prostate and testis

Question 1

what prostate gland?

Answer 1

fibromuscular galndular organ that surround the prostatic urethra

Roughly the size and shape of chestnut with its apex below

Question 2

Situation of prostate?

Answer 2

Lies between the neck of the gallbladder ABOVE the Urogenital diaphragm below

Question 3

what are the parts of prostate?

Answer 3

Base

Apex

Four surfaces –> anterior, posterior and two lateral surfaces

Question 4

Location of the base?

Answer 4

Superior and related to the BLADDER Neck

The urethra enter the center base

Question 5

location of the apex?

Answer 5

directed inferiorly on the UPPER surface of the UROGENITAL DIAPHRAGM

THE URETHRA LEAVE AT THE APEX

Enter at the base and leave at apex

Question 6

what is anterior to the prostate?

Answer 6

Pubic symphysis

separated from it by :

Retropubic fat

Prostate venous plexus

Deep dorsal vein of penis ( theres a superficial dorsal vein but not here )

Question 7

posterior relation of prostate ?

Answer 7

Rectum ( separated by Rectovesical septum )

Act as a barrier to the Reciprocal spread of prostatic or rectal disease

This surface is palpable by rectal examination ( 4cm above the anus )

Posterior surface is divided by TRANSVERSE GROOVE into the upper small areas and lower large areas

The transverse groove is pierced by EJACULATORY DUTS

Upper area above the groove is called MEDIAN LOBE

The lower area below the groove is DIVIDED by MEDIAN SULCUS INTO 2 LATERAL LOBES

Question 8

Relation of inferolateral surface?

Answer 8

Puboprostatic ligament on either side and levator ani

they attach the false capsule to the pubic symphysis

they are medial and lateral ligaments

Question 9

What are the coverings of prostate ?

Answer 9

Truee capsule —> INVEST THE ENTIRE ORGAN , formed by condensation of fibrous stroma of the gland

False capsule/Prostatic sheath –> Derived from the VISCERAL LAYER OF PELVIC FASCIA

at the bladder neck the FALSE CAPSULE is connected to the pubic bones –> BY MEDIAL AND LATERAL PUBO-PROSTATIC LIGAMENTS ( was on the inferolateral )

Space between true and false CAPSULE is occupied by PROSTATIC VENOUS PLEXUS

Question 10

what are the lobes of prostate ?

Answer 10

anatomically : Median and TWo lateral lobes and ISTHMUS ( by transverse groove, median sulcus )

Isthmus –> junction

Surgically : Incompletely divided into 5 LOBES, median , anterior, posterior and TWO lateral lobes

Question 11

describe anterior lobes?

Answer 11

lies in front of the urethra

DEVOID of glandular tissue ( no gland )

Question 12

describe median/middle lobe ?

Answer 12

Wedge of the gland

Situated between the urethra and ejaculatory ducts

Upper surface is related to the trigone of the bladder

Rich in glands

Question 13

describe posterior lobe?

Answer 13

Posterior to the urethra

Below the Ejaculatory ducts

Also contains glandular tissue

Question 14

describe right and left lateral lobe?

Answer 14

lie on both sides of the urethra

The lateral lobes contain many glands

Separated by shallow vertical groove + Felt on rectal examination

In malignant tumor the gland feel hard and nodular , the groove is obliterated and the rectal wall become fixed to prostatic fascia

Question 15

describe benign prostatic hyperplasia ?

Answer 15

affects – Median lobe of the gland which projects upward into the bladder as a swelling behind the internal urethral orifice in the region of trigone called UVULA VISCAE

The enlargement obstructs the flow of urine and results incomplete emptying of the bladder with symptoms of frequency of micturition , straining during the act

BPH can impede internal urethral sphincter –> normally it contracts during ejaculation to stop semen from going to the bladder but when impaired semen goes to the bladder

Question 16

is the clinical name of median lobe?

Answer 16

Transitional zone

Same same

Surrounds the Urethral proximal to EJACULATORY DUCTS

main site of BPH

Question 17

clinical name of posterior and lateral lobes?

