Session 1

Question 1

Label the diagram

Answer 1

Question 2

Where is the origin of the testicular arteries?

Answer 2

Abdominal Aorta

Question 3

Describe the venous and lymphatic drainage of the Right Testis, Left Testis, Scrotum and Prostate Gland

Answer 3

Question 4

On the diagram label the:

Vas deferens

Spermatic cord

External spermatic fascia

Cremaster muscle/fascia

Internal spermatic fascia

Tunica vaginalis

Answer 4

Question 5

From which layers of the anterior abdominal wall are the fascial coverings of the spermatic cord derived?

Answer 5

External Spermatic Fascia - External Oblique,

Creamsteric fascia - Internal Oblique,

Internal spermatic fascia -Transversalis Fascia

Question 6

Shade the vas deferens in the picture

Answer 6

Question 7

Complete the following table

Answer 7

Question 8

Label the prostate and seminal vesicles on the diagram

Answer 8

Question 9

Identify the different regions of the prostate

Answer 9

insert diagram

Question 10

Label the diagram

Answer 10

Question 11

What is the function of the male reproductive system?

Answer 11

Produce sperm which will travel through the reproductive system so that fertilisation can occur.

Question 12

What is the purpose of the testis descending into the scrotum?

Answer 12

To allow spermatogenesis to occur at the optimum temperature which is slightly cooler than the core body temperature

Question 13

Describe how blood supplies and leaves the testis

Answer 13

Blood supply is via the testicular artery which arises directly from the abdominal aorta. Venus drainage is via the pampiniform plexus which then goes on to form the right and left testicular vein. On the right, this drains directly into the inferior vena cava and on the left, it drains into the left renal vein before draining into the IVC.

Question 14

What can happen if the venous drainage of the testis becomes obstructed?

Answer 14

It can cause a varicocoele

Question 15

Where in the testis does spermatogenesis occur?

Answer 15

Seminiferous tubules

Question 16

Describe the route to which sperm leaves the testis

Answer 16

Made in seminiferous tubules, leaves them via straight tubes into the rete testis (seminiferous tubules come together here) in mediastinum testis, which then drains into the head of the epididymis via the efferent ductules. Moves through epidiymis (head to body to tail) into the ductus/vas deferens out of the testicle.

Question 17

What happens in the epidymis?

Answer 17

Sperm maturation

Sperm “learn to swim”, are concentrated and fluids are reabsorbed

Question 18

Describe the layers of the testis from the seminiferous tubules

Answer 18

Seminiferous tubules surrounded by a capsule called the tunica albuginea (made of connective tissue). This capsule is then surrounded by tunica vaginalis which has two layers; A visceral layer (inside) and parietal layer (outside) which are separated by a cavity. Then wall of the scrotum.

Question 19

What is a hydrocoele

Answer 19

Tunica vaginalis cavity fills with fluid

Question 20

Describe the wall of the seminiferous tubule and its function

Answer 20

Walls of the seminiferous tubules are made from sertoli cells which trim away cytoplasm from the spermatocytes as they pass through them in order to make them more streamline/lighter. The sperm cells initially form from a germinal epithelium where the stem cells divide to give our sperm cells. Theres then a myoid cell layer (smooth muscle layer).

Question 21

What are leydig cells and where are they found?

Answer 21

Found in the interstitial tissue between seminiferous tubules. They synthesis testosterone and are adapted to do this by having lots of smooth endoplasmic reticulum (involved in lipid metabolism), big neuclei and vacuoles (lipid storage)

Question 22

Why is it believed that left testis sits lower then the right?

Answer 22

More venous congestion causing it to be lower as left testicle drains into left renal vein instead of straight into IVC

Question 23

What is the benefit of the pampiniform plexus surrounding the testicular veins?

Answer 23

There is counter-current flow so heat exchange takes place. Arterial blood loses heat the venous blood. This helps to maintain a lower temperature in the testis to allow spermatogeneis to ccur at its optimum temperature - 35 degrees celsius

Question 24

What is it called when a testicle get twisted? What are the risks and how does it happen?

Answer 24

Called testicular torsion. It is a surgical emergency. Spermatic cord gets twisted causing compression which leads to venous occlusion causing calpillary presure to rise which compresses arterial blood supply. This all leads to the blood supply to the testicle being cut off. This can result in necrosing of the testicle and can lead to infertility if not treated fast enough. Infertility can be caused by immune system now recognising the testicle as antigen within it now exposed and so it attacks the contralateral testicle so no healthy testicle left.

Question 25

Why would someone be predisposed to testicular torsion and what can be done to help them?

Answer 25

Predisposition as a result of having Bell-clapper deformity. This can be overcome by attaching the testis to the wall of the scrotum to prevent twisting.

Question 26

Can your testis cross over?

Answer 26

No as they are separated by the septum of the scrotum.

Question 27

How is the spermatic cord formed?

Answer 27

The testis evaginate the abdominal wall as they are pulled through by the gubernaculum, forming the spermatic fascia that surrounds the testis and its vessels.

