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Male Reproductive System Karolina Janus kjanus01@qub.ac.ukLearning Objectives: • Identify and describe the anatomy and relations of the male reproductive organs • Identify and describe the spermatic cord and its contents • Identify and describe the course, relations and distribution of the testicular artery • Identify and describe the location of the recto-vesical pouch • Identify and describe the anatomy of the pelvic floor in the male • Describe the lymphatic drainage of the pelvis in the male Identify and describe the anatomy and relations of the male reproductive organs Penis Root - most proximal part. Contains erectile tissue (two crura and bulb) and two muscles (ischiocavernosus) and bulbospongiosus) Body - composed of two corpora cavernosa and the corpus spongiosum Glans - most distal. An extension of the corpus spongiosum. Contains opening of the urethra.Muscles: Fascia : • Bulbospongiosus (x2) - located • The most superficial layer is at the bulb. Contracts to empty Colles fascia (a continuation urethra of residual semen or of Scarpa's fascia) urine. Also aids in maintaining • Deep to Colles fascia is the erection. deep fascia of the penis • Ischiocavernosus (x2) - located (Buck's fascia). at the right and left crura. • Underneath the deep fascia Forces blood from cavernous there is the tunica albuginea. spaces into corpora cavernosa - maintains erection. Neurovasculature Arterial supply • Dorsal arteries of the penis, deep arteries of the penis, bulbourethral artery. • Branches of the internal pudendal artery - arises from internal iliac artery Venous supply • Cavernous spaces drained by the deep dorsal vein of the penis. The superficial dorsal veins drain skin and cutaneous structures. Innervation • Supplied by S2-S4 • Sensory and sympathetic innervation is supplied by the dorsal n. - a branch of the pudendal n. Scrotum Contents : • Testis • Epididymis • Spermatic Cord • Dartos muscle Arterial supply: • Ant. and post. scrotal a. Venous drainage: • Scrotal veins - drain into external pudendal veins Innervation: • Anterior - ant. scrotal n. • Post - post. scrotal n. Testes and Epidymis • The testes are located within the scrotum - with the epididymis on the posterolateral aspect. • Suspended from the abdomen by the spermatic cord. • The testes will initially develop on the post. abdominal wall - will then descend during embryonic development through the inguinal canal.Testes • Consist of lobules containing seminiferous tubules where spermatozoa are produced. Epididymis • Divided into three parts - head, body and tail. • Spermatozoa enter the epididymis at head. • The tail is where the vas deferens originates - which will transport sperm to urethra for ejaculation.Innervation - testicular plexus Arterial supply - mainly testicular arteries, but also supplied by branches of cremasteric a. and artery of the vas deferens. Venous drainage - pampiniform plexus. The left testicular vein will drain into the left renal vein whereas teh right testicular vein will drain into the inferior vena cava.Temperature Regulation of Testes • Cremaster muscle pulls testes closer to body in cold conditions • Dartos muscle - will wrinkle skin to reduce surface area for heat loss • Pampiniform plexus - will cool arterial blood entering the testis Scrotal Lumps Hydrocele • Collection of fluid in tunica vaginalis • May be transilluminated • Soft, fluctuant • Testicle palpable within hydrocele Varicocele • Veins in pampiniform plexus become swollen • 'Bag of worms' appearance • More prominent on standing, disappears when lying down • Subfertility/infertility Epididymal Cyst • Fluid filled sac - if contains sperm it is a spermatocele • Soft round lump, typically at top of testicle • Separate from testicle Ductus Deferens • Continuation of the epididymis • Begins at the tail of the epididymis and will then ascend via the inguinal canal • Retroperitoneal • Joins the duct of the seminal gland to form the ejaculatory duct • Supplied by the artery to the ductus deferens • Veins drain into testicular vein • A vasectomy is excision of part of the ductus deferens Seminal Vesicles • Located between bladder and fundus • Gland lined by pseudostratified columnar epithelium • Function is to secrete fluid that helps sperm to perform its function ⚬ Fructose - energy ⚬ Prostaglandins - suppress female immune response to sperm ⚬ Alkaline fluid - facilitates survival of sperm • Secrete majority of semen volume • Sympathetic innervation Ejaculatory Ducts • Formed by union of vas deferens and duct of seminal vesicle • Arise near neck of bladder • Run through part of the prostate - but carry no prostatic secretions • Opens into urethra Prostate Gland • Lies sup. to external urethral sphincter • Ampulla of rectum is post. to prostate gland • 2/3 of prostate is