RENAL ANATOMY

List the muscles found in the SUPERFICIAL PERINEAL POUCH

* 3 muscles -- Ischiocavernosus -- Bulbospongiosus -- Superficial Transversus Perinei

Explain the ARTERIAL SUPPLY of the Kidneys

* 5 SEGMENTAL ARTERIES - do NOT anastomose -- Apical + AS (Anterior Superior) + AI (Anterior Inferior) + Posterior + Inferior -- They divide into INTERLOBULAR ARTERIES which go on to produce AFFERENT ARTERIOLES

What are the different areas to induce REGIONAL ANESTHESIA for CHILDBIRTH?

* A - for complete block at the spinal cord level -- Sensations below that level are lost -- Usually done in C-sections * B - Caudal Epidural blocks -- It includes the Pelvic Plexus (Pelvic Splanchnic nerves) + the Peritoneum -- The person can feel the contraction of the uterus -- Done below the Pelvic Pain line * C - we are ONLY blocking the Pudendal nerve -- Block the sensation of the Perineum (low birth canal)

List some disorders of SEXUAL DEVELOPMENT

* AMBIGUOUS GENITALIA -- Genitalia appears as large clitoris + small penis -- Hermaphrodites * TRUE HERMAPHRODITISM -- Testis on one side + ovary on the other side -- External genitalia may be male + female * PSEUDOPHRODITISM -- Gonads and Internal Genitalia are of now sex + External Genitalia is of the other sex -- Gonads and External Genitalia are of one sex + Internal Genitalia is of other sex * TURNER SYNDROME -- XO females (only one X chromosome) -- Female phenotype with streak gonads

What are the ANTERIOR + POSTERIOR branches of the Internal Iliac arteries?

* ANTERIOR -- Superior Vesical artery: part of umbilical artery - Median umbilical ligament -- Obturator artery -- Uterine artery + Vaginal artery -- Middle Rectal artery -- Inferior Gluteal artery -- Internal Pudendal artery -- Inferior Vesical artery (in males) * POSTERIOR -- Iliolumbar -- Superior Gluteal -- Lateral Sacral

Diagram showing the Anatomic + Histologic lobes of the PROSTATE GLAND

* ANTERIOR LOBE -- Made up of fibrous-muscular parts -- Connects the 2 Lateral lobes -- Anterior to the Urethra * LATERAL LOBES -- PZ: Peripheral Zone -- SM: Superomedial - surrounds the opening of the Ejaculatory Duct -- AM: Anteromedial - lateral to the Urethra -- IL: Inferolateral - on either side of the Anterior lobe * MEDIAN LOBE -- Above the Ejaculatory Duct -- CZ: Central Zone -- When this lobe gets enlarged, there is constriction of the male Urethra. This person feels the urge to urinate bc of compression

What are the anterior + posterior relations of the KIDNEYS?

* ANTERIOR: -- R: suprarenal gland + liver + duodenum + hepatic flexure of colon + small intestine -- L: suprarenal gland + gastric area (stomach) + spleen + pancreas + splenic flexure of colon + jejunum * POSTERIOR: -- Diaphragm + Psoas major (medially) + Quadratus lumborum + subcostal nerves (Iliohypogastric and Ilioinguinal nerves) * R kidney at the level of the 12th rib * L kidney at the level of the 11th + 12th rib

Explain the Arterial and Venous supply + Lymphatic drainage of the PROSTATE GLAND

* ARTERIAL -- Inferior Vesical and Middle rectal (branch of Internal Iliac vessels) + Internal Pudendal * VENOUS -- PROSTATIC VENOUS PLEXUS - in bw the 2 capsules --- Drain into Internal Iliac Veins --- Associated with PROSTATIC SHEATH - gives passage to PNS fibres for Cavernous nerves that pass to the erectile bodies of the penis + responsible for erection -- Veins may communicate with BATSON'S VENOUS PLEXUS (where we see metastasis of cancer) * LYMPHATICS -- Into Internal and External Iliac Nodes + Sacral group of lymph nodes

Explain the blood supply + lymphatic drainage of the TESTIS

* ARTERIAL -- TESTICULAR ARTERY - branch of Abdominal Aorta * VENOUS -- PAMPINIFORM PLEXUS - forms the Testicular Veins -- R drains into IVC directly -- L drains into Left Renal Vein * LYMPHATICS -- Into PREAORTIC + PARA-AORTIC groups of lymph nodes

Diagram showing the DIFFERENTIATION OF GONADS

* Absence of Testosterone - the indifferent gonad will develop into an ovary. * Differentiation of Gonads occurs during weeks 7-8 * -- External Genitalia starts differentiating into males + female genitalia by weeks 9-12

What is a CULDOCENTESIS?

* An endoscopic instrument (CULDOSCOPE) is inserted through an incision made in the posterior part of the Vaginal Fornix into the peritoneal cavity to drain the pelvic abscess + fluid + blood in the Rectouterine pouch

What is the BLOOD SUPPLY to the Urinary Bladder?

* Arterial -- SUPERIOR VESICAL ARTERES is a branch of the Internal Iliac arteries + supplies anterosuperior part of the Urinary bladder -- Males: INFERIOR VESICAL ARTERIES supply funds + neck -- Females: VAGINAL ARTERIES replace Inferior Vesical arteries + supply the posteroinferior part * Venous -- Tributaries of Internal Iliac veins -- Males: VESICAL VENOUS PLEXUS is continuous with the PROSTATIC VENOUS PLEXUS -- SACRAL VENOUS PLEXUS communicated with the Vertebral or Batson's Plexus (metastasis can spread from the pelvis to the CNS)

Explain the blood supply + lymphatics + nerve supply of the FEMALE URETHRA

* Arterial + venous -- INTERNAL PUDENDAL -- VAGINAL ARTERIES * Lymphatics -- SACRAL + INTERNAL ILIAC NODES -- INGUINAL NODES * Nerve supply -- VESICAL PLEXUS (SNS + PNS) -- Somatic: PUDENDAL NERVES

What is the blood supply + lymphatics + nerve supply of the MALE URETHRA?

* Arteries + veins -- INFERIOR VESICAL -- MIDDLE RECTAL -- INTERNAL PUDENDAL * Lymphatics -- Prostatic + Membranous portions drain into INTERNAL + EXTERNAL ILIAC NODES -- Spongy portion drains into DEEP INGUINAL + EXTERNAL ILIAC NODES * Nerve supply -- SNS: L1-L2 -- PNS: Pelvic Splanchnic nerves -- Somatic: Pudendal nerves

List the JOINTS OF THE PELVIS + their location + function

* Avulsion fracture: injury to the bone where a tendon or a ligament attaches to the bone

Explain the Blood supply + Lymphatics + Innervation of the FEMALE EXTERNAL GENITALIA

* BLOOD SUPPLY -- External Pudendal artery -- Internal Pudendal arteries (main) -- Veins same as arteries * LYMPHATICS -- Glans Clitoris + Labia Minora drain into Deep Inguinal + Internal Iliac nodes -- Other parts: drain into Superficial Inguinal nodes * INNERVATION -- Anterior: anterior labial nerves (branch of Ilioinguinal nerve) + Genital branch (from Genitofemoral nerve) -- Posterior: Perineal branch of posterior cutaneous nerve of thigh + Pudendal nerve

What is the blood supply + Lymphatics + Innervation of the PERINEUM?

* BLOOD SUPPLY -- Internal Pudendal artery including erectile tissue * LYMPHATICS -- To Superficial Inguinal nodes -- EXCEPT for Testis - drain into the Aortic (Lumbar) group of lymph nodes * INNERVATION -- Pudendal Nerve (S2-S4): provide motor + sensory to most of the Perineum -- Anterior part: innervated by Ilioinguinal nerve (L1)

List the 4 muscles of the VAGINA

* BULBOSPONGIOSUS: located in the perineum ** These muscles act as sphincters

Explain the development of the FEMALE EXTERNAL GENITALIA

* CLITORIS: from the Genital Tubercle * VESTIBULE: Urogenital Groove remains open * LABIA MINORA: from the Urethral Folds * LABIA MAJORA: from the Genital Swellings ** The Urethral + Labioscrotal folds do NOT fuse in the midline (as in males)

Explain the development of the ADULT DEFINITIVE KIDNEY - COLLECTING vs EXCRETORY PARTS

* COLLECTING PART -- From the URETERIC BUD - outgrowth from the Mesonephric Duct close to the entrance of the Cloaca. -- Ureteric Bud invaginates into the METANEPHRIC BLASTEMA at the 5th week -- Collecting tubules + Minor/Major calyxes + Renal pelvis + Ureter will be formed -- 1-3 million Collecting Tubules are formed from the Ureteric Bud * EXCRETORY PART -- From the METANEPHRIC MESODERM -- METANEPHRIC TISSUE CAPS give rise to small RENAL VESICLES (S-shaped tubules) -- Capillaries start growing into the tubules and differentiate into the RENAL GLOMERULUS -- RENAL (BOWMAN'S) CAPSULE is formed -- The Proximal Convoluted tubule (PCT) + Loop of Henle + Distal Convoluted tubule (DCT) will be formed *** The portion between the Distal Ductule + Collecting Tubule is the communication bw the Colleting and Excretory parts (Utereic bud and Metanephric Tissue Caps)

Explain CONGENITAL / INGUINAL HERNIAS + HYDROCELE related to the development of the Testis

* CONGENITAL HERNIAS: -- Occurs if the open connection bw the Processus Vaginalis + Peritoneal Cavity persists after birth -- Intestinal loops may descend into the scrotum * HYDROCELE -- If the obliteration of this connection is abnormal - small cysts are formed -- Hydrocele of the Testis or Spermatic Cord can be seen

What is the role of the COLLECTING + CONNECTING TUBULES?

* CONNECTING TUBULES carry filtrate into the Collecting Tubules -- Lined by SIMPLE CUBOIDAL epithelium -- Contains PRINCIPAL CELLS (remove Na + secrete K) + INTERCALATED CELLS (remove K + add HCO3-) * COLLECTING TUBULE caries filtrate into the Minor Calyx

What are the structures composing the OVARIES?

* CORTEX -- Peripheral portion of the ovary -- OVARIAN FOLLICLES: primary oocyte covered by flat FOLLICULAR CELLS embedded in CT --- THECA INTERNA: inner cellular layer + with developing follicles + w/ LH receptors + secrete ANDROSTENEDIONE (male sex hormone) - Androgens are converted to Estradiol using AROMATASE --- THECA EXTERNA: outer fibrous layer * MEDULLA -- Central portion of the ovary -- BVs + lymphatics + nerves -- Loose CT network

Explain the development of the SUPRARENAL / ADRENAL GLANDS

* CORTEX -- Proliferates from Mesoderm coming from the Posterior Body wall -- The FETAL/PRIMITIVE (ACIDOPHILIC) CORTEX is formed by the 5th week -- Hormones maintain placenta + pregnancy -- Replaced by a secondary proliferation of Mesoderm to orm the DEFINITIVE CORTEX -- In the 2nd trimeter - DHEA (Dehydroepiandrosterone) is produced, which gets converted to Estrogen by the placenta -- After birth, the fetal cortex REGRESSES + definitive cortex differentiates into the Zoma Glomerula, Zona Fasciculata and Zona Reticularis * MEDULLA -- Proliferates from the NCCs (from the Ectoderm) -- Contain CHROMAFFIAN CELLS (modified postganglionic sympathetic neurons) - come from the Neural Folds + secrete Ep and NE

What is CONGENITAL POLYCYSTIC KIDNEY DISEASE? What are the inherited types of the disorder?