Question 28

In detail describe/draw a cross section of the spermatic cord and its contents. Describe the origins of the structures too.

Answer 28

3 fascial layers, 3 arteris, 3 veins, 3 nerves and Vas deferens. From deep to superficial: Internal Spermatic Fascia (derived from Transversalis Fascia) (fibrous), Cremasteric Fascia (derived from internal oblique) (contains muscle fibres which forms the cremaster muscle) and External Spermatic Fascia (derived from external oblique) (fibrous) From deep to superficial (found between each layer of fascia): testicular artery, cremasteric artery and artery to vas From deep to superficial: Testicular vein/pampiniform plexus, vein to the cremaster and vein to the vas From deep to superficial: Nerve to cremaster / genital branch of the genitofemoral nerve (between internal and cremasteric fascia), sympathetics/nerve to the vas (mediate ejaculation), ilioinguinal nerve Vas deferens, lymphatics and obliterated processus vaginalis found surrounded by the internal spermatic fascia.

Question 29

Where is the cremaster muscle found and what is its function?

Answer 29

Found in the cremasteric fascia and regulalate height that the testes sit at in the scrotum. This is done to maintain optimum temperature. E.g on a cold day testes will be pulled higher to conserve heat

Question 30

What is the processus vaginalis

Answer 30

Peritoneal connection between the testis and peritoneal cavity formed as testes descend.

Question 31

Describe the important pelvic relations of the vas

Answer 31

Between vas and uereter. In the male the ureter passes under the vas . In the female the ureter passes under the uterine artery Remember by thinking "ureter is water under the bridge"

Question 32

What is the ejaculatory duct?

Answer 32

Where seminal vesicles join up with the vas deferens, runs through central zone of the prostate to enter urethra.

Question 33

How can enlargement of the prostate affect the urethra and which region most commonly becomes enlarged?

Answer 33

Benign prosatic hyperplasia = prostate enlargement. Compresses the urethra, and transitional zone of the prostate which surrounds the urethra, is the area most commonly enlarged. This causes symptoms of lower urinary tract obstruction.

Question 34

Which area of the prostate is most commonly affected by cancer? How does this relate to urinary flow and what does this mean for detection?

Answer 34

Peripheral zone so urinary flow may not affected however men with prostate cancer often have benign prostatic hperplasia which does affect urinary flow so both are often picked up at the same time.

Question 35

Why is it more difficult to pass a catheter in males?

Answer 35

Men have a longer urethra and it has two bends. To do it the penis must be straightened and pointed downwards. There's a risk of pushing the catheter into the prostate or into the wall of the urethra.

Question 36

What are the functions of the penis?

Answer 36

Expulsion of urine via the urethra Deposition of sperm in the female genital tract Possibly removal of competitors' sperm and attarction of mates

Question 37

Describe the erectile tissue of the penis and how an erection is achieved and lost

Answer 37

Two corpus cavernosum and corpus spongiosum (surrounds urethra). erectile tissue surrounded by tunica albuginea which gives shape during erection. It has collagen fibres running in both transverse and longitudinal planes. Vasodilatation in penile arteriles, and compression of veins results in erection. Vasodilatation is initiated by parasympathetic stimulation. Erection is terminated by vasoconstriction which is initated by sympathetic stimulation Ejaculation is primarily orchestrated by the sympathetic system THINK Point and Shoot Point - Parasympathetic Shoot - Sympathetic

Question 38

Is penis anchored to bone?

Answer 38

Yes suspensory ligaments hold it to the pubic bone corora cavernosa anchored to pelvis

Question 39

How does the penis relate to the clitoris

Answer 39

They are homolgous structures. Both have corpus cavernosa anchored to the pelvis

Question 40

Describe the blood supply and drainage of the penis. Why is this important when looking at diabetes?

Answer 40

Arterial blood from the internal iliac artery to the internal pudendal artery and into the penis. Blood leaves via the internal pudendal vein which runs into the internal iliac vein. Microvascular disease and neuropothy can contribute to impotence

Question 41

What is a fractured penis?

Answer 41

Penis is bent to such an extent that the tunica albuginea is ruptured resulting in haemorrhage of the corpus cavernosum. If not fixed quick enough a bend can persist.

Question 42

Explain why trans-ilumination with a small bright torch can distinguish between a hyrdorcoele (or cystic mass) and a solid mass such as a tumour

Answer 42

Little if any light would penetrate the solid mass

Question 43

What is the cremasteric reflex?

Answer 43

Stroking the skin on the medial side of the thigh evokes a reflex contraction of the cremaster which elevates the ipsilateral testicle. The reflex is mediated by the genitofemoral nerve (L1 and L2 nerve roots), although the afferent arc reflex may be via sensory fibres of the ilioinguinal nerve. The reflex is normally absent if the patient is suffering from testicular torsion.

Question 44

Which portion of the prostate is felt in a rectal examination?

Answer 44

Peripheral lobe