Answer 17

Central zone

Peripheral zone –> BULK OF PROSTATE

Surrounds ejaculatory DUCTS projects under the BLADDER base

Site of 10% of carcinoma

Peripheral zone :

Contitutes the bulk of apical , posterior and lateral aspects of the prostate (70% )

THIS ZONE DOESNT GO HYPERPLASIA

Site of prostate carcinoma

Question 18

clinical name of anterior lobe?

Answer 18

Anterior-fibro muscular stroma

Located in the anteromedial portion of the gland

Question 19

describe prostatectomy ?

Answer 19

most adenmatous enlargement of prostate are resected transurethrally using special instruments

removal of hypertrophic centrally located tissue leaving a condensed rim of prostatic tissue

Prostatic venous plexus lying EXTERNAL to the pathological capsule is thus undisturbed

Following prosatatectomy, vesical sphincter id disrupted and the ejaculated fluid flow back to the bladder ( vesical sphincter =internal urethral sphincter )

Resection of prostatic tissue distal to the uretrhal cresst may cause damage to the EXTERNAL sphincter ( Which surrounds the membranous urethra )

Question 20

Blood supply of prostate ?

Answer 20

Inferior vesical artery

Middle rectal artery

Internal pudendal artery

Question 21

venous drainage of prostate?

Answer 21

Prostatic plexus —> Vesical plexus –> INTERNAL ILIAC VEIN

Communication with baston plexus of paravertebral veins –> VERTRBAL VENOUS PLEXUS may be responsible for spread of cancer metastasis into vertebral bodies or intra-cranial invasion

Question 22

describe male urethra?

Answer 22

extend from the neck of the bladder –> Internal urethral orifice

to the external urethral meatus on the glans of penis

3 parts :

Prostatic –> most dilated

Membranous –> 2nd most constricted

Penile/spongy —> most constricted

Question 23

describe prostatic urethra?

Answer 23

Widest and most distensible part of the urethra - 3 cm long

Features :

Urethra crest –> Median longitudinal mucosal

Prostatic utricle:( embryological remnant )

Minute depression in the CENTER of the urethra crest , it is an EMBYROLOGICAL REMNANTS , the mohologue of the female uterus or vagina

Seminal colliculus –>Rounded eminence in the middle of the uretheral crest –> OPENING OF EJACULATORY DUCT

Prostatic sinus –> Mucosal depressions on the side of the crest –> OPENINGS OF THE PROSTATIC

Question 24

describe membranous urethra?

Answer 24

Second narrowest part of the urethra after external urethral orifice

Located at urogenital diaphragm

Question 25

describe penile/spongy urethra?

Answer 25

Longest portion of the urethra Passes through the bulb and the corpus spongiosum of the penis hence it also called spongy urethra Expanded in the bulb of penis to form the BUBLB of urethra and in the glans to FORM --> NAVICULAR FOSSA Ducts of the bulbourethral gland open into proximal part of spongy urethra

Question 26

describe urethral catheterization?

Answer 26

External urethral meatus is the narrowest part of the urethra An instrument passes through this opening , should pass through all other parts of the normal urethra The membranous part of the urethra is narrow and slightly resistance is felt when reached Prostatic urethra is the widest and most dilated part of the urethra

Question 27

rupture of penile urethra ?

Answer 27

rupture of spongy urethra is common after an blow to the PERINEUM is torn as it is aught between a hard object and the lower part of the symphysis of pubis Urine escapes the superficial perineal space oand from there into scrotum and the anterior abdominal wall deep to the superficial fascia doesnt go tothe TIGH CUZ OF HOLDENS LINE

Question 28

describe female urethra ?