* CYSTIC STRUCTURES are wide dilatations of parts of the loop of Henle -- Cysts could be present in the kidneys + liver + pancreas + lungs -- Caused by gene mutations + faulty signalling * ARPKD (AR Polycystic Kidney Disease) -- Progressive disorder -- Cysts form in the Collecting ducts -- Kidneys enlarge -- RENAL FAILURE occurs in infancy or childhood * ADPKD -- Cysts form in all segments of the nephrons -- Do NOT cause Renal Failure until adulthood -- More common

When does the PELVIC KIDNEY occur?

* Caused by failure of ascent from the pelvic position to the abdomen (T12-L3) --- The kidney remains in the pelvis

When can an ISCHIOANAL ABSCESS occur?

* Caused by infection - leads to collection of pus -- Painful (below the pectinate line - innervated by Pudendal Nerve) -- Tenderness bw the anus + Ischial Tuberosity -- It can rupture spontaneously opening into the Anal Canal + Rectum + Perianal skin

What is RENAL AGENESIS?

* Causes: -- Failure of the URETERIC BUD to develop -- NO interaction bw the Metanephric Mesoderm (Metanephric blastema) + Uteretic bud --- Caused by mutation in GDNF gene * It could lead to Unilateral or bilateral Renal agenesis -- Related to POTTERS SEQUENCE - Oligohydramnios (no amniotic fluid) + the infant is not cushioned from the walls of the uterus + develops facial abnormalities -- Related to ANURIA - failure of the kidneys to produce urine

What could happen during RUPTURE of the URINARY BLADDER?

* Causes: injuries at the anterior abdominal + fractures of the pelvis * Rupture of the Superior Surface of the bladder leads to tearing of the PERITONEUM -- Results in passage of urine into the Peritoneal cavity * Rupture of Extraperitoneal cavity -- Urine collects bw the peritoneum + anterior abdominal wall

Explain the development of the TESTIS

* Coelomic epithelium covering the medial side of the Mesonephric Ridge thickens to form the GENITAL RIDGE * PRIMITIVE SEX CORDS form the MEDULLARY (Testis) CORDS -- At the hilum, the cord break to form the RETE TESTIS * Germinal epithelium of the Genital Ridge proliferates and invades to form the SEMINIFEROUS TUBULES + LEYDIG CELLS * Primordial Germ Cells migrate into the Seminiferous Tubules * TUNICA ALBUGINEA is derived from the local mesenchyme * Duct system of the testis is developed from the proximal 12-15 MESONEPHRIC TUBULES

What are the characteristics of the MALE URETHRA?

* Common passage for urine + semen -- Length: 20 cm -- Extends from the bladder neck (Internal Urethral orifice) to the External Urethral Orifice on the Gland Penis

What are some characteristics + parts of the PENIS?

* Common passage of urine + semen * Parts -- Root + body + glans -- 3 erectile tissues covered by DEEP FASCIA (BUCK'S FASCIA) -- CORPUS SPONGIOSUM: covers the urethra -- Pair of CORPORA CAVERNOSA

What are the histological characteristics of the PENIS?

* Composed of skin + 3 cylindrical masses of erectile tissue around the Spongy or Penile Urethra -- CORPORA CAVERNOSA: (2) + w/ irregular vascular spaces lined by ENDOTHELIAL CELLS -- CORPORA SPONGIOSUM: (1) + w/ vascular spaces + it expands distally to form the GLANS of the Penis -- VASCULAR SPACES: become engorged during ejaculation due to PNS activity - increased blood flow to DEEP ARTERIES through Corpora Cavernosa * Lined by PSEUDOSTRATIFIED COLUMNAR epithelium -- These 3 masses are surrounded by the TUNICA ALBUGINEA * GLANS OF PENIS -- Distal end -- Made up of DCT covered by a prepuce -- Lined by STRATIFIED SQUAMOUS KERATINIZED epithelium

List some UTERINE + VAGINAL DEFECTS

* DUPLICATION OF THE UTERUS -- Caused by failure of fusion of the Paramesonephric Ducts 1. UTERUS DIDELPHYS: double uterus + 2 vaginas 2. UTERUS ARCUATUS: slight indentation in the middle 3. UTERUS BICORNIS: 2 horns + 1 vagina * PARTIAL/COMPLETE ATRESIA OF PARAMESONEPHRIC DUCTS -- uterus Bicornis with 1 rudimentary horn -- ATRESIA OF VAGINA: inferior part fails to canalize + at the cervix or at the lower vagina

What are the principal supports of the Uterus?

* DYNAMIC: -- Muscles of the Pelvic Floor (Perineal muscles + Pelvic diaphragm + Urogenital diaphragm) * PASSIVE: -- Endopelvic fascia -- Position of the uterus -- Transverse / Cervical ligament: attaches cervix + vagina to the lateral walls of the pelvis -- Uterosacral ligaments: attach cervix to sacrum

From which EMBRYONIC GERM LAYER is the Reproductive System developed from?

* Developed from the INTERMEDIATE MESODERM -- It gives off the Urogenital System (kidneys + gonads)

Explain the development of the OVARY

* Developed from the Surface Epithelium of the female Gond -- Primitive Medullary (Testis) cords degenerate -- Secondary sex cords (CORTICAL / Ovarian cords) form * At 3rd month, Cortical Cords break into CELL CLUSTERS -- Cells proliferate + surround Oogonium (PRIMORDIAL FOLLICLES = primitive follicles containing oogonia + follicular cells) * Germ cells in degenerating Medullary Cords invade the Cortical Sex Cords -- Germ cells differentiate into Oogonia + enters 1st meiosis (arrest) * Stimulated by ESTROGEN -- Mesonephrons disappears due to the absence of Testosterone

What do we use to determine the capacity of the Pelvis for Childbirth?

* Diameter of LESSER PELVIS are noted during Pelvic examination or Imaging -- Minimum AP diameter is determined * TRUE + OBSTETRICAL CONJUGATE: -- From the middle of the Sacral promontory to the posterosuperior margin of the Pubic Symphysis -- Baby's head must pass during vaginal delivery * DIAGONAL CONJUGATE: -- from the Sacral Promontory to the inferior margin of the Pubic Symphysis ** The distance bw the index finger + the marked level of the Pubic Symphysis is measured to estimate the TRUE CONJUGATE (> 11 cm)

When does DISTENSION OF THE VAGINA can occur?

* Distension by the fetus during childbirth * Distension by examination of the Vagina done with a vaginal speculum (Pap smear)

What is the Lymphatic Drainage + Nerve supply of the KIDNEYS?

* Drain into the LUMBAR NODES * Nerve supply via the THORACIC SPLANCHNIC NERVES -- Visceral referred pain: T10-T11 -- At Lumbar + Inguinal region -- T10 dermatome - for the umbilicus -- L1 dermatome - for the inguinal region

How can EXTRAVASATION OF URINE be seen in males if caused by catheterization of the Spongy Urethra?

* During catheterization, rupture of the Spongy Urethra at the bulb of the penis may occur -- Urine or blood passes into the SUPERFICIAL PERINEAL SPACE - pass into subcutaneous tissue of the scrotum + penis + superiorly deep to the membranous layer of the anterior abdominal wall -- Urine or blood do NOT pass in the thigh --- Colle's Fascia blends with FASCIA LATA distal to the Inguinal ligament.

When and where is PUDENDAL + ILIOINGUINAL NERVE BLOCK performed?

* During childbirth - anesthesia is injected into the tissues surrounding the Pudendal Nerve -- PUDENDAL NERVE cross lateral to the SACROSPINOUS ligament (near attachment to the Ischial Spine) -- Eliminates pain from the anterior part of the Perineum

What happens during injury to the PELVIC FLOOR?

* During childbirth, the Pelvic Floor (Levator And muscle + Perineum + Pelvic fascia) support the fetal head -- A tear in the Pubococcygeus muscle can lead to URINARY STRESS INCONTINENCE (drilling of urine while coughing)

What happens during injury to the PELVIC NERVES?

* During childbirth, the fetal head may compress the mother's SACRAL PLEXUS - may lead to pain in the lower limbs -- During childbirth, the fetal head lies on the sacrum at the last stage of pregnancy. -- Injury to OBTURATOR NERVE during surgery can lead to painful spasm of medial muscles of the thigh

What types of epithelium are present in the TESTIS?

* EPIDIDYMIS -- Long convoluted duct on the posterior aspect of the testis -- SMOOTH MUSCLE increases from the head to the tail of the Epididymis -- Lined by PSEUDOSTRATIFIED COLUMNAR epithelium with STERCOCILIA -- Storage + maturation of sperm take place * RETE TESTIS -- Network of channels inside the Mediastinum of the Testis -- Lined by SIMPLE CUBOIDAL epithelium

An oblique VCUG (Voiding Cystourethrogram) image of a young male showing a short EPISPADIC URETHRA on the dorsal surface of the penile shaft

* EPISPADIC URETHRA: duplication of the urethra

List the URETHRAL SPHINCTERS

* EXTERNAL SPHINCTER -- Skeletal muscle + voluntary -- Somatic: PUDENDAL NERVES * INTERNAL SPHINCTER -- At apex of Trigone of the bladder (neck) -- Contraction of Detrusor Muscle opens this sphincter -- Involuntary

Explain the development of the URETHRA in females + males

* FEMALES -- Derived from the MIDDLE / PELVIC part of the Urogenital Sinus * MALES 1. PROSTATIC URETHRA: from the lower part of the VESICO-URETHRAL CANAL -- Absorption of the Mesonephric Duct occurs -- This is the PELVIC part of the definitive Urogenital Sinus 2. MEMBRANOUS PART: pelvic part of the definitive Urogenital Sinus 3. PENILE PART: phallic part of the definitive Urogenital Sinus 4. TERMINAL PART: derived from the SURFACE ECTODERM

What is CRYPTORCHIDISM?

* Failure of one / both testis to descend -- May be in lumbar region + iliac fossa + inguinal canal -- If BILATERAL, it leads to sterility -- Descent may complete after birth -- Spermatogenesis fails to occur -- patient more prone to develop a malignant tumour

What are the contents of the ISCHIOANAL FOSSA?

* Fat bodies * Sensory neuromuscular structures -- Internal Pudendal vessels -- Pudendal nerve -- Inferior Rectal vessels + nerves -- Posterior Scrotal + Labial vessels + nerves -- Perineal branch of S4 -- Perforating branches of S2 + S3

What controls filling of the Urinary Bladder + Micturition?

