What parts of the urinary tract are found in the pelvis?
Distal Ureter
Bladder
Proximal Urethra
What parts of the urinary tract are found in the perineum?
Distal Urethra
At what level does the abdomen become the pelvis?
At the level of the hip bones (Iliac Crests)
What is the pelvis split into?
False Pelvis
True Pelvis
What is the divide between the false pelvis and the true pelvis?
The pelvic rim
Name the parts of this diagram?
A = Pelvic Inlet
B = False Pelvis
C = True Pelvis
D = Pelvic Floor Muscles
E = Perineum
What is the differentiation between the true pelvis and perineum?
The pelvic floor (More specifically the levator ani)
Describe the pelvic floor?
This is composed of a number of muscles
Formed by the bowl shaped ‘pelvic diaphragm’
One of the muscles is the levator ani muscle
What is the main muscle of the pelvic floor called? (Muscle of the pelvic diaphragm)
Levator Ani
Where does the false pelvis go from?
From the iliac crests to the pelvic inlet
Where does the true pelvis go from?
From the pelvic inlet to the pelvic floor
Which part of the pelvis is the bladder found in?
True Pelvic (Pelvic Cavity)
How does the urethra get into the perineum from the pelvic cavity?
Passes through the pelvic floor
What are the openings in the pelvic floor for?
For the distal parts of the alimentary, renal and reproductive tracts to pass through
What are the borders of the perineum?
From the pelvic floor to the external skin
Describe the depth of the perineum - deep or shallow?
Shallow
What part of the urinary tract is contained in the perineum?
The urethra
Describe where the ureters cross the common iliac arteries?
The ureters cross the common iliac arteries at the pelvic brim
This is often the point of bifurcation
Do the ureters pass anteriorly or posteriorly to the common iliac arteries when they enter the pelvis?
The ureters pass ANTERIORLY to the common iliac arteries when the enter the pelvis
Describe the direction of the ureters once they have crossed the common iliac arteries?
They run along the lateral walls of the true pelvis
What happens when the ureters reach the ischial spine?
The ureters turn medially once the reach the ischial spine.
They enter the posterior aspect of the bladder
The ureters turn medially to enter the posterior aspect of the bladder
At what landmark do they turn medially?
The ischial spine
Describe the position of the ureters in relation to the peritoneum when they are in:
- The abdomen
- The pelvis
When in the abdomen they are retroperitoneal
When in the pelvis they are sub peritoneal
What direction do the ureters enter the bladder? Why?
Ureters enter the bladder in an inferiomedial direction
Helps prevent urine reflux
What is the pouch between the rectum and bladder (in males) called?
Retrovesicle pouch
What is the deepest part of the peritoneal cavity in males?
Retrovescile pouch
Identify this diagram (A –> J)?
A = Right Ureter
B = Right Iliac Artery
C = Right Iliac Vein
D = Right Testicular Vessels
E = Vas Deferens (At deep inguinal ring)
F = Retrovesicle Pouch
G = Rectum
H = Bladder
I = IVC
J = Sigmoid Colon
In females, what is the pouch between the rectus and uterus called?
Rectouterine Pouch OR Pouch of Douglas
In females, what is the pouch between uterus and bladder called?
Vesico-uterine pouch
What is the deepest part of the peritoneal cavity in females?
Rectouterine pouch (pouch of douglas)
Identify the labels (A–>I)?
A = Right Ureter
B = Right Ovary
C = Right uterine tube
D = Vesico-uterine pouch
E = Recto-uterine pouch (pouch of douglas)
F = Inferior part of parietal pleura
G = Bladder
H = Uterus
I = Rectum
What is lateral to the ureter in females?
The suspensory ligament of the ovary
Describe the anatomical relationship of the ureter, uterine tubes and uterine artery in females?
The ureter is inferior to the uterine tubes and uterine artery (water under the bridge)
Describe the anatomical relationship of the vas deferens and the ureter in males?
The ureter runs inferiorly to the vas deferens
The arteries entering the pelvis are mainly branches from the …?
Internal Iliac Artery
Describe the blood supply to the pelvis in females?
- Vesical Arteries (to bladder)
- Middle Rectal Artery
- Uterine Artery
- Vaginal Artery
Describe the blood supply to the pelvis in males?
- Vesical Arteries
- Middle Rectal Artery
- Prostatic Arteries
Which arteries are seen in the pelvis of both males and females?
Vesical Arteries
Middle Rectal Artery
Which arteries are specific to:
- Females?
- Males?
Females have the vesical arteries, middle rectal artery AND the vaginal artery and uterine artery
Males have the vesical arteries, middle rectal artery AND prostatic arteries
The prostatic arteries are branches of which arteries?
