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Flashcards in Male Reproductive System Deck (35):
0

Testes descend along the normal pathway but do not reach the scrotum

If bilateral --> associated with sterility

⬆️ incidence of cancer & torsion

Cryptorchidism

1

Surrounded by a thick connective tissue layer (tunica albuginea)

Further surrounded incompletely by a peritoneal sac (tunica vaginalis)

Contents:
- seminiferous tubules
- straight tubules
- Rete testes
- efferent ductules

Blood supply: abdominal aorta via testicular artery
- rich collateral blood supply provided by:
1. Internal iliac artery via artery of the ductus deferens
2. Inferior epigastric artery via cremasteric artery
3. Femoral artery via external pudendal artery

Venous drainage:
- Pampiniform plexus unite to form testicular veins
- R testicular vein --> IVC
- L testicular vein --> L renal vein (L-sided testicular varicocele may indicate occlusion of L testicular vein or L renal vein by a malignant renal tumor

Lymph drainage:
- testes: deep lumbar nodes near the renal hilus (spread of testicular CA)
- scrotum: superficial inguinal nodes

Testes

2

Testes descends along an abnormal pathway

Ectopic tests

3

Small patency of processus vaginalis remain --> peritoneal fluid flows into tunica vaginalis surrounding the testes

Hydrocele

4

Abnormal dilatation of Pampiniform plexus & testicular vein (bag of worms)

More common on the left side (90%) - caused by compression of left testicular vein by sigmoid colon

Associated with infertility

Varicocele

5

Rotation of testes around the spermatic cord, usually toward the penis (eg. medially)

⬆️ in bell clapper deformity (testes is horizontal & tunica vaginalis is attached high on spermatic cord)

An emergency because it can cause ischemic necrosis within 6 hours

Torsion

6

MC form of testicular CA in men older than 60 year old

Occurs when malignant lymphoma metastasizes to the testes

Testicular lymphoma

7

MC form of testicular CA in infants & boys up to 3-year old

⬆️ a-fetal protein levels

Yolk sac tumor

8

MC type of germ cell neoplasm in 20-40% year old

Painless testicular mass, usually on the right side or diffuse nodularity

⬆️ b-hCG

Seminoma

9

Germ cell neoplasm

Early histology: resemble a blastocyst with 3 primary germ layers "male pregnancy"

Well differentiated cells from each primary germ layers (endoderm, mesoderm & ectodermh

Testicular teratoCA

10

Highly coiled duct, consists of head, body & tail

Sperm maturation & storage occur in the head & body

Tail is continuous with the vas deferens

Epididymis

11

Begins at the inferior pole of the testes --> enter spermatic cord --> inguinal canal --> deep inguinal ring

Joined by seminal vesicle to form the ejaculatory duct opens into the prostatic urethra

Ductus deferens (vas deferens)

12

Vasectomy cuts through the ff???

Skin --> COLLE'S fascia & dartos muscle --> external spermatic fascia --> cremasteric fascia & muscle --> internal spermatic fascia --> extraperitoneal fat

Tunica vaginalis is not cut

13

Contents of the spermatic cord

Ductus deferens

Artery of ductus deferens

Testicular artery

Cremasteric artery

Pampiniform venous plexus

Sympathetic & parasympathetic nerves

Genitofemoral nerve

Lymphatics

14

Function: produces seminal fluid, which fructose & choline

In forensic med: detection of choline crystals is the preferred method of determining the presence of sperm

Seminal vesicle

15

Location: between base of urinary bladder & urogenital diaphragm
- anterior surface: related to retropubic space
- posterior surface: related to the seminal vesicles & rectum

Collection of tubulo-alveolar glands

Prostate gland

16

5 lobes of prostate gland

R & L lateral

R & L posterior

Middle

17

3 zones of prostate gland

Peripheral (site of most cancers)

Central

Transitional (periurethral) -BPH

18

The lumen of the glands normally contain deposits

Corpora amylacea

19

Contains citric acid, phosphatase, prostaglandins, fibrinogen, & prostate-specific antigen (PSA)

Serine protease that liquefies semen after ejaculation

Serum acid phosphatase & PSA - diagnostic tools to detect prostatic CA

Prostatic fluid

20

Arterial supply prostate gland

INTERNAL ILIAC ARTERY via inferior vesical artery

21

Venous drainage of prostate gland

2 pathways

Prostatic venous plexus --> internal iliac veins --> IVC

Route of prostatic CA metastasis to the heart & lungs

Prostatic venous plexus --> vertebral venous plexus --> cranial dural sinuses

Route of prostatic CA metastatic to vertebral column & brain

22

Hypertrophy of transitional (periurethral) zone

MC location: lateral & middle lobes

Compresses prostatic urethra --> obstructs urine flow

May be caused by ⬆️ sensitivity of prostate to dihydrotestosterone (DTH)

Not premalignant

SSX: urinary frequency, nocturia, sense of incomplete emptying of the bladder

Tx: surgery, 5a-reductase inhibitor (finasteride) to block the conversion of testosterone & DHT; or a-adrenergic antagonists (e.g. Terazosin, Prazosin) to inhibit prostate gland secretion

Benign prostatic hypertrophy (BPH)

23

MC location: peripheral zone, which usually involves the posterior lobes

Dx: Serum PSA

Bone metastasis is common

Tx: surgery, radiation, Leuprolide (GnRH agonist that inhibits FSH & LH release, cyproterone or flutamide (androgen receptor antagonists)

Prostatic carcinoma

24

External genitalia

Scrotum

Penis

25

3 columns of erectile tissue

1 corpus Spongiosum

2 corpora cavernosa

26

Supported by suspensory ligament

Innervations: dorsal nerve of the penis

Penis

27

Blood supply of penis

INTERNAL PUDENDAL ARTERY via deep artery of the penis & dorsal artery of the penis

28

Venous drainage of the penis

DEEP DORSAL VEIN OF THE PENIS --> prostatic venous plexus --> internal iliac vein --> IVC

SUPERFICIAL DORSAL VEIN OF THE PENIS --> external pudendal vein --> great saphenous vein --> femoral vein --> external iliac vein --> IVC

29

Begins as bulb of the penis & ends as glans penis, ventrally located, transmits the urethra

Corpus Spongiosum

30

Begin as the cruris of the penis & end proximal to the glans, dorsally situated

Corpora cavernosa

31

Urethral folds do not fuse completely --> external urethral orifice opens onto the ventral surface

Associated with chordee (penis that curves ventrally)

Hypospadias

32

External urethral orifice opens onto the dorsal surface

Associate with bladder extrophy

Epispadias

33

Adult female

Gonads: ovary, follicles, Rete ovarii

Paramesonephric ducts: uterine tubes, uterus, cervix, upper part of vagina

Mesonephric ducts: duct of Gartner

Phallus: clitoris

Urogenital folds: labia minora

Labioscrotal swellings: labia majora

34

Adult male

Gonads: testes, seminiferous tubules, Rete testes

Paramesonephric ducts: appendix of testes

Mesonephric ducts: epididymis, ductus deferens, seminal vesicle, ejaculatory duct

Phallus: glands & body of penis

Urogenital folds: ventral aspect of penis

Labioscrotal swellings: scrotum