Male Internal Genitalia
epididymitis
Epididymitis, inflammation of the epididymis from infectious or chemical (urine) causes
nausea when kicked in the nuts?
Some visceral afferents also likely travel with the vagus nerve which can explain the nausea and vomiting that sometimes accompanies severe testicular pain.
The testicle also receives small branches from the ________________
cremasteric artery and the artery of the ductus deferens.
testicular torsion
Testicular torsion is a medical emergency since compromised blood flow to the testicle can result in death of the tissue after a few hours. Males with a "bell-clapper" deformity where the tunica vaginalis completely surrounds the testis are predisposed to this condition since the testis is "free-floating" and more likely to twist on its cord.
what is the tunica vaginalis?
The cavity of the tunica vaginalis is a blind-ended remnant of the processes vaginalis derived from the peritoneum during descent of the testicle. The tunica vaginalis normally does not totally surround the testicle, leaving the posteriolateral part of the testicle in contact with the epididymis and through that, to the scrotal wall.
drainage of Right testicular v. and left testicular v.
Typically, the right testicular vein drains into the inferior vena cava while the left testicular vein drains into the left renal vein. (At the deep inguinal ring, the pampiniform plexus typically consolidates into two veins which then become one vein on each side.)
function of epidydimis -
storgge and maturation site of sperm
primary artery to seminal vesicles? main supply of prostate? supply for the bulbourethral glands?
superior vesical artery. inferior vesical artery the artery of the bulb of the penis (branching from internal pudendal a. deep in perineal space
visceral afferents accompany the sympathetics and have their neuron cell bodies in:
DRG of T10-T11
prostatic plexus of nerves
A subdivision of the pelvic plexus, the prostatic plexus of nerves, contains both sympathetic and parasympathetic components, as well as sensory fibers. Besides innervating the prostate gland, nerves in this plexus also help innervate the bladder, urethra, and penis. Damage to these nerves during prostate surgery can lead to incontinence and/or impotence.
lymph drainage from ductus deferens EXTERNAL to the pelvis from ductus deferense WITHIN pelvis from seminal vesicles and prostate?
- travel with testicular lymphatics and reach aortic and pre aortic nodes - within pelvis: travel to internal and external iliac nodes. - mainly to internal iliac lymph nodes
Arteries that supply the male genital organs and where they arise from! (6)
1. testicular artery - from abdominal aorta 2. cremasteric artery (from inferior epigastric artery) 3. artery of ductus deferens (usually from superior vesical artery) 4. superior vesical artery (from umbilical artery) 5. inferior vesical artery (from anterior branch of internal iliac) 6. artery of the bulb of the penis (from internal pudendal artery)
Pain info for prostate
Pain information from the prostate travels back to sacral spinal cord levels, accompanying parasympathetic fibers since the prostate is below the pelvic pain line.
mediastiunum testis
The connective tissue from the tunica albuginea penetrates the testicle at its posterior aspect to form an area termed the mediastinum testis. Connective tissue septa extend from the mediastinum testis to delineate lobules where highly coiled seminiferous tubules lie that produce sperm. At the end of each seminiferous tubule is a straight tubule that connects to a network of epithelial-lined channels in the mediastinum testis termed the rete testis. Leaving the rete testis are 12 -15 efferent ductules that penetrate the tunica albuginea and help form the initial part of the epididymis.
structure of epidydimis
The efferent ductules that arise from the rete testis and penetrate the tunica albuginea become a coiled mass of tubules that form the head (caput) of the epididymis, the most superior part of this structure. These empty into a single, highly coiled duct which descends as the body (corpus) of the epididymis and most inferiorly as the tail (cauda) of the epididymis which is continuous with the ductus deferens. The lower part of the tail of the epididymis is connected to the testis with fibrous tissue. Attached to the head of the epididymis frequently is the appendix epididymidis, a remnant of the mesonephric duct, that, like the appendix testes, can cause scrotal pain if it undergoes torsion on its stalk.
coverings of spermatic cord
The external spermatic fascia arises from the external abdominal oblique aponeurosis and its investing fascia. Deep to this is the cremaster muscle, which is a slip of skeletal muscle from the inferior aspect of the internal abdominal oblique that is innervated by the genital branch of the genitofemoral nerve and functions to elevate the testes. Surrounding the cremaster muscle in this layer of the spermatic fascia is the cremasteric fascia derived from the investing fascia of the internal abdominal oblique. The internal spermatic fascia arises from the transversalis fascia.