Vesical Arteries
What do vesical arteries supply?
The Bladder
When empty, where is the bladder contained?
Within the true pelvis
When the bladder begins to fill, where does it expand into?
Can expand into the false pelvis
Describe the relationship between the bladder and the peritoneum?
Only the superior border of the bladder is in contact with the peritoneum
This relationship stays constant even when the bladder is full or empty
Where is the prostate in relation to the bladder?
Below the bladder
What is the part of the ureter that passes through the prostate called?
The prostatic ureter
What is the triangle of the bladder called?
The Trigone
What makes up the top corners (base) of the trigone/bladder triangle?
Left and right ureteric orifices
What are the left and right ureteric orifices?
This is where the ureter from the kidneys opens into the bladder
What is the point of the bladder triangle/trigone?
This is the internal urethral orifice
Describe the internal urethral orifice?
This is where the bladder empties into the urethra
What muscle surrounds the ureteric orifices? Function?
The detrusor muscle fibres encircle the ureteric orifices
When the bladder contracts to expel urine, these fibres also contract to prevent back flow of urine
The muscle that forms the main bulk of the bladder wall is called the…?
Detrusor Muscle
Describe the internal urethral sphincter muscle?
This is seen in males only
Formed by the detrusor muscle fibres around the internal urethral orifice
Contracts during ejaculation to prevent semen back flow
Name the labels on this diagram? (A–>D)
A = Ureteric Orifices
B = Internal Urethral Orifice
C = Urethra
D = Prostate Gland
What is the most anterior organ in the pelvis?
The bladder (when empty)
Describe the anatomical relationships between the uterus and bladder in females?
The uterus sits superior to the bladder in an anteflexed position
They are separated by the vesico-uterine pouch
Most of the weight of the uterus is borne by the bladder
Describe the anatomical relationships between the prostate and bladder in males?
In males, the prostate is inferior to the bladder
The rectum is posterior to the bladder
The rectovesical pouch is between the bladder and rectum
What are the two types of catheterisation?
- Urethral
- Suprapubic (if urethra is blocked)
Name the labels A –> L
A = Bladder (Empty)
B = Internal Urethral Orifice
C = Urethra
D = Level of the levator ani (pelvic floor)
E = External Urethral Sphincter (Voluntary)
F = External Urethral Orifice
G = Vaginal Orifice
H = Anus
I = Perineum
J = Pelvis
K = Rectum
L = Uterus
Which is longer, the male or female urethra?
Male
Label the diagram (A –> K)
A = Ureter
B = Pelvis
C = Levator Ani/Pelvic Floor
D = Perineum
E = Spongy Urethra (Within corpus spongiosum)
F = External Urethral Orifice
G = External Urethral Sphincter (Voluntary)
H = The prostatic urethra
I = Prostate Gland
J = Internal Urethral Sphincter (Involuntary)
K = Internal Urethral Orifice
What is the black arrow pointing at?
Corpus Spongiosum
Describe the route sperm follows in the male reproductive system?
Produced in testes
Stored in epididymis
Travels in the vas deferens
Through spermatic cord
Spermatic cord passes through superficial ring, inguinal canal then deep ring
Vas deferent then enters abdomen
Passes posterior to bladder
Joins with seminal duct to become ejaculatory duct
Becomes prostatic urethra
Becomes spongy urethra
Exits through external urethral orifice
Where is sperm produced?
Testicles
Where is sperm stored?
Epididymis
What happens to sperm in the epididymis?
Goes into the vas deferens
Vas deferens passes through spermatic cord
Passes through the superficial ring then inguinal canal then exits through the deep ring
What happens to sperm once it has left the deep ring of the inguinal canal?
Enters the abdomen
Passes posteriorly behind the bladder
What happens to the vas deferens/sperm after it has passed posteriorly to the bladder?
Joints with seminal duct (gets semen)
Becomes ejaculatory duct
What happens to the ejaculatory duct after it has formed?
Passes into prostate
Joints with prostatic urethra
What happens to the prostatic urethra (which contains sperm and semen) after it exits the prostate?
Become the spongy urethra
Exits through the external urethral orifice (ejaculation)
What is the embryological origin of the testicles?
Posterior abdominal wall
Describe movement of the testicles from original position to final position?
Testes descend from the posterior abdominal wall into the scrotum through the inguinal canal
Should be descended by birth
The spermatic cord goes through the inguinal canal and contains a number of important structures. Name them:
- Testicular arteries
- Testicular veins
- Vas Deferens
- Lymphatic Drainage
- Nerves
The testes sit inside a sac. What is this sac called?
