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Male Reproductive Viscera
Christopher Ramnanan, [email protected]
-Describe the embryological origins of the male reproductive system
-Identify the anatomical structures, blood supply, and innervation associated with the male reproductive system
-Identify the histological features of the testis, epididymis, prostate, seminal vesicles and penis
This talk will focus on anatomy; embryology and histology covered thoroughly in Dr. Savory and Dr. El-Bialy’s respective presentations
Male Reproductive
System
Epididymis
Testes
Seminal Vesicle
Prostate
Ductus Deferens
Penis
Testes originate on posterior body wall (proximal to kidneys) and descend during development in retroperitoneal position.
Posterior wall of parietal peritoneum
Testes
Ductus deferens
Gubernaculum testis (caudal portion of genital ligament)
Processus vaginalis: outpouching of peritoneum
7th week
In the last trimester, the testes descend through the inguinal canal in part due to the relative shortening of the gubernaculum.
7th month
Gubernaculum testis
Note: the processus vaginalis precedes the testes; the testes pick up layers derived from anterior abdominal wall
9th month
Testes descend to their final position in 9th month (97%). The communication b/w the processus vaginalis and the peritoneal cavity becomes obliterated, leaving behind the tunica vaginalis.
Gubernaculum testis (scrotal ligament)
Clinical NotesOne or both testes fail to descend, a condition termed cryptorchidism (resulting in ectopic testis, and increased risk of infertility and testicular cancer).
The tunica vaginalis can be associated with (A) testicular hydrocele. A patent process vaginalis increases risk of (B-C) indirect inguinal hernias. Risk of this type of herniation is greater in males and is routinely tested for (D; ‘turn your head and cough’).
A
B C D
Inguinal CanalAnatomical passage between the deep and superficial inguinal rings for:
-Spermatic cord in males -Round ligament of uterus in females
-Ilioinguinal nerve and Genital br. of genitofemoral n. in both sexes
1. External Oblique
2. Int. Oblique
3. Transversalis Muscle and Fascia4. Peritoneum
Note: Layers of Abdominal Wall will give rise to coverings of Spermatic cord/Testis
Epididymis: 1. Head2. Body3. Tail
1
2
3Lobules (containing sperm-producing seminiferous tubules)
Tunica Albuginea (fibrous coat; gives rise to septa)
Ductus deferens
Ductus (vas) deferens and Testis
Ductus (vas) Deferens and Seminal VesiclesDuctus deferens enters body via inguinal canal, moves medially and ends by joining the duct of the seminal vesicle to form the ejaculatory duct
Seminal Vesicle and its duct
Prostatic Urethra (termination of Ejac. Duct)
Ductus Deferens
Ejaculatory Duct
Prostatic Urethra and openings of prostatic ducts (many)
Ductus Deferens and its Ampulla
Ejaculatory Duct (most of duct runs within prostate)
Posterior View Anterior View (Frontal Section)
Seminal Vesicle
Ejac Ducts open at margins of seminal colliculus (bump) near the prostatic utricle (blind pouch; derived from parames. ducts)
Membr. Urethra
Spongy Urethra
Opening of Ejac. Duct (2)
Visible in Lab Conceptual View
Prostate3 major anatomical lobes in adult (5 in fetus):
Anterior lobe (isthmus): anterior to urethra
Two lateral lobes (posterior to urethra; adjacent to rectum; separated from each other and from isthmus by median sulcus; can be palpated via rectal exam)
Prostate3 clinically-described zones in adult:
Peripheral Zone: ~70% of volume; typical site of cancer
Central Zone: 25% of volume; surrounds ejaculatory ducts
Periurethral transitional zone: 5% of gland; surrounds urethra; typical site of B.P.H.
Peripheral ZoneCentral Zone
Periurethral Transitional Zone
External Genitalia
Homology
Scrotum
Body (Shaft) of Penis
Prepuce
Glans Penis
Labia majora
Body of Clitoris
Prepuce
Glans of Clitoris
Labia minoraRaphe of penis
Male Erectile Bodies
-Crura and bulb of penis are homologous to crura of clitoris and bulb of vestibule in females; crura and bulb erectile tissue covered by perineal muscles (perineum anatomy on Nov. 11th)-Spongy urethra is conveyed in corpus spongiosum
View of Superficial Perineal Pouch MusclesMale Female
-The bulbospongiosus muscles are fused (midline raphe of penis) in males but are separate in females; in both sexes, associated with bulb erectile body-The ischiocavernosus muscles attach to ischiopubic rami and are associated with crura erectile bodies in both sexes-Perineal body allows for support and attachment-Muscles generally more prominent in males (bulbospongiosus and ischiocavernosus both aid in maintaining erection; Bulbospongiosus also functions in expelling semen and urine
-Described in anatomical position as being in the erect state-Root: muscles+erectile bodies and attached; Body: only erectile tissue and ‘free’-Spongy urethra is conveyed in corpus spongiosum-Key neurovasculature (dorsal nerve, dorsal artery, deep artery, deep dorsal vein) derived from pudendal n. and internal pudendal a/v (perineum anatomy lab, Nov 12th)
Sympathetic (S; shoot) supply:Descending with testicular arteries or via hypogastric plexuses
Parasympathetic (P, point) supply:From S2-S4; traveling via pelvic splanchnic nerves pelvic plexus (prostatic plexus) cavernous nerves reach erectile tissue
Somatic Innervation (Voluntary Motor to Perineal Muscles/Touch Sensation to Penis/Scrotum): Pudendal N. (S2-S4)
Note: Pelvic Pain Line
Male Reprod. Viscera Innervation
Visceral Pain Lines
Heart (CardiopulmonarySplanchnic Nn., T1- 6)
Thoracic Pain Line: ~plane of sternal angle
Pelvic Pain Line: ~ plane of lower extent of peritoneum
Note: TESTES
Male Reprod. Viscera VascularizationTesticular arteries and veins (pampiniform venous plexus) are visible, descending from abdomen Note: veins are asymmetrical; relationship to ureter; ‘Nutcracker’ effect
Male Reprod. Viscera Vascularization
Blood supply of other viscera (seminal vesicles, prostate, ductus deferens) not discernable in gross lab, but derived from internal iliac artery, drain to internal iliac veinNote: prostatic arteries from nearby arteries (middle rectal, inferior vesicle); prostatic venous plexus in males can communicate with vertebral veins
Blood supply of scrotum, penis, perineal muscles derived from internal pudendal artery
Internal pudendal artery
Male Reprod. Viscera Lymphatics
-Deep structures drain to back body wall following lymph nodes associated with arteries (gonadal, internal iliac) to reach chyle cistern-Superficial structures (scrotum, skin of penis) drains superficially to superficial inguinal lymph nodes (not shown)Clinical Note: Prostatic venous/lymphatic plexus communicates with vertebral plexuses; common site of prostatic cancer metastasis is to vertebral column
Superficial Ing. l. n.
NOTE: TestesPara-aortic Lymph nodes