Answer 28

4 cm from the bladder to the external meatus (very short ) Muscular at the INTERNAL urethral orifice is not ORGANIZED INTO an INTERNAL SPHINCTER ( NO INTENRAL SPHINCTER) Traverse the urogenital diaphragm Paraurethral gland (skene glands )--> OPEN NEAR THE EXTERNAL URETRHAL ORIFICE Skene glands --> located between urethra and vagina Is distensible and can be easily dilated without INJURY -> passage of catheter is easier than in the males Infection of the bladder and urethra are more common in females cuz the urethra is short, distensible,, open into vestibule of vagina

Question 29

describe development of the testis ?

Answer 29

During development gonads descend from the posterior abdominal wall to the pelvis in the females and to the scrotum in males Gubernaculum connects --> lower poles of gonads , passes through the anterior abdominal wall , to the labium majora in females and to the scrotum in males Processus vaginalis ( peritoneum ) precedes the descents of testis and forms pathway in the inguinal canal and it closes at birth -- tunic vaginalis ( covers the anterior and lateral parts of testis )

Question 30

describe undescended testis ?

Answer 30

Failure of the testis to the reach the scrotum Usually lie along the normal path of its descent commonly in the inguinal canal increases risk of developing malignancy

Question 31

What is processus vaginalis ?

Answer 31

Tubular process of peritoneum Passes into the scrotum with the descending testis Neck usually closed at the time of birth if not = hernia

Question 32

what is tunica vaginalis ?

Answer 32

Distal part of process vaginalis after closure

Question 33

shape and situation of testis ?

Answer 33

Oval glandular organs Suspended in the scrotum by SPERMATIC CORD As the testis descend from the posterior abdominal wall , they collect various covering Left testis -- LOWER THAN RIGHT Epididymis is related to its posterolateral aspect COVERINGS : INTERNAL SPERMATIC FASCIA ( TRANSVERALIS FASCIA ), CREMASTERIC ( internal oblique muscle ) , EXTERNAL ( EXTERNAL ), dartos muscle and fascia, skin

Question 34

describe tunica vaginalis ?

Answer 34

remanents of procesus vaginalis closed serous sac with visceral and parietal layers contain small amount of serous fluid

Question 35

describe sinus of epididymis ?

Answer 35

Slit like recess of the tunica vaginalis between the body of the epididymis and the posterolateral surface of the testis its located laterally and helps in identifying which side of the testis is shown

Question 36

describe tunica albuginea?

Answer 36

Tough fibrous outer surface of testis

Question 37

mediastinum of the testis ?

Answer 37

thickening of the internal aspects of the tunica albuginea

Question 38

describe fibrous septa?

Answer 38

Extend from the mediastinum inward between lobules to separate them

Question 39

describe seminferous tubules?

Answer 39

Coiled tubule within the lobules in which sperm are produced

Question 40

describe straight tubules ?

Answer 40

Join the seminferous tubule to the rete testis short ducts that connect seminiferous tubules to the rate testis

Question 41

describe rete testis ?

Answer 41

Network of canals in the mediastinum of the testis ( thickening of the tunica albuginea )

Question 42

describe ductus vas deferens ?

Answer 42

carries the sperm from epididymis to ejaculatory duct travel through inguinal canal , loop around the bladder, join the seminal vesicle duct to for ejaculatory duct

Question 43

covering of testis from outside to inside?

Answer 43

Skin Superficial fascia of the scrotum which contain dartos muscle External spermatic fascia ( from external ) Cremaster muscle and fascia ( from internal ) Internal spermatic fascia--> from transversalis fascia parietal layer of tunica vaginalis Tunica vaginalis Visceral layer of tunica vaginalis

Question 44

describe hydrocele ?

Answer 44

excessive fluid accumulating in tunica vaginalis aka tapping the hydrocele Detection of hydrocele requires TRANS-ILLUMINATION, a red glow indicates excess serous fluid in the scrotum Hematocele --> COLLECTION OF BLOOD IN THE TUNICA VAGINLAIS, DOESNT TRANST ILLUMINATE

Question 45

describe dartos muscle and fascia ?

