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Flashcards in Male Reproductive System Deck (35)
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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