Tunica Vaginalis
What are the two layers of the tunica vaginalis?
The parietal layer (fibrous outer part)
The visceral layer (covers the testicle)
What is between the parietal and visceral layers of the tunica vaginalis?
A small amount of serous fluid
What is excess fluid between the parietal and visceral layers of the tunica vaginalis called?
Hydrocele
What is a hydrocele?
Excess fluid accumulation between the two layers of testicles - the visceral and parietal layers of tunica vaginalis
What is the appendix testis?
An embryological origin - has no function
What can happen to the appendix testis?
Can twist (torsion) and cause pain
What does this photo show?
A hydrocele
The testes and the epididymis are connected to the …. superiorly
Fill in the blank?
The testis and the epididymis are connected to the spermatic cord superiorly
Is the testicle very mobile or very immobile? Complications of this?
The testicles are very mobile
This can lead to testicular torsion –> Causes pain and can lead to necrosis
What is contained within the spermatic cord?
- Testicular artery
- Vas Deferens
- Pampiniform Plexus
What is the pampiniform plexus?
This is a network of veins found in the spermatic cord that drains the testes and epididymis
Label this diagram (A–>D)?
A = Vas Deferens
B = Testicular Artery
C = Pampiniform (Venous) Plexus
D = Spermatic Cord
Describe the blood supply and drainage of the testes?
Left and right testicular arteries
Left and right testicular veins
Where do the testicular arteries arise from? How do they pass to the testicles?
Arise from abdominal aorta
Pass to the testicles in the spermatic cord
Describe the drainage of the testes? Where do these veins drain?
Left testicular vein drains into left renal vein
Right testicular vein drains into IVC
What passes in/out of the deep inguinal ring?
Testicular Arteries
Testicular Veins (Pampiniform Plexus)
Vas Deferens
Lymphatics
Nerves
Where specifically in the testicles is the sperm produced?
Seminiferous tubules
Which part of the testicles is the epididymis found at?
Superior pole
Describe what happens to sperm produced by the seminiferous tubules?
Passes to the epididymis for storage
Describe the route of sperm from testicles to ejaculation?
- Carried in vas deferent which passes through spermatic cord - Travels through superficial ring, inguinal canal then deep ring - Passes posterior to the bladder
- Joins with seminal duct to form ejaculatory duct
- Ejaculatory duct drains into prostatic urethra
- Drains into spongy urethra
- Ejaculation via external urethral orifice
Describe the size of the prostate?
Walnut Sized
Describe the zones of the prostate?
Peripheral zones (palpated on digital rectal exam)
Central zones (between bladder and prostatic urethra)
Label this diagram (A–>D)?
A = Peripheral Zones
B = Prostatic Urethra
C = Peripheral Zone
D = Central Zone
Which zone do prostate cancers most commonly occur in?
Peripheral Zone
Label this diagram (A–> H)
A = Root
B = Body
C = Glans
D = External Urethral Orifice
E = Corpus Spongiosum
F = Skin
G = Superficial and Deep Fascia
H = Corpus Cavernosum
Label this diagram (A–>E)?
What lies deep to B?
A = Glans
B = Penile Raphe
C = Scrotal Raphe
D = Scrotum
E = Anus
The spongy urethra within the corpus spongiosum lies deep to B, the penile raphe
What is another name for the foreskin?
Prepuce
Describe retraction of the prepuce?
Prepuce (foreskin) can constrict the neck of the penis causing swelling and pain Treatment is circumcision (KGB)
Describe the blood supply to the penis?
Via the:
- Deep arteries of the penis
- Branches of the internal pudendal artery (from the internal iliac)
Supply comes from internal iliac only
Describe the blood supply to the scrotum?
Via the:
- Internal Pudendal Artery (from internal iliac)
- Branches from the external iliac
Supply comes from internal iliac and external iliac
Match these options to the correct answer.
A = Supply from internal iliac only
B = Supply from both internal iliac and external iliac
Choose from penis and scrotum.
Penis = A (Supply from internal iliac only)
Scrotum = B (Supply from internal and external iliac)
Where does lymph from the scrotum and most of the penis drain to?
Superficial Inguinal Lymph Nodes
Where does lymph from the testes drain to?
Lumbar Nodes around abdominal aorta
Why do the testes have lymph drainage to the lumbar nodes around the abdominal aorta?
Due to embryological origins of the testes being in the posterior abdominal wall
Where does the glans of the penis lymph drainage go to?
Deep inguinal nodes
Summarise lymph drainage:
- Penis
- Glans
- Scrotum
Penis = Superficial Inguinal Nodes
Glans = Deep Inguinal Nodes
Scrotum = Lumbar Nodes