Male Reproductive Tract

By Joshua BowerPeer Support 2013/14

J.Bower@warwick.ac.uk

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Identify the following:- Urinary bladder- Pubic symphysis- Sigmoid colon- Corpus spongiosus- Prostate gland- Membranous urethra- Epididymis- Corpus cavernosus

OSCE

Distinguish spermatocoele and

hydrocoele• Spermatocoele -

cyst forming in the epidydimis

• Hydrocoele - cyst forming in the tunica vaginalis

Describe the descent of the testis

List the THREE coverings of the spermatic cord, and their origin

[3+3]

• Internal spermatic fascia Transversalis fascia

• Cremasteric fascia Internal oblique

• External fascia External oblique

What are the three arteries in the spermatic

cord? [3]

• Testicular artery

• Ductus deferens artery

• Cremasteric artery

What are the three nerves in the spermatic cord? [3]

• Genital n.

• Autonomic n.s

• Ilioinguinal n.

List THREE other contents of the spermatic

cord [3]

• Pampiniform plexus (venous drainage)

• Ductus deferens

• Lymphatics

Remember the rule of 3s

• 3 fascia

• 3 arteries

• 3 nerves

• 3 “everything else”

What is an undescended testis called?

• Cryptorchid testis

• Associated with increased incidence of malignant testicular tumours

Testicular lymphatics drain where?

• Para-aortic lymph nodes

• ~L2

The ductus deferens runs from where to where?

• Tail of epididymis to the ejaculatory duct

Where does the ductus deferens run in relation to

the ureter?• Superior to it

• Water under the bridge

In females?Uterine arteries

What is the dilated portion of the ductus

deferens called?

• Ampulla

Median lobe

Anterior lobe Posterior lobe

Prostatic lymph drains where?

• Internal iliac nodes

What do these produce?

• Seminal vesicles produce alkaline fluid

What is the purpose of the bulbourethral (Cowpers)

glands?• Secrete lubricant into the urethra for sperm

passage

What are the FOUR regions of the urethra?

• Pre-prostatic

• Prostatic

• Membranous

• Spongy

How can urethral development go wrong?

• Epispadias - urinary meatus emerges on dorsum of penis

• Hypospadias - urinary meatus is displaced along the urethral groove

Give THREE indications for catheterisation [3]

• Surgery

• Retention

• Patient incapacitated

What are the FOUR areas of difficulty during

catheterisation? [4]

• Navicular fossa

• Angle at penile bulb and membranous urethra

• Prostate

• Sphincters

What is priapism?

• Persistent, painful, non-stimulated erection lasting >4 hours

Distinguish phimosis from paraphimosis

• Phimosis - prepuce (foreskin) can’t be retracted

• Paraphimosis - prepuce permanently retracted

What nervous systems control erection, emission and

ejaculation?• Point - shoot - score

• Erection = parasympathetic (S2,3,4)

• Emission = sympathetic (L1+L2)

• Ejaculation = somatic (branches of pudendal n.)

Describe the steps leading to erection [3]

• Smooth muscle in helicine arteries relaxes and straightens

• Blood flows into corpus cavernous

• Bulbospongiosus and ischiocavernosus muscles compress venous plexus to retain blood in penis

Describe the steps leading to emission [4]

• Sympathetic nerve supply:

• Closes internal urethral sphincter

• Peristalsis of ductus deferens and seminal vesicles

• Prostate smooth muscle contraction

• Ejaculate is squeezed into the penile bulb