glandular and 1/3 is fibromuscular • Secretes enzymes for seminal fluid • Part of urethra passes through it (prostatic urethra) which will join with two ejaculatory ducts Bulbourethral Glands • Also known as Cowper's glands • Situated in the deep perineal pouch • Ducts of the gland pass through perineal membrane and open into proximal portion of spongy urethra in the bulb of the penis • Function is to produce a mucus secretion containing glycoproteins for lubricationIdentify and describe the spermatic cord and its contentsCourse of the Spermatic Cord • Formed at the opening of the inguinal canal - the deep inguinal ring • Passes through the inguinal canal and enters scrotum via the superficial inguinal ring • Continues into scrotum - ending at the post. border of testes External fascia - external oblique aponeuroses Cremaster fascia - internal oblique muscle and its fascia Internal fascia - derived from transversalis fascia Contents of the Spermatic Cord Fascia: • Arteries: • External spermatic • Testicular • Cremasteric • Cremasteric • Internal Spermatic • Artery of the vas Nerves: deferens • Nerve to Other structures: cremaster • Vas deferens • Sympathetic fibres • Pampiniform plexus • Genital branch of • Lymphatics genitofemoral n.Identify and describe the course, relations and distribution of the testicular artery The Testicular Artery • The main arterial supply of the testes and epididymis • Arises directly from the abdominal aorta - at L2-L3 just distally to renal arteries • Descends into abdomen, passes into scrotum via inguinal canal. • The testes are also supplied by branches of the cremasteric a. (from inf. epigastric a.) and artery of the vas deferens (from inf. vesical a.). These branches anastomose with testicular a. Testicular Torsion • Acute, painful scrotum • Tender swollen testes • Scrotal erythema • No cremasteric reflexIdentify and describe the location of the recto-vesical pouch Recto-vesical pouch • Double folding of peritoneum between the rectum and the bladder. • Lies above the seminal vesicles. • Can contain loops of small bowel or sigmoid colon. • Completely closed in males. • When supine, it is the lowest part of the peritoneal cavity. Peritoneal fluids (ascites, blood, pus) will collect in this cavity.Identify and describe the anatomy of the pelvic floor in the male The Pelvic Floor • The pelvic floor is a The functions of the pelvic floor: funnel shaped structure • Support abdominopelvic viscera that attaches to the • Resist increases in lesser pelvis. intraabdominal or intrapelvic • It separates the pelvic pressure cavity from the • Urinary and faecal continence perineum. Muscles of the Pelvic Floor Levator ani - broad sheet of muscle composed of three separate paired muscles: • Puborectalis • Pubococcygeus • Iliococcygeus Coccygeus - located posterior to levator ani muscle group Gaps in the Pelvic Floor These gaps aid in urination and defecation. Urogenital hiatus - ant. gap allows the passage of the urethra Rectal hiatus - centrally positioned - allows for the passage of the anal canalDescribe the lymphatic drainage of the pelvis in the male Where does the lymph drain? Testes and epididymis Right testes - right lumbar nodes Left testes - left lumbar nodes Ductus deferens, ejaculatory ducts, seminal vesicles, bulbourethral glands and prostate gland Internal and external iliac nodes Penis Skin: superficial inguinal nodes Glans penis: superficial inguinal, deep inguinal and external iliac nodes Scrotum Superficial inguinal nodesMCQs! A 15 yr old boy presents to ED with acute scrotal pain. O/E the pt has a swollen, tender erythematous left testis. The cremasteric reflex is absent. How should this pt be managed? A) Reassure pt and discharge home B) Refer pt for doppler ultrasound scan C) Emergency surgery D) Refer pt for CT scan E) Perform a urine dip on the pt A 15 yr old boy presents to ED with acute scrotal pain. O/E the pt has a swollen, tender erythematous left testis. The cremasteric reflex is absent. How should this pt be managed? C) Emergency surgeryA 30 yr old man presents to a fertility clinic. He has been unable to conceive a child with his partner. What is the most likely finding O/E? A) Scrotal pain and swelling that has developed over the past week B) Painless hard mass on left testicle C) Soft fluctuant mass that may be transilluminated D) Bag of worms appearance of left testicle E) Soft round discrete lump near the top of the testicleA 30 yr old man presents to a fertility clinic. He has been unable to conceive a child with his partner. What is the most likely finding O/E? D) Bag of worms appearance of left testicleA vasectomy involves ligation of which structure? A) ejaculatory ducts B) vas deferens C)epididymis D) ducts of Cowper's glands E) ducts of prostate glandA vasectomy involves ligation of which structure? B) vas deferens