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Case 4: Male Reproductive System By Nortree (Lead) Learning agenda & sources Moore's Clinically Oriented Anatomy (page 560-573, 428-432, 602-609, 630-642) Textbook: YouTube: Malereproductivesystem - thepath of ejaculation Malepelvic organs introduction Testis or testicle (anatomy) Website: https://teachmeanatomy.info/pelvis/the-male-reproductive-system/ CompleteAnatomy TheApp Learning Agenda: Contents 01 02 03 Male v Female Male Reproductive Pelvic Pelvis Organs Floor/Perineum 04 05 06 Sperms’ Journey Histology Glands (thebest,you can argue with the wall) Extra Function : provide attachment for the erectile bodies of the external Male vs Female Pelvis genitalia 01 MALE FEMALE Malepelvis is small because its compact – narrow pelvic outlet/inlet allows greater stability for heaviermass (inlet is heart shaped which is Structure Small, thick and heavy Larger, thin and light comparatively narrower) PelvicOutlet Smaller Larger Female pelvis is large with a wider outlet/inlet becauseit's adapted for childbirth (inlet is circularwhich is comparatively wider) Pelvicinlet Heart-shaped Circular Pelvicinlet/outlet narrow ∴ pelviccavity is narrow/deep Pelvicinlet/outlet wide ∴ pelviccavity is wide/shallow Narrower/deep Wider/shallow PelvicCavity Malepelvis is thick and heavy becauseits adapted to support a heavierbuild since higher testosterone fosters greater muscleand SubpubicAngle Narrower: <70° Wider: >80° bone growth alongsideincreased bone density prominent flattened Women haveless testosterone on average so the pelvis is thinner and Sacral Promontory lighter Greatersciaticnotch Narrower Wider Men have a narrower subpubic angle as it doesn’t need to support childbirth and thenarrow angle makes the pelvis more compact and Large Small stable. Acetabulum Women havea widersubpubicangle to support childbirth – wider Obturator Foramen Round Oval birth canal Testosterone promotes narrowing Oestrogen promotes wideningFemale Male Clinical relevance: In crush incidents thereis anteroposterior compression– commonly produces fractures of the pubic rami OR you could have a lateral compression of thepelvis leading to theacetabula and ilia being squeezed towards each other (happens mostly in skydivers so the femoral head is driven up) The Parts 1. Scrotum 2. Spermatic Chord 3. Prostate Testis +Epididymus + lower end of the Vas Deferens(or known asDuctus spermaticchord Deferens) Epididymus – responsiblefor sperm Responsible forthe transport ofthe collection and maturation sperm Testis – responsiblefor spermproduction On top ofthe VasDeferens ithas ac & isfound separate to the abdominal collection ofvesselsto and fromthetestes cavity asoptimum temperature is3 degrees less. 4. Penis 5. Glands Urethra Seminal vesicles – contributes the biggest Prostaglandinssignalthe uterusto proportion to the volumeofsemen & startcontractingin a retropulsating prostaglandins)ort(fructose & manner to move sperm cells into the uterus prostate– secretes proteases, helps with pH balance(alkaline) and mobility Bulbourethral – actsselective& lubricatingOverview Scrotum Located in the superficial fascia and isresponsiblefor regulating temperature of the testes by wrinkling the skin ONE scrotumsplitinto TWO Elevates/descends testisaccordingto temperatureTestis & Epididymus Comes out of the section known as Rete Testis Located within each septa Outer tunicawhich surrounds the testis Invaginatesinto the testisand splitsit into different sectionsviathe septa Where does it go – quick answer Seminiferous Tubules ● Sperm produced here and exits via the lumen and into the rete testis via the straight tubules. From hereit enters the Ductus Efferentesthen epididymus to mature ● Sperm matures & becomes motile at this stagedueto DHT Histological reference: Sertoli cells are present and they support developing sperm. Just outside oftheseminiferous tubules areLeydig cells which produce testosterone. Arterial Supply: Abdominal aorta enters pelvicregion and bifurcates at L4 into common iliac artery (then bifurcates into external and internal iliacartery) Vasculature of Testes/Epididymus VENOUS ARTERIAL Blood exitsthe righttestes through the PP (veins tied around the vasdeferens)and drains straight into the inferior vena cava Abdominalaorta enterspelvic region and bifurcatesat L4 INNERVATION into common iliac Testesinnervated viathetesticular artery (then plexus. bifurcatesinto Parasympatheticviathe vagus external and internal nerve. iliac artery) Sympathetic innervation from T7 segment of spinalcord Blood exitstheleft testes into the left testicular vein Testes originate fromthe posterior then into the left renalvein and then into the abdominal wall.Testicular artery stems inferior vena cava directly fromabdominal aorta, whilst the cremasteric and artery to vas deferensstemfromsomewhere else idk. Quick fire questions ● Where does the left and right testes drain into? Left testicular vein → left renal vein → inferior vena cava Right testicular vein → inferior vena cava ● Where do thetesticular arteries originate from? ABDOMINAL AORTA and they then pass through the INGUINAL canal and through the spermatic chord to get to the testes • WHEREDOES THE AA BIFURCATE? & INTOWHAT? At fourth lumbar vertebrae into the internal illiac artery and common illiac