* Filling of the bladder is controlled by SNS * Micturition is controlled by PNS

What are ACCESSORY RENAL ARTERIES?

* Formed by the persistence of EMBRYONIC VESSELS -- Arteries usually arise from the Aorta + enter the Superior and Inferior poles of the kidneys

What are the characteristics of the DISTAL CONVOLUTED TUBULE (DCT)?

* Found beyond the Macula Densa -- Electrolyte levels of the filtrate are further adjusted -- Leads to short CONNECTING TUBULES -- SIMPLE CUBOIDAL CELLS are smaller compared to PCT + NO Brush border + more empty lumen

Explain the development of the URINARY BLADDER

* From the ENDODERM * UPPER PART of the Urogenital Sinus comes from the Endoderm -- Connects with the ALLANTOIS - connects to the Umbilicus -- Allantois obliterates at birth + remains in adults as URACHUS / MEDIAN UMBILICAL LIGAMENTS -- The tip of the Urinary Bladder is derived from the Allantois * TRIGONE of the Bladder: -- The lower ends of the MESONEPHRIC DUCTS incorporate into the posterior wall of the Urogenital Sinus -- Mesodermal tissue will be covered by endodermal epithelium

What are the structures seen during the development of the MALE EXTERNAL GENITALIA?

* GENITAL TUBERCLE (PALLUS) - enlarges to form the Glans of the Penis + erectile bodies * URETHRAL FOLDS -- Form as Phallus grows -- They fuse VENTRALLY in the midline -- Terminal part of the UROGENITAL SINUS is enclosed as the PENILE URETHRA, while the Urethral Folds fuse * GENITAL SWELLINGS - fuse in the midline to form the scrotum

What are the histological characteristics of the MATURE GRAAFIAN FOLLICLE?

* GRANULOSA CELLS: help in the development of the oocyte * TI: Theca Interna * A: Antrum * SG: Stratum Granulosa * CO: Cumulus Oophorus - connects the outer layer with the Corona Radiata

List the different types of PELVIS

* GREATER PELVIS: aka False Pelvis -- Superior to the Pelvic inlet -- Bound anteriorly by the anterior abdominal wall + head of the Ileum on either side + L5-S2 vertebrae posteriorly * PELVIC CAVITY: bw the Pelvic Inlet + Pelvic Outlet * LESSER PELVIS: aka true Pelvis -- Same as the Pelvic Cavity -- Includes Urinary bladder + Uterus + Ovaries -- Bounded by the Ileum + sacrum + coccyx

List the type of PELVIS

* GYNECOID: normal women * ANDROID: normal men -- AP > Transverse diameter * ANTHROPOID: resembles pelvis of Anthropoid age + elongated AP diameter + shorter transverse diameter * PLATYPOID: Transverse diameter > AP

List some DEFECTS IN MALE GENITALIA

* HYPOSPADIAS (A + B) -- Failure of complete fusion of the Urethral Folds -- Results in External Urethral Orifice opening onto the VENTRAL surface of the penis -- Coul occur near the glans + along the shaft + at the base of the penis * EPISPADIAS (C) -- Abnormal closure of the body wall -- Urethral Meatus is found on the DORSUM of the penis -- Associated with Exstrophy of the Bladder * MICROPENIS -- Insufficient Androgen stimulation * BIFID / DOUBLE PENIS -- Caused by splitting of the Genital Tubercle

Diagram showing the FASCIAS of the Perineum

* INFERIOR FASCIA of the Pelvic Diaphragm -- First fascia seen * PERINEAL MEMBRANE -- Second fascia * COLLE'S FASCIA or PERINAL FASCIA -- Third fascia + Deep Fascia -- Membranous layer that fuses with the Perineal Membrane * CAMPER'S FASCIA: with an outer fatty layer below the umbilicus * DARTOS FASCIA: outer layer of fat in the scrotum * SCARPA'S FASCIA: inner membranous layer -- These 2 are SUPERFICIAL FASCIA * Outer fatty layer is continuous with the Labia Minora/Majora + goes into the Ischioanal Fossa + continuous with the ANAL TRIANGLE * BUCK'S FASCIA: in the penis + covers the crura -- Deep Fascia -- Covers the Corpora Spongiosum + Cavernosa * SUPERFICIAL PERINEAL POUCH / SPACE: bw the Perineal Membrane + Colle's Fascia * DEEP POUCH: located bw the Superficial Fascia of the Urogenital Diaphragm + the Perineal Membrane

What are some clinical correlates that could happen in females related to the SUPERFICIAL PERINEAL POUCH?

* INFLAMMATION OF GREATER VESTIBULAR GLAND -- Happens in the Superficial Perineal Pouch -- It may enlarge 4-5 cm + impinge the wall of the Rectum -- aka BARTHOLIN CYSTS * DILATION OF FEMALE URETHRA -- Urethra is distensible bc it contains elastic + smooth muscle -- It easily dilates -- The passage of CYSTOSCOPES / catheters in females is much easier than in males

Which germ layer is the UROGENITAL SYSTEM derived from?

* INTERMEDIATE MESODERM: gives rise to the Urogenital system (kidneys + gonads) -- Located bw the Paraxial and Lateral Plate Mesoderm.

What are HEMORRHIDES?

* INTERNAL -- Caused by dilation of veins of the Internal Rectal Venous Plexus -- Breakdown of Muscular Mucosa is seen * EXTERNAL -- Thromboses (blood clots) in the veins of the External Rectal Venous Plexus -- Covered by skin

What are the 2 MUSCULAR SPHINCTERS related to the wall of the Anal Canal?

* INTERNAL ANAL SPHINCTER -- Smooth muscle sphincter -- Relaxation: by PNS (Pelvic Splanchnic nerves S2-S4) -- Contraction: by SNS (Lumbar Splanchnic nerves L1-L2) * EXTERNAL ANAL SPHINCTER -- Circular skeletal muscle -- Assists in Renal Continence -- Voluntary control -- Innervated by the Pudendal nerves

What happens to the INDIFFERENT GONADS at week 4? Where is GONADAL PAIN felt?

* Indifferent Gonads are at the T10 level -- UROGENITAL RIDGE appear in the middle of the Intermediate Mesoderm -- CLOACA: located in the lower end of the embryo -- PRIMORDIAL GERM CELLS migrate from the Yolk Sac to the Indifferent Gonda **** If they FAIl to migrate, the gonads will NOT develop -- GONADAL PAIN: at the Umbilical region (T10 dermatome)

List some Clinical Correlates relating to the EXTERNAL FEMALE GENITALIA

* Inflammation of the Greater Vestibular Glands * Pudendal + Ilioinguinal nerve blocks -- At the ISCHIAL SPINE level where we feel the Sacro-spinal ligament

Explain the position of the KIDNEYS

* Initially, present in the PELVIC REGION -- Arterial supply is by Pelvic branches of the Aorta * Ascends to the Abdomen (T12-L3) -- Supplied by branches of the Aorta + lower arteries disappear -- Ascend occurs due to fetal growth of the lumbar + sacral regions -- Ureter elongates

List the main VEINS OF THE PELVIS

* Internal Iliac veins * Superior Rectal vein: drains into IMV (Inferior Mesenteric vein) -- Portal Vein * Median Sacral vein * Ovarian vein: R drains into IVC L drains into L Renal * Internal Vertebral Plexus * Internal Iliac vein: drains pelvic organs through Pelvic Venous Plexus (Rectal + vesicle + prostatic + uterine + vaginal) * Lateral Sacral veins: drain into Internal Vertebral Plexus

How can EXTRAVASATION OF URINE be seen in males if caused by a FRACTURE of the Pelvic Girdle?

* It can cause rupture of the Intermediate part of the URETHRA -- Extravasation of urine or blood into the DEEP PERINEAL POUCH is seen - it could also go in the space bw the Anterior Abdominal wall and the Parietal Peritoneum -- Fluid mass pass superiorly through the Urogenital Hiatus - distribute extraperitoneally around the prostate and bladder

What are the characteristics of the MACULA DENSA? Where does it come from?

* It comes from the LOOP OF HENLE -- The THIN ascending and descending limbs are SIMPLE SQUAMOUS + the THICK ascending limb is SIMPLE CUBOIDAL -- In the Cortex, the TAL (Thick Ascending Limb) forms Macula Dense * JUXTAGLOMERULAR APPARATUS: Macula Densa cells + JG cells regulate BP

What is the role of the SPHINCTER URETHRA (aka External Urethral Sphincter)?

* It forms a voluntary muscle of MICTURITION -- Surrounds the urethra + prevents leakage of urine -- Important in URINARY CONTINENCE -- Innervated by the PUDENDAL nerve -- It is found in the Urogenital Diaphragm

What are the characteristics of the VAGINA?

* It is a SUB-PERITONEAL musculomembranous tube -- Superiorly: surrounds the cervix (External Os) + communicates with the cervical canal -- Ends at the Vestibule -- Canal for Menstrual fluid -- Receives the penis + ejaculate during intercourse * Fornixes: anterior + lateral + posterior (deepest part related to Rectouterine pouch)

What is EPISIOTOMY?

* It is a surgical incision of the Perineum + Inferoposterior vaginal wall -- Done during vaginal surgery + labor to enlarge the vaginal orifice -- Done to avoid tears of the anal sphincter + Levator And muscle * MEDIAL INCISION: the Bulbospongiosus + Perineal Membrane are cut * MEDIOLATERAL INCISION: the Bulbospongiosus + Superficial Transverse Perineal muscle are cut

What is DYSTOCIA?

* It refers to abnormal or difficult labor -- Caused by inability of the infant to pass through the Pelvic Inlet -- Pelvic Inlet may be too small (seen in Android + Platypoid shaped pelvis) -- The baby may be too large - MACROSOMIA

Diagram showing the surface anatomy of Kidneys + Ureters

* KIDNEYS -- Located 5 cm lateral to the medial line -- Hilum at L1-L2 passes at the Transpyloric plane * URETERS -- Pass anterior to the Psoas Major muscle -- Lie over the transverse process of the Lumbar vertebrae

What happens to the KIDNEYS at 12th week of gestation?

* Kidneys become functional at 12th week -- Urine goes to the Amniotic cavity - it is swallowed by the fetus - recycled through the kidneys -- During fetal life, EXCRETION is done through the Placenta (NOT through the Kidneys)

When do you see the NUTCRACKER SYNDROME?

