Flashcards in Male Pelvis Deck (63):
Where is the pelvic viscera relative to the pelvic pain line?
Inferior to it (pelvic pain line runs along inferior border of peritoneum)
What happens to the pelvic fascia when they penetrate the pelvic floor and what is this called?
The parietal and visceral pelvic fascia become continuous and thick, forming the tendinous arch
What is the anterior aspect of the tendinous arch of pelvic fascia called in males and females respectively?
Puboprostatic ligament (males), pubovesical ligament (females)
Two potential spaces of the male pelvis
Rectropubic and rectrorectal
Name the three leaflets of the hypogastric sheath, including alternate names and where each attaches
Anteriormost (Lateral ligament of the bladder) - attaches to bladder. Posteriormost (presacral fascia) - attaches to rectum, Middle lamina (rectovesical septum in males runs btwn bladder and rectum, transverse (cardinal) ligament in females, attaches to cervix of uterus)
Where are the ureters relative to the ductus deferens in males?
Posterolateral to ductus deferens
List the arteries that send branches to supply the ureter
Renal artery, Gonadal artery, Aorta, Common Iliac, Internal Iliac, Superior Vesical, Uterine (f), Middle Rectal, Vaginal (f), Inferior Vesical (m)
Where does the ureter get its innervation from?
Adjacent autonomic plexuses
Is the course of the ureter mostly superior or inferior to the pelvic pain line?
What does the bladder rest on?
Anteriorly on the pubic bone and symphysis, posteriorly on the prostate (male) or vagina (female)
What holds the neck of the bladder in place?
Lateral ligament of bladder and tendinous arch of pelvic fascia
List the four surface and four parts of the bladder
Surfaces - Superior, 2 inferolateral, and posterior. Parts - Apex, fundus, body, neck
What three points create the triangular-shaped trigone of the bladder?
The two ureteric orafices (superior) and the internal urethral orifice (inferior)
Uvula of the bladder
Elevated ridge along the wall of the inferior bladder, in the trigone region
Where is the detrusor muscle and what is the orientation of its fibers?
Muscle of the bladder, fibers are scattered in orientation, no particular pattern
What feature of the bladder is present in one sex but not the other, which sex is it present in, and what does it do?
The involuntary internal urethral sphincter is present only in males, it prevents reflux of semen into the bladder
Arterial supply to the bladder
Superior vesical aa, Inferior vesical aa (m), Vaginal aa (f), Obturator aa, Inferior Gluteal aa
Venous drainage for the bladder
Vesical venous plexuses (m/f), also prostatic venous plexuses (m), drain to internal iliac vein (m/f)
What system innervates the detrusor muscles?
Parasympathetic (this tells you to go to the bathroom)
Where do visceral afferent fibers leaving the bladder go?
Fibers from superior portion of bladder follow sympathetic fibers retrogradely, fibers from inferior portion follow parasympathetic fibers retrogradely (remember pelvic pain line)
Which nervous system helps you not go to the bathroom and which system helps you go to the bathroom?
Parasympathetic - go to bathroom, Sympathetic - not now
How long are the male and female urethrae?
Male - 18-22 cm, Female - 4 cm
4 parts of the male urethra and the lengths of each
Intramural (preprostatic) (1-1.5 cm), Prostatic (4 cm), Intermediate (less than 1 cm), Spongy (15-16 cm)
What are the widest/most distensible and shortest/least distensible parts of the male urethra?
Prostatic is widest and most distensible, Intermediate is shortest and least distensible
Into what structure does the female urethra open?
Vestibule of vagina
At what vertebral level is the rectosigmoid junction?
What are the two longitudinal flexures of the rectum and what is the more distal flexure useful for?
Sacral and anorectal flexure (important for maintaining fecal continence)
List the lateral flexures of the rectum
Superior and inferior (left side), intermediate (right side)
What causes transverse rectal folds and lateral flexures of the rectum?
