Male Repro Tract

Question 1

Define the following terms:

a) spermatoceleb) Hydroceoelec) Haemotocoele

Answer 1

a) benign growth filled with clear liquid found at the head of the epididymis b) serous fluid in the tunica vaginalis c) Blood within the scrotal sac but outside the testis

Question 2

What is an inguinal hernia?

Answer 2

Inguinal hernia: tissue (such as intestines) protrudes through a weak spot in the abdominal muscles, the resulting bulge can be very painful.

Question 3

What are the three central contents of the spermatic cord?

Answer 3

1. Pampiniform plexus; drains venous blood from testis to testicular vein, it wraps around the testicular artery and acts as a heat exchanger to cool the arterial blood before it reaches the testis
2. Ductus deferens
3. Lymphatics

Question 4

What are the three arteries in the spermatic cord?

Answer 4

1. Testicular artery: from AA, L2
2. Ductus deferens artery
3. Cremasteric artery; supplies cremasteric fascia and muscle

Question 5

What are the three major nerves in the spermatic cord?

Answer 5

1. Genital branch of the genitofemoral nerve/external spermatic nerve
2. Autonomic nerves
3. Ilioinguinal nerves

Question 6

List the three fascias surrounding the spermatic cord in medial-lateral order, where do they each arise from?

Answer 6

Overall they are derived from the three layers of anterolateral abdominal wall muscles and collect around the testis as they push down

1. Internal spermatic fascia; derived from the lining of transversus abdominis muscle
2. Cremasteric fascia; derived from internal oblique muscle
3. External spermatic fascia; derived from external oblique muscle

Question 7

What does the Genitofemoral nerve innervate?

Answer 7

Gives off two divisions:

1. Femoral: gives sensory innervation to the upper medial thigh
2. Genital: supplies cremaster muscle around the testis

Question 8

What is the cremasteric reflex?

Answer 8

When you stimulate the upper medial thigh the testis should rise!!!!!!!!!

Question 9

Describe the anatomical course of the spermatic cord

Answer 9

1. Formed in the opening of the inguinal canal
2. Enters scrotum via superficial inguinal ring (terminal end of the inguinal canal)
3. Ends at the posterior border of the testis; its contents disperse to supply the testis and the scrotum

Question 10

What is a varicocele and why does it form?

Answer 10

A lump in the scrotum due to incompetent valves in the pampiniform plexus

Question 11

What happens when there’s torsion?

Answer 11

The testicle rotates and twists the spermatic cord, reducing the bloodflow to the testis and causing sudden and severe pain/swelling

Question 12

Which branch of the autonomic NS allows for peristalsis in the ductus deferens?

Answer 12

Sympathetic

Question 13

Describe the pathway of the ductus deferens

Answer 13

From tail of epididymis to the ejaculatory duct, it is the ONLY structure that passes superiorly to the ureter (hence, water under the bridge)

Question 14

Which structures form the ejaculatory duct?

Answer 14

Convergence of ductus deferens and the seminal vesicle duct

Question 15

What is a vasectomy? Is it reversible?

Answer 15

When the ductus deferens is cut distal to the superficial inguinal ring, occasionally the cut ends can find each other and rejoin :’)

Question 16

What are the two main components of the prostate?

Answer 16

1/3 Fibromuscular: contracts during ejaculation to squeeze out the fluid in the glandular tissue

2/3 Glandular: produces 20% of seminal fluid

Question 17

Which vessels supply the prostate? (arterial and venous). Which lymph nodes drain it?

Answer 17

Supply: Internal iliac artery

Drain: venous blood goes into the prostatic venous plexus which communicates with the vertebral veins

Lymph drains into the internal iliac nodes

Question 18

Name the three zones of the prostate, which are tumours usually found?

Answer 18

Central zone: surrounds the prostatic urethra

Peripheral zone: usually the zone with tumours

Transitional zone

Question 19

Where does prostate cancer commonly spread to and why?

Answer 19

Spreads to the vertebrae via the venous plexus as valveless veins form the plexus (so blood can flow freely in either direction)

Question 20

What do the seminal vesicles produce? Where do they arise from?

Answer 20

They produce alkaline fluid and develop as outgrowths of the ductus deferens

Question 21

Which vessels (arterial, venous) and which lymph nodes supply the seminal vesicles?

Answer 21

Blood supply: internal iliac artery

Vesical and prostatic venous plexus

Internal iliac, external iliac and sacral nodes

Question 22

What does the perineal membrane do?