* L RENAL VEIN passes bw the SMA + Abdominal Aorta -- Caused by an Aneurysm of the L Renal Vein -- This vein can be compressed affecting the left Gonadal vessels + left Suprarenal vessels

List the muscles found in the PELVIC DIAPHRAGM

* LEVATOR ANI -- Supports pelvic viscera -- Resists increase in intra-abdominal P -- Involved in voluntary control of Urination -- Controls the External Anal Sphincter -- Innervated by S4 + Inferior Rectal nerve + Coccygeal plexus 1. PUBOCOCCYGEUS + PUBORECTALIS -- U-shaped muscle around the junction of the Rectum + anal canal + at the pelvic diaphragm -- Maintains the anorectal flexion + Fecal Continence -- Voluntary relaxation of this muscle allows emptying of the rectum -- Weakness leads to RECTAL INCONTINENCE 2. ILIOCOCCYGEUS * COCCYGEUS / ISCHIOCOCCYGEUS -- Innervated by S4 + S5 -- Supports the pelvic viscera + flexes the coccyx -- Nerve supply is SOMATIC

List the Ligaments associated with the Uterus + Uterine Tubes + Ovaries

* LIGAMENTS * support + provide conduit for neuromuscular structures * BROAD LIGAMENT: sheet of Peritoneum associated with the Uterus + Fallopian tubes + Ovaries -- From the lateral pelvic walls on both sides -- Folds over the Internal Female Genitalia to cover their surface anteriorly and posteriorly * MESOMETRIUM: surrounds the uterus * MESOVARIUM: associated with the ovaries -- From the posterior surface of the Broad Ligament -- Attaches to the hilum of the ovary -- It does NOT cover the surface of the ovary itself. * MESOSALPINX: encloses the Fallopian tubes * Ligaments located within the Broad Ligament: -- SUSPENSORY LIGAMENT OF OVARY: aka Infudibulopelvic ligament + attaches to the Pelvic brim -- UTERINE LIGAMENTS: associated with the uterus -- OVARIAN LIGAMENTS: associated with the ovaries (remnant of the Gubernaculum posteroinferiorly) * ROUND LIGAMENT: remnant of the Gubernaculum anteroinferiorly

What are the Histological characteristics of the URETERS?

* Lined by UROTHELIUM (TRANSITIONAL EPITHELIUM - TEp) -- Protects underlying cells from Hypertonic or toxic effects of urine -- UMBRELLA CELLS: large superficial cells -- Longitudinally folded MUCOSA is surrounded by thick MUSCULARIS that moves urine by waves of Peristalsis -- When relaxed or empty: 4-5 cell thick -- When filled: 3-4 flat cell -- Primary cells at the surface are very rounded.

Explain the blood + lymphatic + nerve supply to the URETERS

* Lymphatics - to LATERAL AORTIC + ILIAC NODES * Innervated by the AUTONOMIC PLEXUS -- Renal + Aortic + Superior and Inferior Hypogastric Plexus (L1) * Blood supply -- RENAL ARTERY supplies the upper ureter -- Branches of the GONADAL ARTERIES + direct abdominal branches + COMMON ILIAC + INTERNAL ILIAC + SUPERIOR VESICAL ARTERIES supply the rest of the Ureter -- In females, as the ureters enter the Urinary bladder - supplied by the UTERINE ARTERIES

List the MALE INTERNAL + EXTERNAL REPRODUCTIVE ORGANS

* MALE EXTERNAL -- Scrotum + Penis * MALE INTERNAL -- Testes + epididymis -- Vas Deferens or Ductus Deferens -- Seminal vesicle -- Ejaculatory ducts -- Accessory sex glands: Prostate + Bulbourethral glands -- Spermatic Cord: suspend the testis into the scrotum

What are the relations of the URETERS in the Pelvis?

* MALES - ureters lie posterolateral + inferior to DUCTUS DEFERENS * FEMALES -- At Pelvic Brim - ureters are medial to the Suspensory Ligament of the ovary -- Ureters pass inferior to the UTERINE ARTERIES

List the LIGAMENTS of the URINARY BLADDER

* MEDIAN UMBILICAL LIGAMENT -- Extends from apex of the bladder to the Umbilicus -- Remnant of the URACHUS -- Developed from the Allantois * PUBOPROSTATIC LIGAMENT - in males * PUBOVESICAL LIGAMENT - in females * LATERAL LIGAMENTS (2) -- From the inferolateral surface of the bladder to the arch of the Pelvic Fascia *** Bladder is related to the RETROPUBIC FAT behind the Pubic Symphysis

What is the role of the SERTOLI + LEYDIG CELLS in Male Reproduction?

* MIF: Mullerian Inhibiting Hormone * Paramesonephric Ducts develop female organs (uterus + uterine tubes + vagina) * DHT: dihydrotestosterone

What are the features of the FEMALE EXTERNAL GENITALIA?

* MONS PUBIS: anterior fat eminence overlying the pubic eminence * LABIA MAJORA: 2 folds of pigmented skin made up of fat + sebaceous glands * CLITORIS: erectile tissue -- Glans covered with Prepuce -- It has Crura (Corpora Cavernosa) * LABIA MINORA: fat free + hairless + pink skin fold with some erectile tissue * VESTIBULE: space covered by Lamia Minora -- Contains openings of Urethra + vagina + vestibular glands * GREATER VESTIBULAR (BARTOLIAN) GLANDS -- Paired mucous glands on either side of the vaginal opening -- Posterior to the bulb of the vestibule -- Ducts open into the vestibule -- When inflamed, it can lead to Bartolli Cysts * BULBS OF THE VESTIBULE: pair of erectile tissues -- Covered by Bulbospongiosus muscle

Diagram showing the Epithelium of the URETER

* MUCOSA -- Transitional epithelium -- Lamina Propria: supporting CT * MUSCULARIS -- Inner longitudinal layer -- Outer circular layer * ADVENTITIA * SEROSA - retroperitoneal + does NOT cover the entire ureter

What are the histological characteristics of the FALLOPIAN + UTERINE TUBES?

* MUCOSA -- w/ extensive folds -- IRREGULAR LUMEN - it has deep grooves within the fold -- Lined by SIMPLE COLUMNAR CILIATED epithelium (found in Infundibulum and Ampulla) + NON-CILIATED PEG CELLS * MUSCULARIS -- Inner circular + outer longitudinal layers -- Contracts + aids in the propulsion of the zygote * SEROSA - outermost layer

What are the main ARTERIES OF THE PELVIS in males + females?

* Main arteries in men (3) + in females (4) -- Unpaired Median Sacral artery -- Paired Superior Rectal artery -- Paired internal iliac artery -- Paired ovarian artery (only in females)

What are the contents of the DEEP PERINEAL POUCH in males + in females?

* Males -- Membranous part of the Urethra -- Bulbourethral glands (Cowper's glands) * Females -- Urethra and vagina pass through this pouch

What are the contents of the SUPERFICIAL PERINEAL POUCH in both males and females?

* Males: -- Root of the penis (bulb + crura) -- Ducts of the Bulbourethral glands * Females -- Crura of the Clitoris -- Greater Vestibular (Bartholin) Glands -- Bulbs of vestibule

What are the boundaries of the ANAL TRIANGLE?

* Midline features: -- Perineal body -- Anal orifice -- Anococcygeal Raphe * On either side of the Anal orifice: Ischioanal + Ischioanal Fossa * Posteriorly: bounded by the tip of the coccyx + Sacrotuberous ligament that connects the Ischial Tuberosities

What are the structures of the NEPHRON?

* NEPHRON: functional unit of the kidney * RENAL CORPUSCLE: Bowmann's capsule + Glomerulus * PCT: where most of the reabsorption takes place.

What are the nerves + vessels seen in the SUPERFICIAL PERINEAL POUCH?

* Nerves - deep muscular branches of the PERINEAL NERVES -- Males: 2 posterior SCROTAL nerves -- Females: 2 posterior LABIAL nerves * BVs -- Males: 2 posterior SCROTAL vessels + Transverse Perineal branch of Posterior Scrotal vessels -- Females: 2 posterior LABIAL vessels + Transverse Perineal branch of Posterior Labial vessels *** Urethra + vagina pass through this pouch in females

What are the nerves + blood supply of the DEEP PERINEAL POUCH?

* Nerves: -- Dorsal nerve of the penis in males -- Dorsal nerve of the clitoris in females * Blood supply -- Internal Pudendal artery -- Artery to the bulb -- Deep + Dorsal artery of the penis in males -- Deep + Dorsal artery of the clitoris in females

Explain the CYSTOSCOPY procedure

* Observation of the interior of the Urinary Bladder and the 3 orifices * SUPRAPUBIC - distended bladder can be approached surgically without transversing the peritoneum

When can DUPLICATION OF URETERS can be seen?

* Occurs due to EARLY SPLITTING of the Ureteric Bud -- it forms 2 Ureters -- It could be partial or complete -- Rare cases: one ureter opens into the urinary bladder + other ureter opens into the vagina

When does the HORSESHOW KIDNEY occur?

* Occurs when the INFERIOR POLES of both kidneys fuse -- Ascent of the Horseshoe kidney is prevented by the root of the IMA

Where does the Excretory Duct of the Urinary + Genital Systems open into?

* Open into the CLOACA -- Derived from the MESODERMAL RIDGE (Intermediate Mesoderm gives off the Urogenital System)

Where is the ONLY part of the Nephron where we see MICROVILLI?

* PCT

What is the PCT?

* PCT: Proximal Convoluted Tubule -- Lined by SIMPLE CUBOIDAL CELLS + MICROVILLI - forms a BRUSH BORDER -- Glucose + small proteins + peptides + water are reabsorbed from the filtrate and moved into Peritubular capillaries

What are the relations of the PELVIC CAVITY?

* PELVIC INLET: aka Superior Pelvic Aperture -- LINEA TERMINALIS: formed by Pubic crest + Pecten pubis + Arcuate line -- Superior margin of the Pubic symphysis -- Inferior rami of pubis -- Ischial tuberosities -- Sacrotuberous ligaments -- Tip of the coccyx * PELVIC OUTLET: aka Inferior Pelvic Aperture -- Inferior margin of the Pubic symphysis -- Inferior rami of pubis -- Ischial tuberosities -- Sacrotuberous ligament -- Tip of coccyx

What are the characteristics of the URINARY BLADDER?

* PELVIC ORGAN located beneath the Parietal Peritoneum within the bony pelvis -- Posterior to Pubic Symphysis * Opening: 2 ureteral + 1 urethral * DETRUSOR MUSCLE: smooth muscle of the Urinary bladder * TETRAHEDRAL shape when empty The apex extends towards the umbilicus bc it is attached by the MEDIAN UMBILICAL LIGAMENT (remnant of the Allantois) * SURFACES (4) -- 2 Inferolateral surfaces -- 1 Superior surface: covered by Peritoneum -- 1 Posterior surface + base + funds * BORDERS (3) -- 1 Posterior + 2 Lateral * NECK - is continuous with the urethra -- In males, it is covered by the Prostate Gland * As the bladder fills, it ascends superiorly intra the Extraperitoneal fatty tissue of the Anterior Abdominal wall -- It lies bw the Anterior Abdominal wall + Parietal Peritoneum

VCGU image of a PENILE HYPOSPADIAS

* PENILE HYPOSPADIAS: congenital disorder of the urethra where the urinary opening is not at the usual location at the head of the penis. -- Penile Hypospadias is seen with Meatal Stenosis in a 10-yo male presenting with a short pallus + thin urinary stream -- A uniformly dilated urethrea up to the tip (arrows) and abrupt narrowing of the urinary stream at the hypospadic meautus (arrowhead) is seen

What could occur during disruption of the PERINEAL BODY?