Thickening of circular muscles
The ampulla of the rectum is located where?
Superior to pelvic diaphragm (i.e. superior to where levator ani muscles connect)
What is immediately superior to the rectum?
What is immediately anterior to the superior rectum?
Rectovesical pouch (males), Rectouterine pouch (females)
What is immediately lateral to the rectum?
What structures are immediately posterior to the rectum?
S3-S5, coccyx, median sacral vessels, sacral sympathetic trunk
Give the arterial supply to the rectum and where each artery comes from
Superior rectal artery (from IMA), Middle rectal arteries (from Internal Iliac), Inferior rectal arteries (from internal pudendal)
How is the pattern of rectal arteries different from that of rectal veins?
Its not. Both have a superior, middle, and inferior
Rectal venous plexuses
Internal (submucosal) and External (subcutaneous)
For each of the rectal veins, give the system it ultimately drains to
Superior - to Portal system, Middle and Inferior - To Internal Iliac Vein to Caval system
Sympathetic innervation of the rectum
Hypogastric/pelvic plexuses, and peri-arterial plexuses via superior rectal artery
Parasympathetic innervation of the rectum
Inferior hypogastric/rectal plexuses
What fibers to visceral afferent fibers leaving the rectum follow and to where?
Parasympathetic fibers retrogradely to S2-S4 spinal ganglia
Which anal sphincter is voluntary and which is involuntary?
Internal is involuntary, external is voluntary
What is the internal anal sphincter formed from, and which nervous system makes it relax and which makes it contract?
Formed by thickening of circular muscles, forced to contract by sympathetic system, forced to relax by parasympathetic system
What is the external anal sphincter attached to?
Pernieal body (anteriorly), Coccyx via anococcygeal ligament (posteriorly), Puborectalis (superiorly)
What is anterior to the prostate gland?
Muscular retropubic space
What is posterior to the prostate gland?
Ampulla of rectum
What is along the inferolateral surfaces of the prostate?
Levator ani muscles
Lobes of the prostate gland
Anterior, Left, Right
What is another name for the anterior lobe of the prostate?
Arterial supply to the prostate
Inferior vesical arteries (majority of blood supply), middle rectal arteries, internal pudendal arteries
Venous drainage of the prostate
Prostatic venous plexuses to internal iliac veins (vesical venous plexus and internal vertebral venous plexus also involved)
Effects of sympathetic fibers on male internal genital organs
Contraction of internal urethral sphincter, rapid contraction of ductus deferens, contraction and secretion of ejaculatory ducts and prostate, ejaculation
Primary effect of parasympathetic fibers on male internal genital organs
Cavernous nerve causes penile erection
Give the number of nerves, vessel pairs, and muscles which pass through the greater sciatic foramen
7 nerves, 3 vessel pairs, and 1 muscle
Name the nerves which pass through the greater sciatic foramen
Sciatic nerve, Superior/inferior gluteal nerves, Internal pudendal nerve, Posterior femoral cutaneous nerve, Nerve to quadratus femoris, nerve to obturator internus (L5, S1)
Name the blood vessels which pass through the greater sciatic foramen
Superior gluteal artery/vein, Inferior gluteal artery/vein, Internal pudendal artery/vein
What muscle passes through the greater sciatic foramen?
Give the relations of the obturator artery while it is in the pelvis
Laterally with the obturator fascia, medially with ureter, ductus deferens, and peritoneum, and it is superior to the obturator nerve
Name the nerves which travel through the lesser sciatic foramen
Pudendal nerve, nerve to obturator internus
Name the blood vessels which travel through the lesser sciatic foramen
Internal pudendal artery and vein,
Name the miscellaneous (e.g. muscles, tendons, etc) structures which pass through the lesser sciatic foramen
Tendon of obturator internus
Name the blood vessels that pass through the obturator foramen (via the obturator canal)
Obturator artery and vein