Preferred site for testicular biopsies?
The middle of the testis has fewer vessels than either the upper or lower pole which is why its preferred
seminal vesicle - what type of fluid do they produce?
The paired seminal vesicles are externally lobulated glands, similar in size and shape to the small finger which are bluntly rounded superiorly and becomes tapered inferiorly. They produce an alkaline fluid, high in fructose and containing prostaglandins and other molecules that forms a significant fraction (about 60%) of the ejaculated semen.
Benign Prostatic Hyperplasia - zone primarily involved
The prostate gland increases in size at puberty and then increases in size again starting at about 25 years of age. Up to 90% of men in their 70's and 80's have signs of benign prostatic hyperplasia (BPH). The transitional zone of the prostate is primarily involved in BPH. Due to the association of this part of the prostate to the prostatic urethra, BPH leads to many conditions associated with obstruction of the urethra, urine stagnation in the bladder, and backflow of urine into the ureters and kidneys.
Location of seminal glands what encloses them?
The seminal glands are enclosed by endopelvic fascia and lie against the fundus of the urinary bladder, lying lateral to the ampullae of the ductus deferens with their superior ends diverging laterally forming a "V-shaped" arrangement. Their superior portion lies posterior to the terminal part of the ureters. Posterior to the seminal vesicles lies the rectovesical septum and then the rectum.
What is there terminal portion of the ductus deferens called and what are its characteristics?
The terminal portion of the ductus deferens which is closely associated with the fundus of the bladder is tortuous and dilated and is termed the ampulla of the ductus deferens
blood supply to epididymis
The tiny artery of the ductus deferens usually arises from the superior vesical artery. This artery is closely applied to the ductus deferens and anastomoses with a branch from the testicular artery near the testis. Both the testicular artery and the artery to the ductus deferens supply blood to the epididymis.
venous drainage from prostate gland spread of prostatic cancer to vertebral column and CNS
The venous blood from the prostate gland drains into the prostatic venous plexus which lies within the prostatic sheath mainly on the anterior and lateral aspects of the prostate. The deep dorsal vein of the penis empties into the prostatic venous plexus which drains into the internal iliac veins. This plexus communicates superiorly with the vesical venous plexus and posteriorly with the internal vertebral venous plexus - this later connection explaining how prostatic cancer can spread to the vertebral column and central nervous system.
venous drainage from ductus deferens
Veins from the ductus deferens drain regionally, with the part in the scrotum and within the spermatic cord draining into the pampiniform plexus and the pelvic portion of the ductus deferens, along with the seminal vesicles, draining their blood to the vesical venous plexus near the bladder.
spermatocele
a benign accumulation of sperm in the epididymis, typically in the head of the epididymis on the superior aspect of the testicle.
variocele
a dilation of the pampiniform plexus of veins within the scrotum. Varicocele is much more common on the left side, likely due to anatomical factors including the angle at which the left testicular vein enters the left renal vein, and the increased pressure in the vein from compression on the left renal vein due to its location between the superior mesenteric artery and the aorta (ie. the "nutcracker effect").
Sympathetic input to ductus deferens, seminal vesicles and prostate gland originate in _____a___spinal cord levels. These sympathetic fibers then pass to ____b__ plexus where any sympathetic fibers that are still preganglionic synapse in small ganglia
a. L1-L2 b. inferior hypogastric
Ductus deferens conveys sperm from ___a__ to _b____
a. epididymis b. prostatic urethra (after merging at its termination with the duct from the seminal vesicle to form the ejaculatory duct)
prostate gland the base of the prostate lies _____a-_____ to the urinary bladder with the prostatic urethra passing through the gland. The APEX of the prostate lies a bit ___b___ the perineal membrane.
a. inferior b. above c
The prostate makes a thin milky alkaline fluid that makes up about 30$ of volume of semen There are about 20-30 prostatic ducts that empty into the _____a____ found in the posterior prostatic urethra, on either side of the ____b____
a. prostatic sinus b. seminal colliculus
Posterior to the prostate is the _____a_____ and through that, the ampulla of the rectum. Anterior to the prostate lies ____b____ with the two connected by the puboprostatic ligaments. Lateral to the prostate lies the ____c______and ____d_____
a. rectovesical septum (Denonvillier's fascia) b the inferior part of the pubic symphysis c. levator ani muscle d. endopelvic fascia
Ejaculatory ducts formed by convergence of? ___a___ Most of the course is within the prostate gland. The opening for the ejaculatory ducts lie: _____b_____
a. the duct of the seminal vesicle and the termination of the ductus deferens on each side, posterior to the neck of the bladder. b. The openings for the ejaculatory ducts lie near to the prostatic utricle on the seminal colliculus within the prostatic urethra.