* PERINEAL BODY provides support of the pelvic viscera in females -- During childbirth: stretching + tearing can be seen * It can cause PROLAPSE of the Pelvic Viscera: -- Prolapse of bladder through the Urethra -- Prolapse of Uterus through the vaginal orifice

What is PHEOCHROMOCYTOMA?

* PHEOCHROMOCYTOMAS -- Tumor involving the Chromaffin Cells in the Adrenal Medulla -- results in overproductive of NE + Ep -- ~10% occurs in sites other than the Adrenal medulla -- Causes: hypertension + increased HR + headaches -- Caused by failure of migration of the NCCs due to mutation in RET gene -- Occurs in adults bw 40-60 years

Explain the NERVE SUPPLY to the Urinary Bladder

* PNS -- PELVIC SPLANCHNIC NERVES (S2-S4): motor to Detrusor muscle + relaxes Internal Urethral Sphincter to facilitate Micturition * SNS -- T11-L2/L3 VESICAL / PELVIC PLEXUS through Hypogastric Plexus: inhibits Micturition -- Contraction of Internal Urethral Sphincter + ejaculation of semen + prevents reflux of semen into the bladder * SOMATIC -- PUDENDAL NERVE contracts the External Urethral Sphincter.

Explain the Innervation of the PENIS

* POINT + SHOOT * ERECTION -- PNS - Pelvic Splanchnic nerves (S2-S4) -- Causes dilatation of branches of Central Artery of penis - leads to engorgement of erectile tissues (Corpora Cavernosa + Spongiosum) with blood * EMISSION -- SNS - Lumbar Splanchnic nerves (L1 + L2) -- Contract the smooth muscle of Ductus deferens + Ejaculatory duct + Seminal vesicles + Bulbourethral glands by which sperms are propelled into the urethra -- It contracts the Internal Urethral Sphincter to prevent RETROGRADE EJACULATION of Seminal fluid into the bladder * EJACULATION -- Somatic + Visceral innervation -- Somatic - PUDENDAL NERVES (S2-S4) -- Contract the BULBOSPONGIOSUS + ISCHIOCAVERNOSUS muscle to assist in erection -- Bulbospongiosus muscle assist in expulsion of semen.

What are the characteristics of the KIDNEYS?

* PRIMARY RETROPERITONEAL structures -- Right kidney is lower than the left due to the liver (from T12-L3) -- HILUM of the kidney is at L1-L2 (at the TRANSPYLORIC plane) - located in the Medial border -- Structures in the hilum from anterior to posterior: Renal Vein + Renal Artery + Renal Pelvis -- Renal Pelvis is in the Lower pole of the kidney - continuous with the Ureter -- Suprarenal / Adrenal Glands: secrete catecholamines + sex hormones

List the types of FOLLICLES present in the Ovarian Cortex

* PRIMORDIAL FOLLICLES: germ cells arrested in Prophase of Meiosis I * GROWING FOLLICLES (primary + secondary) * MATURE FOLLICLE (aka Graafian follicle) -- These are embedded in the Theca Internal + Theca Externa layers -- Follicles start developing in the middle - as they mature, they start moving to the periphery

What is the difference bw the PROLIFERATIVE + LUTEAL PHASE?

* PROLIFERATIVE -- UTERINE GLANDS: straight in superficial portion + branching in deeper region -- STRATUM FUNCTIONALIS layer increases in thickness -- COILED ARTERIES are only seen in deeper layers (have not reached the Endometrium) -- LAMINA PROPRIA becomes more cellular -- BASALIS CT is more compact + darker * LUTEAL / SECRETORY -- Starts after Ovulation -- FUNCTIONALIS LAYER becomes very thick + lightly stained - under the influence of LH -- Increase glandular secretion -- Glands will start to convolute as they get deeper into the layers -- Endometrium becomes thicker (hypertrophy + more uterine glands) -- Lumen becomes full of secretory products -- COILED ARTERIES extend to the Endometrium + become prominent -- Minimal changes in BASALIS LAYER * MENSTRUAL PERIOD -- The STRATUM FUNCTIONALIS has slugged off -- Endometrial lining is fresh for a new ovarian cycle.

What are the Histological Structures of the PROSTATE GLAND?

* PROSTATIC CAPSULE -- False: dense fibrous capsule (PELVIC FASCIA) -- true: PROSTATIC SHEATH * PROSTATIC VENOUS PLEXUS - in bw the capsules -- Continuous with PUBOPROSTATIC LIGAMENT (anteriorly) + RECTOVESICAL SEPTUM (posteriorly) * Structures of the gland -- GLANDULAR PART: 2/3 of the gland -- FIBROMUSCULAR PART: 1/3 of the gland

Structures seen from the Posterior wall of the MALE URETHRA

* PROSTATIC SINUS: -- Contains openings of Prostatic Ducts -- We see mixing of secretions from the Ductus Deferens + Seminal vesicles + Prostate

What are the divisions of the MALE URETHRA?

* PROSTATIC URETHRA -- Widest + most dilatable portion -- Benign Prostatic Hypertrophy leads to urinary retention in old age -- Where the Ejaculatory Duct opens -- Includes the External Urethral Sphincter (voluntary) * MEMBRANOUS URETHRA -- In the Urogenital Diaphragm -- Shortest + least dilatable portion * PENILE / SPONGY URETHRA -- Surrounded by Corpus Spongiosum -- Bulbourethral glands open into the Penile urethra -- Opens into the External Urethral orifice

Where is pain from URETERIC CALCULI felt?

* Pain is referred to T11-L2 dermatome (LUMBAR + INGUINAL REGION)

Diagram showing the AUTONOMIC INNERVATION of the Uterus + Vagina + Ovaries

* Pain sensation: to T11-L1 segments

List the differences bw the MALE + FEMALE BONY PELVIS

* Pelvic Outlet is large in females bc of parturition

What are the boundaries of the PERINEUM?

* Perineum contains: -- DEEP POUCH: towards the Pelvic Diaphragm -- SUPERFICIAL POUCH: towards the skin * SACROTUBEROUS LIGAMENT: connects the sacrum + Ischial tuberosity * UROGENITAL TRIANGLE: contains the perineal membrane + opening of Urethra in both sexes + vagina + root of the scrotum, penis and vestibule * ANAL TRIANGLE: contains the External Anal Sphincter + Ischioanal or Ischiorectal Fossa (on either side + related to the Ischial Tuberosity)

What are the relations of the URINARY BLADDER?

* Posterior surface + Base -- Females - anterior walls of uterus (rests over the bladder when it is empty) + cervix + anterior fornix + vagina -- Males: rectum -- Upper part is covered by Peritoneum, which forms the anterior wall of the RECTOVESICAL POUCH * Superior surface -- Covered by Peritoneum -- Related to the ileum + sigmoid colon * Inferolateral surface -- Related to Retropubic fat + pubic bones anteriorly. * Neck -- Males: rests on the Prostate Gland -- Females: in the Urogenital Diaphragm * Posteriorly -- Males: Rectovesical Pouch + Ductus Deferens + Seminal vesicles + Rectovesical fascia + Ampulla of the Rectum -- Females: bladder is separated from the Rectum by the Vagina -- Related to the Supravaginal part of the cervix * Laterally -- OBTURATOR INTERNUS muscle is above the Levator And muscle * Superiorly -- Females: related to UTEROVESICAL POUCH + Body of the Uterus

Diagram showing the Anterior + Posterior views of the PELVIS

* Posteriorly, the sacrum is fused with the Ilium through the SACRO-ILIAC JOINT.

What are the relations of the PELVIC GIRDLE?

* Posteriorly: sacrum + coccyx * On either side: pair of hip bones (ileum + ischium + pubis) * Anteriorly: Pubic Symphysis (secondary cartilaginous joint)

What is WILM'S TUMOR?

* Primary renal tumor (CANCER) affecting children by 5 years or fetus -- Cause: mutation in WT1 gene

What is the function of the MALE REPRODUCTIVE SYSTEM?

* Production + storage + nourishment + transmission of spermatozoa and hormones.

IVU (Intravenous Urography) image of a child with BLADDER EXSTROPHY

* Pt shows PUBIC DIASTASIS (separation of the Pubic Symphysis with no concomitant fracture) -- Lack of a well-formed bladder -- Ureters are seen escaping out on to the skin surface

In a PUDENDAL BLOCK, what nerves should be included?

* Pudendal nerve + Ilioinguinal nerves

What are the relations of the R + L URETER in the Abdomen?

* R URETER: -- Anterior - duodenum + terminal ileum + R ileocolic vessels + R gonadal vessels + root of mesentery -- Posterior - R psoas muscle + R common iliac artery * L URETER: -- Anterior - sigmoid colon + sigmoid mesocolon + L colic vessels + L gonadal vessels -- Posterior - L psoas muscle + L common iliac artery

What is RENAL FASCIA + CAPSULE and PARARENAL FAT?

* RENAL CAPSULE: thick fibrous CT that covers each kidney * RENAL FASCIA: surrounds kidney + suprarenal gland -- Covers PERINEPHRIC FAT (Perirenal Fat Capsule) -- it is continuous with the Renal Fat * PARARENAL FAT: bw the Renal Fascia and the Posterior abdominal wall -- Located posterior to the kidney

List the characteristics of the RENAL CORPUSCLE

* RENAL CORPUSCLE: glomerular capillaries + Bowmann's capsule -- This is where BLOOD FILTRATION takes place. -- Visceral layer of Bowmann's capsule has PODOCYTES (epithelial cells) - assist in Renal Filtration + it will create a FILTRATION BARRIER -- Outer (parietal) layer has SIMPLE SQUAMOUS EPITHELIUM - forms surface of the capsule -- URINARY SPACE: bw these 2 layers -- Poles: a) VASCULAR where afferent + efferent arterioles enter and leave. b) TUBULAR where PCT begins

What are the internal features of the Kidneys?

* RENAL SINUS: space within the hilum * RENAL CORTEX: surrounds the Renal Medulla + contains NEPHRONS (units of filtration) and renal Tubules * RENAL COLUMNS: bw the Pyramids * RENAL MEDULLA: contains Renal PYRAMIDS (renal tubules + collecting ducts) * RENAL PAPILLAE: at the apex of the renal Pyramid -- opens into the Minor Calyx * MINOR CALYX: receives urine from the Collecting Ducts * MAJOR CALYX: where several Minor calyx drain * RENAL PELVIS: point where Major Calyzes convey urine to the Proximal Ureter

Explain the Venous Drainage of the KIDNEYS

* RENAL VEINS drain into the IVC - L Renal Vein drains blood from the L gonad at perpendicular angles + L Suprarenal gland --- It is longer than the R Renal Vein --- L Renal vein passes in bw the SMA + Abdominal Aorta

What are the characteristics of the URETERS?

