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Lecture Notes - Male Reproductive Anatomy |
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Bony Structure
- 2 hip bones: ilium, pubis, ischium
- 1 sacrum
- 1 coccyx
Ligaments - hold/bind bony pelvis together and hold pelvis in proper orientation to resist forces
PeritoneumOrientation - NOT a basin!!! Tilt to ~80° angle
- sacrotuberous
- sacrospinous
- sacroiliac
- Pubic tubercles and ASIS in vertical line
Viscera
Falls short - does not reach pelvic floor/diaphragm - Pouches
- Female - vesicouterine & rectouterine
- Male - rectovesical
- Broad Ligament - mesosalpinx, mesovarium, & mesometrium
Rectum
Anal Canal
- peritoneal covering - top 1/3 on front and sides, middle 1/3 on front, inferior 1/3 none
- transverse rectal folds
- passes through pelvic diaphragm to become anal canal
- blood supply and venous return - portocaval anastomosis
Reproductive Organs
- internal anal sphincter - thickened circular (smooth) muscle
- external anal sphincter - skeletal muscle
- anal columns, valves, and sinuses - what forms columns?
- Pectinate Line - functional significance??
Bladder
- Female:
- Uterus
- fundus, body, isthmus, cervix (internal and external os)
- round ligament (anterior)
- uterine artery OVER ureter
- anteverted vs. anteflexed
- Uterine Tube
- isthmus, ampulla, infundibulum, fimbriae
- Ovary
- suspensory ligament (contains ovarian vessels)
- proper ovarian ligament
- (ovarian + round ligaments = gubernaculum)
- Vagina
- from cervix to vestibule
- vaginal fornices - recess around cervix (anterior, posterior, lateral)
- Male:
- Testis
- seminiferous tubules
- epididymis - head, body, tail
- Spermatic Cord
- ductus deferens
- testicular artery
- pampiniform plexus of veins
- Ejaculatory Ducts
- ampulla of ductus deferens + seminal vesicles
- through prostate to join urethra at seminal colliculus
- Prostate
- base of bladder
- median lobe = uvula
Perineum - inferior to pelvic diaphragm
- apex, fundus, body, neck
- trigone = ureteric orifices + internal urethral orifice
- urethra
- male: prostatic, membranous, penile (spongy)
- female: membranous
- Anal Triangle
- ischioanal fossae - lateral to anal canal
- obturator internus muscle is lateral wall
- pudendal canal - fascia of obturator internus muscle
- contains internal pudendal vessels & pudendal nerve
- anal canal - review anal canal - internal structures and sphincter muscles
- Urogenital Triangle
- Perineal Membrane - bands of connective tissue between midline viscera and ischiopubic rami; erectile tissues attached to caudal surface
Female Male 2 corpora cavernosa
shaft of clitoris
diverge as 2 crura along ischiopubic rami
crura covered by ischiocavernosus muscle2 corpora cavernosa
shaft of penis
diverges as 2 crura
crura covered by ischiocavernosus m.2 bulbs of the vestibule
glans of clitoris
covered by bulbospongiosus m.
greater vestibular glands1 corpus spongiosus
glans of penis
spongy urethra
bulb covered by bulbospongiosus m.perineal body
muscle fibers from:
bulbospongiosus, external anal sphincter
& superficial transverse perinealcentral tendinous point
mm. fibers from:
bulbospongiosus, ext. anal sphincter
& superficial transverse perinealsphincter urethrae (urethrovaginal sphincter & compressor urethrae) sphincter urethrae
bulbourethral glands
Pudendal NerveInternal Pudendal Artery
- motor to all perineal muscles and sensory to most perineal structures
- 3 branches
- inferior rectal - external anal sphincter and skin around anus
- perineal - posterior labial/scrotal branches
- dorsal nerve of clitoris/penis - remainder of pudendal; within connective tissue of perineal membrane; pierces membrane at anterior border and runs with dorsal aa. and v.
Vessels
- 3 branches
- inferior rectal - anastomoses with which vessels?
- perineal - superficial; terminates as posterior labial/scrotal
- internal pudendal - runs deep with dorsal n. of clitoris/penis
- 2 terminal branches
- deep artery of clitoris/penis - within corpora cavernosa
- dorsal artery of clitoris/penis - with nerves and vein
Innervation
- Common Iliacs
- External Iliacs - vessel of lower limb
- Internal Iliacs - pelvis, gluteals, medial thigh, perineum
- Internal Iliac - highly variable!!
- posterior division - parietal branches only
- iliolumbar
- lateral sacral
- superior gluteal
- anterior division - parietal and visceral branches
- inferior gluteal
- obturator (30% aberrant)
- internal pudendal (around sacrospinous ligament)
- umbilical (1st branch off anterior division)
- superior vesical (artery of the ductus deferens)
- middle rectal
- inferior vesical (prostatic branches)
- uterine (relationship to ureter!!)
- vaginal
Review Intro to Autonomics Module - this is the time to make it all come together!
- Sacral Plexus
- ventral primary rami of L4,5 (aka, lumbosacral trunk) and S1,2,3,4
- relationship to piriformis muscle
- Autonomics
- Inferior hypogastric plexus (sides of rectum) - continuation of preaortic plexus via hypogastric nerves
- Sacral splanchnics - sympathetic fibers from sacral portion of sympathetic chain
- Pelvic splanchnics - parasympathetic fibers from S2,3,4
Also, review the formation of the inferior hypogastric plexus (Pelvic Autonomics Module)Pelvic Diaphragm/Floor
- where do sympathetics come from?
- where do parasympathetics come from?
- how are specific pelvic viscera innervated?
- Wall of Pelvic Cavity
- Obturator Internus m.
- Arcus Tendineus Levator Ani - attachment for portion of levator ani m.
- Piriformis m. - exits pelvis via greater sciatic foramen, sacral plexus lays on piriformis
- Floor or Diaphragm
- Above = pelvic cavity
- Below = perineum
- Coccygeus m. - on internal surface of sacrospinous ligament
- Levator Ani m.
- pubococcygeus
- iliococcygeus
- puborectalis
- genital hiatus