artery (which gives rise to theexternal iliac artery) Spermatic Chord ● Ruleof 3 – arteries, nerves, fascias and others ● Testicular art●ry Genital branch ofthe Genitofemoralnerve ● Deferential ar●eryCremastericnerve ● CremastericArt●ry Sympathetic nerve ● External spermatic fascia ● Cremastericfascia ● Internalspermatic Fascia ● DuctusDeferens – sperm transport ● Pampiniform plexus – venousdrainage ● Lymphatic vessels VAS DEFERENS PATHWAY Thick muscular tube that takes sperm fromthe epididymus → Ampulla → Ejaculatory duct → Prostatic Urethra Ampulla is joined by the seminal vesicles and forms the Ejaculatory duct Anatomical Path How do you find the Vas Deferens (easy 100% guarantee): Find the epididymus and look for the tail stretching out ofit. Recall the path it takes – it travels through the inguinalcanal as PART OF the spermatic cord Moves down the lateral pelvis wall closeto the ischial spine then mediallyto pass between the bladder and the urethra. Traverses inferiorly on theposterior surface of thebladder Inferior narrow portion of the ampulla joins theduct from the seminal vesicle to formthe ejaculatory ductPenis Neuravasculature of the penis VENOUS ARTERIAL Deep and superficial DORSAL vein -Dorsal Artery -Deep Artery -Bulbourethral artery ALL are branches of the internal pudendal Innervation artery S2-S4NERVE ROOTS Sympathetic +Sensory - Branch of pudendalnerve Parasympathetic - Peri-Prostatic NervePlexus Penis - Urethra Prostate Bulbourethralgland Seminal Vesicles + bulbourethral gland Anatomical position: between the bladder fundusand therectum Anatomical position: Deep perinealpouch + posterolateralto the Histologicalsignificance: pseudostratified columnar epithelium membranousurethraand superior to the bulb ofthe penis Physiological importance: influenced by testosterone isresponsiblefor Physiological importance: Mucussecretion containingglycoproteins production ofseminalvesicles ● Alkaline fluid: neutralises maleurethra and female vaginal ● Lubrication medium forurethra and tip ofthepenis acidity forspermatozoa survival ● Expels any residueofurine,dead cell debris or mucous through ● Fructose: Energy source for spermatozoa motility the urethralmeatus ● Prostaglandins: suppresses female immune response to foreign ● Helpsto neutralise residual acidity in themale urethra semen ● Clotting factors: keeps semen in female reproductivetract after ejaculation Prostate Gland Anatomicalposition: inferior to the neck ofthebladder and superior to the external urethralsphincter,with the levator ani muscleslying infero-laterally to thegland Liesposteriorly to the Ampullaofthe rectum Physiological importance: secretesproteolytic enzymes into the semen (breaks down clotting factors in the ejaculate) – keepssemen in afluid state to enhance mobility and increase the chance of potential fertilisation Pelvic Cavity → Pelvic Floor Pelvic Cavity Pelvic Floor Pelvic Cavity is inferoposterior to the abdominopelvic cavity Infero because itsbeneath and continousfrom with the abdominal cavity atthepelvic The pelvic floor ismade up of the pelvic diaphragmmuscles – LevatorAniand inlet. And posterior becauseit gets angulated out anatomically by the sacrum. coccygeus – this closes offthe inferior pelvicaperture. Whilst its bounded by a Pelvic cavity islimited inferiorly by thepelvic diaphragm (Levator aniand coccygeus) lateral and poserosuperior wall (obturatorinternus and piriformis). which stayssuspended on the level ofthepelvic inletand descendscentrally to thelevel of the pelvic outlet. LevatorAniconsistsofthe Pubococcygeus,Puborectalis,and Iliococcygeus. With the Pelvic cavity isbounded posteriorly by thecoccyx and inferiomost sacrum. Coccygeus it supports the bladder, prostate and rectum – whilst also contributingto Pelvic cavity islimited by an antero-inferior pelvicwall which is formed primarily by the erectionsand ejaculations. bodiesand ramiofthe pubicbones and symphysis. It allowsonly for 2main passages which istheurethra and the rectum in males. Pelvic Cavity is bounded laterlly by theleft and righthip bones– the respectiveobturator foramensclosed by an obturator membrane. It does thisthrough an anterior gap between the medialborders ofthelevator ani muscleson each side(formingtheurogenitalhiatus for the urethrato exit) Perineum – split them Urogenital Triangle Anal Triangle The analtriangleistheposterior half of the perineum. The urogenital triangle in malescontainsthe Samein both M + F samemusclesasin the female,though their Boundaries: coccyx, sacrotuberous ligaments,and a theoretical functionsdiffer slightly and itincludesthemale line between the ischialtuberosities. external genitalia. The main contentsofthe analtriangleare: Maleshavetheischiocavernosus muscle covering Anal aperture: the openingofthe anus. the crusof the penis. External analsphincter muscle – voluntary muscle responsible for opening and closingthe anus. Maleshavethe bulbospongiosum muscle Ischioanalfossae (x2) – spaceslocated laterally to the anus surroundingthebulb ofthepenis. Both in the ROOT of thepenis THANKS! DO YOU HAVE ANY QUESTIONS? https://yaqeeninstitute.org/watch/series/kaab-ibn-malik-ra-the- greatest-story-of-repentance-the-firsts Slidesgo icons by laticon and infogr phics & images by r epikidesgo, including Made By Nortree Please keep this slide for attribution