* RETROPERITONEAL -- Descend of the Ventral surface of the Psoas Major muscle -- Cross the Pelvic Brim at bifurcation of Common Iliac Vessels -- Courses on lateral wall of pelvic cavity -- Opposite to the Ischial Spine - curves medially to enter the Urinary Bladder -- Length: 25 cm * Divisions: -- Renal Pelvis -- Abdominal -- Pelvic

What is the role of the JG cells?

* Respond to decreased arterial P - leads to increased AUTONOMIC STIMULATION to the JGA (Juxtaglomerular Apparatus) as a result of baroreceptor function. -- JG cells release RENIN -- RENIN converts ANGIOTENSINOGEN into A1 -- ACE (Angiotensin-Converting Enzyme) converts A1 into A2 -- A2 is a potent VASOCONSTRICTOR + increases systemic BP + stimulates secretion of ALDOSTERONE from Adrenal Gland. -- Aldosterone promotes Na + H2O reabsorption in the DCT + Connecting Tubules - increases blood volume to help increase BP -- Return of normal BP turns off secretion of Renin by JG cells

List the NERVE SUPPLY of the Pelvis

* SACRAL SYMPATHETIC: L1-l3 - Sympathetics to Inferior Hypogastric Plexus * HYPOGASTRIC / Pelvic system of Plexus: receive SNS fibres via Lumbar Splanchnic + PNS fibres via Pelvic Splanchnic * SNS produces vasomotor + inhibit peristaltic contraction of the rectum + stimulates contraction of the genital organs during orgasm + stimulates ejaculation in males * PNS stimulates contraction of the rectum (defecation) + stimulation contraction of the urinary bladder (micturition) + innervate the Prostatic plexus - supply erectile bodies allowing erection during orgasm * PELVIC SPLANCHNIC: S2-S4 + PNS to Inferior Hypogastric Plexus + innervates handgun and pelvic reproductive organs * HYPOGASTRIC PLEXUS 1. SUPERIOR HP (Lumbar Splanchnic - L1-L3): formed only by SNS --- Branches into R/L Hypogastric nerves --- Convey pain from body of the uterus + urinary bladder + other pelvic organs 2. INFERIOR HP (PELVIC PLEXUS): --- SNS + PNS --- SNS conveys pain from pelvic organs --- PNS conveys pain from cervix + distension of hallow viscera for reflexes like micturition and defecation

What are the characteristics of the SCROTUM + TESTIS?

* SCROTUM -- Covered by skin + Dartos muscle + Superficial Scrotal Fascia -- Developed in the PERINEUM * TESTIS -- Developed in the abdomen -- L testis is slightly lower -- Epididymis is located at the posterior border -- Tunica Vaginalis: outermost covering derived from Peritoneum -- Tunica Albuginea: innermost covering -- Mediastinum of testis: where the Seminiferous tubules are + open into the Rete Testis -- Efferent Ductules enter the epididymis carrying sperm

What are the histological characteristics of the SEMINAL VESICLES?

* SEMINAL VESICLE -- Secrete yellow viscous alkaline fluid that nourishes + activates sperm - rich in Fructose + Vitamin C + Prostaglandins -- Constitutes 70% of volume of SEMEN -- The size of the gland varies with the Testosterone level * Layers: -- MUCOSA: PEUDOSTRATIFIED COLUMNAR epithelium + Lamina propria -- MUSCULARIS: inner circula + outer longitudinal layer -- ADVENTITIA: suspends the structure in the peritoneal cavity * SM: smooth muscle + expels secretions

What are the histological characteristics of the SEMINIFEROUS TUBULES?

* SEMINIFEROUS TUBULES -- Sertoli cells + spermatozoa are found inside the ST -- Leydig cells are found in the interstitium of the testis + outside the ST --- Secrete androgens (Testosterone) in response to LH from the Anterior Pituitary - responsible for male sexual characteristics --- REINKE CRYSTALS: rod-like cytoplasmic inclusions seen in Leydig cells * MATURE sperm are found in the lumen of the ST * IMMATURE sperm are found in the periphery of the ST

List some clinical correlates related to the URINARY BLADDER

* SPASTIC BLADDER -- Lesions of spinal cord ABOVE the sacral spinal cord levels -- Loss of inhibition of PNS that innervate the Detrusor Muscle during the filling stage -- Detrusor responds to MINIMAL STRETCH - it causes frequent urination * ATONIC BLADDER -- lesions of sacral spinal cord segments or sacral spinal nerve roots -- Loss of PELVIC SPLANCHNIC MOTOR INNERVATION + loss of contraction of the Detrusor muscle -- Results in full bladder with a continuous drilling of urine from the bladder * URINARY INCONTINENCE -- Results from weakness of External Urethral Sphincter

Explain Gene influence on INDIFFERENT GONAD formation in MALES

* SRY (Sex-determining Region on Y) gene produces TDF (Testis Determining Factor) -- Regulates male sexual development * SOX9 + SF1 (Steroidogenic Factor) -- Present downstream from SRY -- Differentiates SERTOLI + LEYDIG CELLS * SRY causes: -- Development of MEDULLARY (Testis) cords -- Formation of Tunica Albuginea -- Failure of Cortical (Ovarian) cords to develop * Absence of SRY - gonad becomes an ovary * The testis has NO Cortex

Explain the LYMPHATICS of the Female Reproductive System

* SUPERFICIAL INGUINAL NODES: drain most of the perineum

List the ACCESSORY GLANDS of the Male Reproductive System?

* Seminal Vesicles * Prostate * Bulbourethral glands (aka Cowper's glands)

What is the EXSTROPHY of the CLOACA?

* Severe ventral body wall defect -- More disruption in progression + closure of lateral body wall folds compared to Exstrophy of the Bladder -- Development of the URORECTAL SEPTUM is affected -- Genital swellings are widely spaced resulting in defects in external genitalia

What are the characteristics of the FEMALE URETHRA?

* Shorter than the Male Urethra (4 cm) - predisposes women to increased risk of UTI -- extends from neck of bladder to External orifice of the Vulva -- Anterior to the vagina -- URETHRAL GLANDS open via Para-urethral Duct on either side of the External Urethral orifice

What are the normal CONSTRICTORS of the Ureters?

* Site most commonly impacted by URETERAL STONES 1. URETOPELVIC JUNCTION: junction bw the ureter + renal pelvis 2. At the PELVIC BRIM: crossing the bifurcation of the Common Iliac Vessels 3. URETER-BLADDER: transversing the bladder

What are the boundaries of the ISCHIOANAL + ISCHIORECTAL FOSSA?

* Space bw the Anal Canal + Pelvic Diaphragm -- Located on either side of the anal orifice -- Bw the pelvic diaphragm + the skin -- Filled with fat + allows expansion of the lower rectum and anal canal during the passage of feces * Boundaries -- Laterally: Ischium + Obturator Internus w/ fascia + Pudendal Canal (pudendal nerve and artery) -- Medially: External Anal Sphincter + Levator Ani muscle w/ fascia -- Posteriorly: Sacrotuberous ligament + Gluteus Maximus muscle -- Anteriorly: pubic bones + inferior origin of the Puborectalis -- Base: skin + superficial fascia

What are the muscles of the DEEP PERINEAL POUCH?

* Sphincter Urethra - voluntary external urethral sphincter * Deep Transverse Perineal muscle A for females + B for males

Explain the LYMPHATIC DRAINAGE of the Urinary Bladder

* Superior part: to the EXTERNAL ILIAC * Inferior part: to the INTERNAL ILIAC

What are the boundaries of the SUPERFICIAL PERINEAL POUCH?

* Superiorly: Perineal Membrane * Inferiorly: Colle's Fascia * Lateral: Ischiopubic Ramus * Posteriorly: closed by fusion of the Perineal Membrane + Colle's Fascia * Anteriorly: open + continuous with the Superficial Inguinal space

What are the MESANGIAL CELLS?

* Support the capillaries of the Glomerulus -- Adjust contraction in response to BP changes (located beside the JG cells) -- Secretes CYTOKINES + PROSTAGLANDINS to help repair the Glomerulus -- Phagocytic: engulf Debra accumulated during filtration -- Foot processes are seen on the Visceral layer of the Bowmann's capsule -- FENESTRATED CAPILLARIES - allow filtration

Explain the DESCENT OF TESTIS

* TESTIS develop in the Lumbar region (posterior abdominal wall) -- Descent is guided by GUBERNACULUM (it shortens during descent) * PROCESSUS VAGINALIS -- Invagination of the peritoneum that extends from the Peritoneal Cavity -- Passes through the Inguinal Canal -- Connection bw the PV with the Peritoneal Cavity closes BEFORE birth - if it doesn't close, it leads to a CONGENITAL / INDIRECT HERNIA -- Lower part forms the TUNICA VAGINALIS * Descent: -- 3rd month: at Iliac Fossa -- Up to 7th month: rests at Deep Inguinal Ring -- During 7th month: transverses Inguinal Canal -- At the end of 8th month: into the scrotal swellings.

Characteristics of the TRIGONE of the Urinary Bladder

* TRIGONE: base of the bladder -- SUBMUCOSA is absent -- Bladder is lined by TRANSITIONAL EPITHELIUM -- INTERNAL URETHRAL SPHINCTER is Involuntary -- EXTERNAL URETHRAL SPHINCTER is Voluntary + present in the UROGENITAL DIAPHRAGM in both males and females.

What are the histological characteristics of the TESTIS?

* TUNICA VAGINALIS: derived from the Peritoneum -- Capsule for the testis * TUNICA ALBUGINEA: thick fibrous CT capsule * TUNICA VASCULOSA: vascular layer of loose CT -- Hard to discern * EPIDIDYMIS -- Tubules are surrounded by BVs and Lymphatics

Explain the stages of KIDNEY development

* The Intermediate Mesoderm forms the NEPHROGENIC CORD from the Dorsal Body wall -- Occurs in a cranio-caudal sequence * PRONEPHROS: develops at week 4 -- Not functional -- It completely regresses * MESONEPHROS: develops at week 5 -- Functional for a short period of time -- Completely regresses except the MESONEPHRIC (WOLFFIAN) DUCT --- In males, it forms the Epididymis + Ductus Deferens + Ejaculatory duct (from the Testis to the Prostatic Urethra) --- In females, it disappears * METANEPHROS: develops at week 5 -- It forms the adult definitive Kidney

Image of the INTERNAL FEMALE REPRODUCTIVE ORGANS

* The Uterus is seen from above -- Uterine Tubes are coming back + connect with the Ovaries

Where does the excretory duct of the Urinary + Genital systems open into?

* They open into a common cavity called the CLOACA -- Happens during the 3rd week of development

What are the histological characteristics of the VAS DEFERENS?