Bulbourethral glands (cowpers)
are paired, pea-sized mucous glands located in the deep perineal space, posterolateral to the membranous urethra, encircled by fibers from the external urethral sphincter.
Lymphatic drainage of tests and epididymis
drains into lumbar (aortic) and pre-aortic lymph nodes in abdomen via lymphatics along testicular vessels.
contents of spermatic cord
ductus deferens and its artery, testicular artery, pampiniform plexus of veins surrounding testicular artery, cremasteric artery, autonomics to smooth muscle of blood vessels and ductus deferens, genital branch of genitofemoral nerve (from ventral rami of L1-L2) which innervates cremasteric and is sensory to scrotum, lymphatics
testicular arteries arise from abdominal aorta _____ to the renal arteries and at ____ vertebral level. They cross ______ to the abdominal ureter
inferior to renal arteries L2 vertebral level anterior They pass inferiorly, cross anterior to the abdominal ureter, travel through the deep inguinal ring and the inguinal canal, to emerge within the spermatic cord, surrounded by the pampiniform plexus of veins.
preganglionic sympathetic neurons for testes are in ____________. These sympathetic neurons send their processes out via ventral roots, white rami, through the sympathetic trunk and lesser splanchnic nerve to the region of the aorticorenal ganglia, where they synapse on postganglionic sympathetic neurons. The postganglionic fibers accompany the testicular vessels to the testicles and epididymis.
lateral horn at T10-T11
zones of prostate
more current way The central zone (anteromedial and superiomedial lobules) forms about 25% of the gland and surrounds the ejaculatory ducts, is cone-shaped, and extends up to the base of the bladder. The peripheral zone (inferoposterior and inferolateral lobules) makes up about 70% of the glandular tissue and lies posterior, lateral, and inferior to the central zone. The small transitional zone, which constitutes about 5% of the glandular tissue, is bilobed and surrounds much of the urethral above the level of the ejaculatory duct. The anterior region (isthmus of prostate) is primarily fibromuscular.
Where do most prostate cancers originate?
most common visceral type of cancer in men. One in six men will be diagnosed with prostate cancer; however, many cases are subclinical with autopsy studies showing about 70% of men between 70 and 80 years of age having cancer in this gland. The peripheral zone of the prostate with its preponderance of glandular tissue is the area of the prostate where most cancers originate. Prostate cancer can spread locally or via lymphatic and venous channels.
lobes of prostate
older way of dividing it up
The testicular arterial branches pierce the _____________ to supply the testis, while other branches help to supply the epididymis and distal ductus deferens.
posterior part of the tunica albuginea
the epidydimis is on what surface of the testicle? what lies between the testicle and the epidydimis?
posterolateral surface the sinus of the epididymus, an intervening recess of the cavity of the tunica vaginalis
Vasectomy
the ductus deferens is clamped/ligated and sectioned as a method of birth control. After a vasectomy, the ejaculate will contain the secretions from the seminal vesicles, prostate gland, and bulbourethral glands, but will be free of sperm. The sperm the testis continues to produce will degenerate in the epididymis and proximal part of the ductus deferens.
The ducts from each bulbourethral gland empty into _____________, in the bulb of the penis
the posterior aspect of the proximal spongy urethra these glands secrete a lubricant typically before ejaculation
The ductus deferent arises from which part of the epididymis? what course does it take?
the tail (its initially tortuous) it ascends medial to the epididymis then runs with the spermatic cord and passes in inguinal canal to exit at deep inguinal ring on lateral side of inferior epigastric artery. It corsses the external iliac vessels and enters pelvis where it passes ABOVE the ureter. The terminal portion (ampulla) lies medial to the seminal vesicles, posterior to fundus of bladder.
thick capsule around the testicle what is external to the capsule?
tunica albuginea external to the capsule is the visceral layer of the tunica vaginalis.
testes are drained by ________ purpose of this arrangement?
veins that form the pampiniform plexus surrounding the testicular artery within the spermatic cord. thermoregulation - to allow the temperature of the testes to remain below body temperature which is optimal for sperm production. Arterial blood that reaches the testis is pre-cooled by the venous blood which is returning from the testis outside the abdominal cavity, in the scrotum.