Answer 45

Continuous anteriorly with SCARPA fascia and posteriorly with COLLE FASCIA Dartos muscle : Smooth muscle fibers in the SUPERFICIAL fascia ( DARTOS FASCIA ) of scrotum Supplied by autonomic fibers Responsible for WRINKLES of the SKIN of scrotum

Question 46

describe scrotal septum?

Answer 46

Internally divide the scrotum Continuation of DARTOS FASCIA Demarcated EXTERNALLY BY THE SCROTAL RAPHE, CUTANEOUS RIDGE

Question 47

Blood supply of the scrotum ?

Answer 47

Anterior scrotal branches of the DEEP EXTERNAL PUDENDAL ARTERY --> From femoral artery Posterior scrotal branches of PERINEAL ARTERY --> branch of internal pudendal artery Cremasteric artery --> INFERIOR EPIGASTRIC ARTERY

Question 48

Nerve supply of the scrotum ?

Answer 48

Lumbar plexus :( anteriorly w anterolateral) Anterolateral surface --> Genital branch of genitofemoral (L1,L2) Anterior surface --> Anterior scrotal of ILIOINGUINAL nerve (L1) SACRAL PLEXUS : ( posterior and inferior) Posterior surface --> Post scrotal branches of perineal branch of the pudendal nerve Inferior surface --> Perineal branches of the posterior femoral cutaneous ( S2,S3)

Question 49

describe epididymis ?

Answer 49

Tightly coiled tube ( duct of epididymis ) Receives efferent ductules from the rete testis Sperm are stored and continue to mature here Parts : Head --> ENLARGED UPPER EXTERMITIES Body Tail --> Tapering lower extremity CONTINUOUS WITH DUCTUS DEFERENS

Question 50

vasectomy ?

Answer 50

Ligation of the ductus deferens Used for male sterlization Incision is made at the top of scrotum

Question 51

blood supply of testis ?

Answer 51

Testicular artery Artery of ductus deferens --> branch of superior vesical These are located in the spermatic cord

Question 52

venous drainage of testis ?

Answer 52

Pampiniform plexus --> TESTICULAR VEIN Right testicular vein --> IVC Left testicular vein --> LEFT RENAL VEIN ( cuz ivc is far away as its closer to the right )

Question 53

nerve supply of testis ?

Answer 53

Sympathetic fibers = T10 , LESSER SPLANCHNIC NERVES ( T10,T11 ) --> CELIAC GANGLION, POST GANGLIONIC FIBERS --> Testicular artery--> Testis Parasympathetic --> PELVIC PLEXUS Pain from testis --> umbilicus cuz its also T10

Question 54

heat regulation of testis ?

Answer 54

temp at testis is 1C lower than that of body Dartos muscle --> control surface area of the scrotum and hence thermal transfer Cremaster muscle --> Pull testis up when heat is required more Pampiniform plexus --> Heat from the testicular artery is lost to the vessels of the plexus so that blood reaching the testis at lower temp, than that of the blood of the rest of the body

Question 55

describe torsion of spermatic cord?

Answer 55

Surgical emergencies --> necrosis of testis Obstruct the venous drainage with resultant edema, hemorrhage, subsequent arterial obstructions Most common during adolescence High scrotal incision is made to approach the cord and the testis The cord is rotated to untwist the torsion To prevent reoccuren we check both sides and fix them at the scrotal septum

Question 56

describe varicocele ?

Answer 56

Varicose veins of pampiniform plexus of veins may result from : Defective valves in the testicular vein Abdominal cause --> kidney or renal vein problems Can be palpated --> Feels like a bag of worms Occurs predominantly on the left side: Cuz angle of which left testicular vein enter the left renal vein is not favorable to flow --> REVERSAL FLOW the affected veins are ligated to detour the flow of blood into normal veins

Question 57

describe cryptorchidism ?

Answer 57

Failure of testis to descend by birth Occur in 4% Unilateral --> less potent Bilateral --> sterile Abodmen --> sterile INGUINAL CANAL MAY CONTAIN TESTES More often affected by malignancy 20x