* Thick muscular layer - inner longitudinal + middle circular + outer longitudinal layers -- Narrow lumen -- Lined by PSEUDOSTRATIFIED COLUMNAR epithelium * EJACULATORY DUCT forms from Vas Deferens + Seminal Vesicle -- It does NOT have a MUSCULAR wall -- It terminates at the Prostatic Urethra

What are the HISTOLOGICAL characteristics of the KIDNEYS?

* Thick outer cortex - covered by thin fibrous capsule -- Renal corpuscle + Convoluted tubules * MEDULLA: 8-12 renal pyramids

What are the histological characteristics of a PRIMORDIAL FOLLICLE?

* This is the very first stage of development.

List some BLADDER DEFECTS

* URACHAL FISTULA -- Allantois persists -- Allows direct communication bw the Urinary Bladder + Umbilicus -- urine will drain through the umbilicus * URACHAL CYST -- Part of the Allantois fails to disappear + it develops into a cystic dilatation * URACHAL SINUS -- Upper part of the Allantois fails to disappear -- It opens at the umbilicus

What are the histological characteristics of the URETHRA?

* URETHRA drains the bladder -- Lined by STRATIFIED COLUMNAR + PSEUDOSTRATIFIED COLUMNAR EPITHELIUM * Males: -- PROSTATIC URETHRA: in the Prostate Gland + lined with Transitional epithelium -- MEMBRANOUS URETHRA: passing through the Urogenital Diaphragm -- PENILE URETHRA * Women: -- 4-5 cm -- Lined by Stratified Squamous (at the orifice) + Pseudostratified Columnar epithelium -- NO Transitional epithelium is seen in the urethra

What are the histological characteristics of the URINARY BLADDER?

* UROTHELIUM is surrounded by lamina propria + SUBMUCOSA -- Lamina propria + dense irregular CT are highly vascularized * MUCOSA -- Transitional epithelium -- Lamina propria: supporting CT * MUSCULARIS -- aka DETRUSOR MUSCLE -- Inner longitudinal layer -- Middle circular layer -- Outer longitudinal layer * ADVENTITIA -- Covers all urinary passages externally * SEROSA -- ONLY covers the upper part of the bladder * The URETHRA pierces the Urinary Bladder

Explain the BLOOD SUPPLY of the Uterus + Vagina + Uterine Tubes + Ovaries

* UTERINE ARTERY is a branch of the Internal Iliac artery -- Supplies the Uterus + upper part of the Vagina + medial part of the Uterine Tubes -- Same with veins * INTERNAL PUDENDAL ARTERY is a branch of Internal Iliac artery -- Supplies the lower part of the Vagina -- Same with veins * OVARIAN ARTERY is a branch of the Abdominal Aorta -- Supplies the ovaries + lateral part of the Uterine tubes * RIGHT OVARIAN VEIN is a branch of the IVC * LEFT OVARIAN VEIN is a branch of the Left Renal Vein * Arteries to the Uterine Tubes anastomose in the Mesosalpinx

What are the relations of the Vagina?

* UTERINE ARTERY passes bw the Broad Ligament + Transverse Cervical ligament

Explain the development of the UTERUS + UTERINE TUBE + VAGINA

* UTERUS -- Formed by fusion of the CAUDAL end of the PARAMESONEPHRIC / MULLERIAN Ducts - it forms the Uterovaginal canal, which later forms the Uterus -- Epithelium is from the fused Paramesonephric Ducts -- Myometrium develops from the surrounding Mesoderm * UTERINE TUBE -- Formed from unfused part of CRANIAL Paramesonephric Ducts * VAGINA -- Upper part: formed from CAUDAL end of the Paramesonephric Duct -- Lower part: from the Urogenital Sinus

What type of surgery could cause STERILIZATION in males?

* VASECTOMY -- Bilateral ligation of the Vas Deferens -- Spermatogenesis ceases immediately + reappears after a few weeks -- Ejaculated fluid only contains secretions from the Seminal Vesicles + Prostate + Bulbourethral Glands

What is the EXSTROPHY of the BLADDER?

* Ventral body wall defect -- Due to failure of the lateral body wall folds to close in the midline in the Pelvic region -- EPISPADIAS: exposure of the mucosa of the bladder to the exterior. --- Open urinary tract extends along the dorsal aspect of the penis through the bladder to the umbilicus

Explain the molecular mechanism of kidney development

* WT1 is a Transcription Factor that makes the mesenchyme competent to respond to the ureteric bud -- WT1 is an oncogene -- GDNF: Glial cell line derived neurotrophic factor -- HGF + GDNF produces higher branching of ureteric buds near the mesenchyme.

Explain gene influence on INDIFFERENT GONAD formation in FEMALES

* WTN4: master gene -- Upregulates DAX1 - inhibits expression of SOX9 * WTN4 causes formation of ovaries with: -- Typical CORTICAL (Ovarian) cords -- Disappearance of the Medullary (Testis) cords -- Failure of the Tunica Albuginea to form * Ovaries have a Cortex where all the Primordial Follicles are present + the Medulla is NOT differentiated (only BVs are present here)

What are the histological characteristics of the UTERUS?

* Wall consists of: 1. ENDOMETRIUM: lined by SIMPLE COLUMNAR epithelium + Lamina Propria -- Epithelium extends into the CT of the Lamina propria + forms the UTERINE GLANDS -- FUNCTIONALIS LAYER -- BASALIS LAYER 2. MYOMETRIUM: w/ smooth muscle layers 3. PERIMETRIUM: w/ Adventitia -- SPIRAL ARTERIES degenerate + regenerate during the cycle -- Very thick Myometrium + thin Perimetrium -- BVs come into the Myometrium - they extend into the Endometrium -- Uterine gland start in the Endometrium + extend downwards into the Myometrium

What happens to the INDIFFERENT GONADS from weeks 4-12?

* Weeks 4-6 -- PRIMITVE SEX CORDS are formed -- cells of the Genital Ridge invade the Mesenchyme * Weeks 7-8 -- Indifferent Gonads begin to differentiate into testis or ovaries * Weeks 9-12 -- External genitalia of males and females are different * These changes are seen in Gonads/Primitive sex glands + Genital Ducts + External Genitalia in both males and females

What is the TRANSFORMATION ZONE in the Female Reproductive Tract?

* Zone bw the Endocervix + Vagina -- The epithelium changes

What are the BULBOURETHRAL GLANDS? Function?

* aka Cowper's glands -- Found within the UROGENITAL SINUS (separates the pelvic organs from the Perineum) on either side of the urethra -- Empty into Spongy or Penile Urethra * Function: produce mucus for lubrication + neutralization of traces of acidic urine

What is the importance of the UTERINE TUBES? What are other names for it?

* aka Fallopian tubes + Oviducts -- INTRAMURAL PART opens into the Fundus of the uterus -- ABDOMINAL OSTIUM: opens into the abdominal cavity * Importance: -- Before fertilization, we see transport of ovum + sperms -- AMPULLA: site of fertilization

What is RENAL DYSPLASIA?

* aka MULTICYSTIC (POLYCYSTIC) DYSPLASTIC KIDNEY -- Numerous ducts are surrounded by undifferentiated cells -- Nephrons fail to develop -- Ureteric Bud fails to branch - Colletinc Ducts NEVER form ** These defects cause involution of the kidney and Renal agenesis (one or borth kidneys fails to develop)

What is ECTOPIA TESTIS?

*Abnormal position of testis

What are the Relations of the UTERUS?

- There is a PERITONEAL REFLECTION in the female pelvis -- Reflects over the superior surface of the bladder - VESICOUTERINE POUCH: bw the Urinary Bladder + the Uterus - RECTOUTERINE POUCH: bw the Uterus + Rectum -- aka POUCH OF DOUGLAS -- This pouch is deeper -- Collections in this pouch can be drained through the POSTERIOR FORNIX of the vagina

What are the characteristics + parts of the CERVIX?

-- 2.5 cm long * INTERNAL OS: connects to the Uterus * EXTERNAL OS: connects to the vagina * Parts: -- SUPRAVAGINAL PART: --- Anteriorly: Urinary bladder --- Posteriorly: Rectouterine pouch -- VAGINAL PART

What are the characteristics + Coverings of the SPERMATIC CORD?

-- Begins at the DEEP INGUINAL RING lateral to the Inferior Epigastric vessels -- Passes through the Inguinal Canal + exists the Superficial ring + ends in the scrotum at the testis * Coverings: -- INTERNAL SPERMATIC FASCIA: from Transversalis Fascia -- CREMASTERIC FASCIA (Cremaster Muscle): from the IAO --- Reflex: maintains T of the testis for spermatogenesis -- EXTERNAL SPERMATIC FASCIA: from EAO

What are the histological characteristics of the PROSTATE GLAND?

-- Covered by a FIBROELASTIC CAPSULE w/ smooth muscle -- Septa from the capsule divides the gland into LOBES -- Surrounds Prostatic Urethra -- Contains 3-50 small glands that empty their secretions into the Urethra --- Secretion helps liquify coagulated semen after deposited in the Female Genital Tract --- Helps form the volume of SEMEN -- Lined by PSEUDOSTRATIFIED COLUMNAR epithelium * CORPORA AMYLACEA - small hyaline masses of unknown significance found in the prostate gland + neuroglia + pulmonary alveoli.

What are the characteristics of the PROSTATE GLAND?

-- Fibro-muscular-glandular organ -- Corresponds with development of PARAURETHRAL GLANDS in females -- Secretions form part of SEMEN -- It surrounds the Prostatic Urethra at the neck of the Urinary Bladder -- Apex lies superior to the Urogenital Diagram -- It is pierced posteriorly by the EJACULATORY DUCTS -- Posterior surface of the gland is related to the Rectovesical Pouch + Ampulla of the Rectum

What are the histological characteristics of the VAGINA?

-- Fibromuscular tube * Layers -- INNER MUCOSA: w/ STRATIFIED SQUAMOUS NON-KERATINIZED epithelium. -- MIDDLE MUSCULARIS -- EXTERNAL ADVENTITIA -- Surrounded by SKELETAL MUSCLE + a sphincter at its orifice

What are the characteristics of the EPIDIDYMIS?

-- Formed by convolutions of the duct of the Epididymis -- Found in the posterior border of the testis -- EFFERENT DUCTULES transport newly formed sperm to the Epididymis * Function: -- Stores sperms until MATURATION * Parts: -- Head: with 12-14 convoluted tubules -- Body: is the convolute duct of the epididymis -- Tail: continues with the Ductus Deferens

Explain the HYSTEROSALPINGOGRAM procedure

-- Hysterus: means Uterus -- Salpingo: means tubes -- The dye should spill into the Peritoneal Cavity - it means that the Uterine tube is patent. -- Usually done as a fertility test

What are the characteristics of the PERINEAL BODY? What muscles does it attach to?

-- Irregular fibromuscular mass -- Located bw Urogenital triangle + Anal triangle -- Anteriorly: blends with Perineal Membrane -- Contains collagenous + elastic fibres with skeletal + smooth muscle -- In females - it is called the GYNECOLOGICAL PERINEUM (it gives support to the uterus) ** Muscles attached: -- Levator Ani -- 2 Deep Transverse Perinei -- Sphincter Urethra -- 2 Bulbospongiosus muscles -- 2 Superficial Transverse perinei -- External Anal Sphincter

What are the characteristics of the UROGENITAL DIAPHRAGM + components + function?