Answer 22

Acts as an anchoring point for external genitalia

Question 23

Name four points on the journey of a male catheter where passage might be more difficult

Answer 23

1. Navicular fossa; superior mucosal fold (right before external urethral orifice)
2. The angle at the penile bulb and membranous urethra
3. Prostate (crest/enlarged lobes)
4. Sphincters (internal and external)

Question 24

Name four things you SHOULD feel in a DR examination and two things you MIGHT feel (that would still be physiological)

Answer 24

Should feel: walls of anal canal and inferior rectum, lymph nodes and prostate (posterior and median lobes)

Might feel inferior bladder and seminal vesicles

Question 25

Briefly describe the three vascular structures of the penis

Answer 25

1. Corpus spongiosum; has urethra and expands distally to form 'glans penis' 2. 2X corpus cavernosum; erectile tissue filled with blood vessels 3. Bulb of the penis; erectile tissue that roots the corpus spongiosum

Question 26

Which structures are contained within the superficial perineal pouch?

Answer 26

Penis, urethra, scrotal contents and superficial perineal muscles

Question 27

What could you do if you wanted to give your penis a greater flaccid length?

Answer 27

Cut the fundiform and suspensory ligaments of course!

Question 28

Where on its journey can the pudendal nerve be anesthetized?

Answer 28

When it passes close to the ischial spine (after exiting the greater sciatic foramen)

Question 29

Which arterial and venous vessels supply and drain the penis?

Answer 29

Arterial: 3 arteries all branching from the internal iliac: internal pudendal artery, deep and dorsal penile arteries, bulbourethral artery Dorsal veins: drain into prostatic venous plexus -> vertebral plexus 1. Superficial dorsal vein: skin and cutaneous tissue 2. Deep dorsal vein: cavernous spaces

Question 30

Describe the vascular component of an erection *including any muscles involved!

Answer 30

In an erection, the coiled helicine arteries straighten to allow blood to fill the corpus cavernosum 1. Erotic stimuli relaxes the smooth muscle surrounding the helicine arteries so the vessels can straighten 2. The arterial-venous anastomoses closes to retain blood in the corpus cavernosum 3. Ischiocavernosum and bulbospongiosum compress the venous plexus to retain blood in the penis

Question 31

Describe the nervous component of an erection, how do the nerves reach the penis?

Answer 31

Nerves lie on lateral pelvic wall and travel medially to form a plexus around the prostate Parasympathetic S2-4: allows for an erection: (Pelvic splanchnic nerves -> inferior hypogastric plexus -> prostatic plexus -> cavernous nerve)

Question 32

Where is the deep perineal pouch and which structures (in males and females) lies within it?

Answer 32

Between the pelvic floor and the perineal membrane; Voluntary muscles Male: external urethral sphincter, bulbourethral glands Female: multiple sphincters

Question 33

Name two things that can exacerbate the pain of having an infection or stones in the male bulbourethral gland

Answer 33

DR examination and defecation

Question 34

Where does the crura of the penis/clitoris attach to?

Answer 34

The pubic arch and the lateral parts of the perineal membrane

Question 35

Define priapism

Answer 35

Persistent painful non-stimulated erection that lasts more than 4 hours

Question 36

What is the major vascular difference between an erect and a flaccid penis?

Answer 36

In a flaccid penis the arterio-venous anastomoses allow blood to bypass the corpus cavernosum

Question 37

Describe the nervous component of ejaculation

Answer 37

Sympathetic brings about ejaculation: L1-2 1. Closes the internal urethral sphincter 2. Peristalsis of ductus deferens and seminal vesicles 3. Prostate smooth muscle contraction

Question 38

What innervates the somatic muscles of erection and ejaculation?

Answer 38

Branches of the pudendal nerve; S2-4

Question 39

What are major lymphatic nodes that drain the male repro tract?

Answer 39

1. Superficial inguinal; scrotal, penile and perineal skin 2. Deep inguinal; glans of penis, distal spongy urethra 3. Para-aortic; testicles 4. Internal iliac; corpus cavernosum, urethra (membranous and proximal spongy), most of the prostate, seminal vesicles and ducts

Question 40

Describe the structure of the pelvic floor

Answer 40

A bowl-shaped sheet of muscle that supports the pelvic viscera and assists with sphincters

Question 41

Describe the journey of sperm, from its creation to its release

Answer 41

1. Following spermiogenesis, spermatozoa are released into the lumen of seminiferous tubules 2. They travel through the rete testis, ductulli efferentes, epididymis and vas deferens 3. They are released into the ejaculatory duct (along with secretions from the seminal vesicle and prostate), and into the prostatic urethra!

Question 42

Describe the two types of inguinal hernias, including - which is more common - how each forms

Answer 42

1. Indirect: More common, the processus vaginalis is a weak area, if it fails to close some coils of the intestine can follow it down with the testis pushing through the deep inguinal ring and causing a lump. 2. Direct: bulging of the peritoneal cavity, often caused by age-related stress and weakened muscles in the inguinal canal

Question 43

Which zone of the prostate tends to becomes bigger with age? What is this known as and what symptom can it cause?

Answer 43

Transitional zone, known as benign prostatic hyperplasia and can cause a degree of incontinence

Question 44

Which nerve innervates the deep perineal pouch?

Answer 44

Pudendal nerve