries
o



Inferior vesical, internal pudental and middle rectal

Veins join to form a prostatic venous plexus, drains into internal iliac veins
o

Plexus continuous with vesical venous plexus and communicates
with the internal vertebral venous plexus

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition

Bulbo-urethral glands


Pea sized, lie posterolateral to urethra, mostly embedded in urethral sphincter



Ducts of the bulbo-urethral glands pass through the perineal membrane with
the urethra, open into the spongy urethra in the bulb of the penis



Mucus-like secretions enter the urethra during arousal

Innervation of internal male genital organs


SNS innervation
o
o



Ductus deferens, seminal glands, ejaculatory ducts, prostate
Originate T12-L2/3, splanchnic nerves, hypogastric and pelvic plexuses

PNS innervation
o

Originate S2-S3 traverse pelvic splanchnic nerves, also joining the
inferior hypogastric and pelvic plexuses



Orgasm
o

SNS


Contraction of internal urethral sphincter to prevent retrograde



Peristaltic contraction of ductus deferens



Contraction and secretion from the seminal glands and
prostate – provides propulsive force

o

PNS function unclear – but are involved in penile erection

Medical application
Male sterilisation




Commonly a deferentectomy (vasectomy)
Vas deferens ligated or excised, so ejaculate doesn’t contain sperm
Reversal can be successful – reattachment of ends

Prostatic hypertrophy














Common after middle age
Projects into urinary bladder, impeding urination by distorting the
prostatic urethra
Usually the middle lobule
Leads to nocturia, dysuria, urgency, increased risk of cystitis and
kidney infection
Digital rectal exam can establish hypertrophy/tumours
o Benign hypertrophy usually affects the median lobe, which
encircles the prostatic urethra
o Prostatic cancer usually occurs in the peripheral zones
(glandular; adenocarcinoma)
Many men have no symptoms; may get blood and urine in semen,
or back pain with metastases
Full bladder provides resistance, aiding palpation of prostate
Feels hard and irregular
Usually find on rectal exam, or incidentally on blood tests e
...
Well
Man screen for PSA (not specific – can be raised on inflammation,
infection, post-ejaculation etc
...
Moore et al
...
Seventh Edition

---