-- It is a musculofascial partition across the Pubic Arch -- Forms the Deep Perineal Space of the Perineum -- Urethra and Vagina pierce through this diaphragm * Components: -- 2 muscles + 2 fascia -- Deep Transverse Perineal muscle -- Sphincter Urethral muscle * Function: -- Support the prostate + urinary bladder -- Constricts the vagina -- Fixes the Perineal body -- Involved in voluntary control of micturition

What are the SEMINAL GLANDS / VESICLES? Function?

-- Lies at the posterior surface of the bladder -- Joins the Vas Deferens to form the EJACULATORY DUCTS - open into the Prostatic Urethra * Function: -- Secretes alkaline fluid rich in fructose - added to the seminal fluid

What are the characteristics of the UTERINE TUBES?

-- Lined by CILIA to allow transport * 2 openings: -- Opening of the Abdominal Ostium: during ovulation, the Secondary Oocyte is released + Fimbriae swipes the ovum into the Uterine Tube -- Opening to the Fundus of the Uterus -- If there is an ECTOPIC PREGNANCY, it could happen in the Pouch of Douglas.

What are the boundaries of the DEEP PERINEAL POUCH?

-- Located above the Perineal Membrane -- Closed on all sides * Boundaries: -- Above: Superior Fascia of the Urogenital Diaphragm -- Below: Perineal Membrane (aka Inferior Fascia of the Urogenital Diaphragm) -- Lateral: Ischiopubic Ramus -- behind: closed by the fusion of the Perineal Membrane + Superior Fascia of the Urogenital Diaphragm

What are the characteristics of the PUDENDAL NERVE?

-- Located in the PUDENDAL (ALCOCK) CANAL * Carries SOMATIC SENSORY from: -- Most of the skin of the Perineum except the small area in front of the scrotum + anterior Labia Majora (supplied by Ilioinguinal nerve - L1) -- Anal canal below the Pectinate Line * Carries SOMATIC MOTOR from: -- Urogenital Diaphragm -- Sphincter Urethra: assist in voluntary urinary continence -- External Anal Sphincter: assists in voluntary fecal continence -- Ischiocavernous + Bulbospongiosus muscles: maintain penile + clitoral erectioj -- Contraction of Bulbospongiosus: helps emptying of urine from the Penile Urethra + the expulsion of seminal fluid during Ejaculation -- Muscles of Urogenital Triangle * It enters the Greater Sciatic Notch

What are the characteristics of the OVARIES?

-- Pair of female gonads located in the posterior surface of the BROAD LIGAMENT (in the Meso-ovarian) * CORTEX: contains Follicles at various stages -- The remaining Graafian follicle will form the Corpus Luteum (secretes Progesterone) -> becomes Corpus Albicans is there is NO pregnancy. -- If there is pregnancy, Progesterone is produced to maintain the placenta. -- Corpus Luteum maintains the PROLIFERATIVE PHASE of the Uterus - if it is NOT present, the Endometrium will shed.

What are the histological characteristics of the BULBOURETHRAL (COWPER) GLANDS?

-- Paired glands located in the Urogenital Diaphragm + next to the Membranous Urethra -- Lined by SIMPLE CUBOIDAL + COLUMNAR epithelium -- Surrounded by a FIBROELASTIC CAPSULE -- Empty secretions in the Membranous Urethra

What are the histological characteristics of OVARIES?

-- Paired gonads covered by SIMPLE CUBOIDAL epithelium -- Covered by TUNICA ALBUGINEA + DCT capsule * Function: OOGENESIS - to form oocytes + ovum

What are the characteristics of the UTERUS?

-- Pear-shaped -- 8 cm long + 5 cm wide -- Supported by the PELVIC DIAPHRAGM * Parts: Fundus + body + isthmus (connects the body and the cervix) + cervix * Uterine wall: Perimetrium + Myometrium (develops the Placenta Previa) + Endometrium (where implantation occurs)

What are the constituents of the CORPUS LUTEUM?

-- Richly vascularized temporary endocrine gland -- Secretes PROGESTERONE to maintain pregnancy * Cells 1. GRANULOSA LUTEIN CELLS: -- Produce Progesterone -- Convert Androgens to Estrogen through AROMATASE -- Cytoplasm contains yellow pigment 2. THECA LUTEIN CELLS: -- Produce Progesterone + Androgens * CORPUS ALBICANS: remnant of degenerated Corpus Luteum + seen when there is NO pregnancy

What are the signs and symptoms of PROSTATIC ENLARGEMENT)?

-- Seen after middle age - BENIGN PROSTATIC ENLARGEMENT / HYPERTROPHY (BPH) -- The Median lobule enlarges + obstructs the Internal Urethral Orifice -- Impedes urination by compressing the Prostatic Urethra * Prostatic tissue is influenced by DHT -- Increased density of DHT-BPH is seen in these cases

What are the signs and symptoms of PROSTATIC CANCER?

-- Seen at >55 yoa in the Posterolateral region + Posterior lobe + PZ (Peripheral Zone) -- Metastasis - seen to Iliac nodes + Sacral lymph nodes + Batson's plexus (Internal Vertebral Venous plexus) * RECTAL EXAMINATION is often done

What are the functions of the Sertoli cells?

-- Sertoli cells are found inside the Seminiferous Tubules * Nourish spermatogenic cells * Forms BTB (Blood Testis Barrier) through Tight Junctions -- Protects developing sperm from autoimmune reactions in the body * Allows phagocytosis of debris * Secretes ABP (Androgen-Binding Protein) in response to FSH * Secreted MIS (Mullerian Inhibiting Substance) in fetal life -- To suppress Female genital tract development

What is the PELVIC DIAPHRAGM?

-- Skeletal muscle = Pelvic floor -- Supports pelvic viscera (especially, in the female) -- Separates the Pelvic Cavity from the Perineum -- It has an aperture (GENITAL HIATUS) for passage bw the pelvis + Perineum -- Muscles here receive Somatic Innervation from the Sacral Plexus (S2-S4)

What is the course + relations of the DUCTUS DEFERENS? Explain its arterial supply

-- Thick cord - 45 cm long -- Develops from the MESONEPHRIC DUCT * Course + Relations -- Begins from tail of epididymis -- Main constituent of the Spermatic Cord -- Transverses the Inguinal Canal along with Testicular veins + arteries of the Vas Deferens -- Crosses over the External Iliac vessels + enters the pelvis -- Crosses superior to the terminal part of the ureter (near posterolateral angle of the bladder) -- Passes posterior to base of the bladder + medial to seminal vesicle -- Forms AMPULLA before its termination -- Joins the duct of the Seminal Vesicle to form the Ejaculatory Duct + opens into Prostatic Urethra * Arterial supply -- Artery of the Vas Deferens - branch of SUPERIOR VESICAL ARTERY (branch of the Internal Iliac artery)

What are the characteristics + attachments of the PERINEAL MEMBRANE?

-- This is the inferior fascia of the Urogenital Diaphragm -- Stretched across the PUBIC ARCH -- Located bw the Superficial + Deep PERINEAL POUCH -- Triangular in shape -- Perforated by the urethra in both sexes + by the vagina in females -- In males: it is tough + attaches the root of the penis and associated muscles * ATTACHMENTS: -- Inner surface of the ISCHIOPUBIC RAMUS on either side -- TRANSVERSE PERINEAL LIGAMENT is formed in front by the thicket Perineal Membrane -- To COLLE'S FASCIA (aka PERINEAL FASCIA) posteriorly -- To Inferior Fascia of the Pelvic Diaphragm -- To the Superior Fascia of the Urogenital Diaphragm

List the types of PELVIS FRACTURE that may occur

1. AP COMPRESSION: fracture of Pubic Symphysis + Pubic rami 2. LATERAL COMPRESSION: fracture of Pubic Rami + Ala of the Ileum 3. OPEN BOOK FRACTURE: disruption of the Pubic Symphysis 4. STRADDLE FRACTURE: fracture of superior and inferior Pubic Rami + it is very unstable

What are the parts of the PROSTATE GLAND?

1. Apex 2. Base 3. Anterior surface: RETROPUBIC SPACE 4. Posterior surface -- Pierced by Ejaculatory Duct -- Related to AMPULLA of the Rectum (important for rectal examination) 5. Inferolateral surface: with LEVATOR ANI muscle

X-Rays showing the Urinary system *

1. HORSESHOE KIDNEY -- Distal poles of the kidneys are fused -- Kidneys stayed at the level of the IMA -- Multiple arteries are seen with dilated calyxes -- Kidneys have to ascend to T12-L3 2. MALE URETHRA

What is the blood supply to the Kidneys?

1. Renal artery 2. Interlobal artery 3. Arcuate arteries 4. Small interlobular arteries or Cortical Radiate arteries 5. Afferent arterioles: towards the glomerulus 6. Glomerulus 7. Efferent arterioles: away from the glomerulus 8. Peritubular capillaries: aka Vasa Recta + give nutrients to the Loop pf Henle * Cortex gets 90% of the blood supply, while the Medulla gets 10%

A 34 yo woman is at her third stage of delivery. The obstetrician is concerned that the pelvic canal is too narrow for a vaginal delivery. Which of the following dimensions is the most reliable determinant of the capacity for a vaginal birth? a. Transverse diameter b. Interspinous distance c. True conjugate diameter d. Diagonal conjugate e. Oblique diameter

B * The INTERSPINOUS DISTANCE is the distance bw the Ischial Spines. This is usually the shortest distance, therefore being the most restricted are along the birth canal. The true conjugate diameter is the AP distance and does NOT change. The Transverse diameter, Oblique diameter and Diagonal conjugate diameter can change slightly during pregnancy, but the Interspinous distance changes the most during birth; plus, it is more easily measured.

Primary oocyte remains arrested in which of the following stages? a. Anaphase of meiosis I b. Metaphase of meiosis II c. Prophase of meiosis I d. Metaphase of meiosis I e. Prophase of meiosis II

C * Primary oocytes will remain until post-menopause

Maturation of sperms begins at which of the following stages? a. Before birth b. Just after birth c. Just before birth d. At puberty

D

Contraction of which of the following muscles facilitates the emptying of urine from the penile urethra? a. Iliococcygeus b. Ischiococcygeus c. Coccygeus d. Bulbospongiosus e. Superficial transverse perineal

D -- Bulbospongiosus muscle assists in emission

In males - at puberty, which of the following stage the gamete will be? a. Primary spermatocyte b. Secondary spermatocyte c. Spermatid d. Primordial germ cell e. Spermatogonia

D * Primordial Germ Cells remain dormant until puberty

When do the INDIFFERENT GONADS start developing?

The INTERMEDIATE MESODERM starts developing at 3 weeks -- The Germ Layers are formed