GROSS ANATOMY (January 11, 2012) MD-1A Continuation of MALE REPRODUCTIVE SYSTEM (after layers of Scrotum) 5.

Includes genital branch of Genitofemoral Nerve -> sends communication to the sympathetic plexus

SPERMATIC CORD
Longitudinal mass of structure going to or coming from the testis Extends from the internal abdominal ring down to the scrotum

Testicular Lymph vessels - They also go upward to the posterior abdominal wall to join the aortic lymph glands at the bifurcation of the aorta.

Constituents of the Spermatic Cord: 1. Vas deferens - Most important constituent of the spermatic cord. - Firm, cord-like consistency - About 1 feet long - Extending from the lower end of epididymis up to back of the seminal vesicle where it becomes the ejaculatory duct. - Commencement: back of the testis, it passes upwards, goes to the external abdominal ring, to the inguinal canal and the internal abdominal ring to enter the pelvis. 2. Arteries Testicular artery direct branch of abdominal aorta Superior/inferior vesicle artery Inferior epigastric artery 3. to vas deferens to cremaster muscle

Pampiniform Plexus of veins - Network of vein along the posterior border of the testis - Surround the vas deferens N Testicular vein - large vein that passes upwards going to the internal abdominal ring towards the posterior wall of the abdomen. o Right Testicular vein joins the inferior vena cava o Left Testicular vein joins the left renal vein Nerves There are sympathetic plexus of nerves that are formed around the testicular artery, both from the renal and aortic plexuses

4.

TUNICA VAGINALIS TESTIS - Also an important structure here - A close serous sac - An extension of the peritoneum. - Proximal part is obliterated and closed - It is invaginated by the testes to form 2 distinct layers of parietal and visceral layer for the testis.

TESTES
Main reproductive gland of male lodged in the cavity of scrotum Slightly oval and flattened [I haven t seen a testes that is square ] Size of normal testes: about 1 inch along the antero-posterior diameter, less than 1 inch from side to side Covered by the visceral layer of tunica vaginalis testes except at the posterior border.  Upper end of the Posterior border - It is where you will find the efferent duct that passes on to the head of the epididymis.  Lower part of the Posterior border of the testes - Where the blood vessels, the nerves and the lymphatic passes through N

Formed by branching and spreading of the vessels that traverse the mediastinum testes.

SEPTUM of the Testis - It complete fibrous partition that radiates from the front and sides of the mediastinum testes going outwards to the tunica albugenia - Found more along the front and the sides of the testis TESTICULAR LOBULES 2 up to 300 partially separated compartments to which the testis is divided by the septum - Each compartment is pyramidal in shape - lodges the glandular component of the testis

Structure of the Testis: N TUNICA ALBUGENIA - Outer covering of the testes - Tough, dense; made up of fibrous tissue - Lies immediately beneath the visceral layer of the tunica vaginalis testes *Mediastinum Testes - It is a thickened ridge along the posterior part of the testes - formed from fibrous coat - represents the thickened portion of the tunica albugenia - projects into the interior of the testes. FXNs: > Form the passageway for blood vessels, lymph glands and nerves > Presents a network of small channel N TUNICA VASCULOSA - A layer of delicate network of blood vessels underneath the tunica albugenia

CONVOLUTED SEMINIFEROUS TUBULES - Also referred to as Tubuli Contorti - There are about 600 of them - Air-like tubes, that when stretched is about 2 feet long - They are paired for each of the testicular lobules - The extremely coiled tubes are separated by fibro-elastic tissue, containing peculiar type of cells: polyhedral cells termed INTERSTITIAL CELLS OF LEYDIG - tubules are lined by special, stratified epithelium showing the developing spermatozoa in various stages of development. - Some of these spermatozoa are attached to a peculiar type of columnar cell called SUSTENTACULAR CELLS OF SERTOLI STRAIGHT SEMINIFEROUS TUBULES - Also called Tubuli Recti - Smaller in number - Formed by the union of the terminal portions of the Tubuli Contorti as they converge towards the mediastinum testis RETE-TESTIS - A network of a seminal channel that occupies the mediastinum testis, to which the Tubuli Recti opens

LOBULES OF EPIDIDYMIS - Small, conical masses - Distinguished from the head of the epididymis - Made up of convoluted and twisted efferent ducts, which eventually unite to form a single canal called the CANAL OF THE EPIDIDYMIS. CANAL OF THE EPIDIDYMIS - A single much convoluted tube measuring about 20 feet long when unraveled - commencing from the union of the different efferent ducts - At the lower part of it, it gives rise to the commencement of vas deferens BODY OF EPIDIDYMIS - Middle tattering portion of the epididymis - main part of canal of epididymis - Separated from the posterior surface of the testis by a part of the Tunica Vaginalis, forming the sinus of the Epididymis TAIL OF EPIDIDYMIS - Lowermost end of the organ - where the vas deferens commences - attached to the inferior part of the testis by means of areolar tissue.

y N

EPIDIDYMIS
Shaped like a coma Lies along the lateral part of the back of the testis Made up of twisted and contorted duct of the epididymis Made up of so many minute coiled tubes when straightened, it is about 20 feet long

PENIS
Main copulative organ of the male Elongated; chiefly composed of erectile tissue. Disposed in 3 longitudinal columns

EFFERENT DUCT - About 15-20 delicate tubules that leave the rete-testis and passes into the head of the epididymis, serving to connect the 2 organs together HEAD OF EPIDIDYMIS - Upper broad end of the organ that caps or covers top of testis

Three Erectile Tissues:  2 Corpora Cavernosa - Dorsal part of the penis  1 Corpora Spongiosa - Ventrally located - traversed by the urethra (tube where the urine passes through)

*The 3 erectile tissues extend from the inferior part of the pubic arch and the anterior part of it or the pre-extremity is expanded to form the GLANS PENIS and the body of the Penis. Parts of the Penis: N SKIN - Delicate, elastic, freely movable skin over the organ - Brown in color; depends on the complexion of the person - It should be devoid of hair (or else para ka nang ungoy) - Forms a cap or a covering over the Glans Penis called PREPUCE y PREPUCE OF THE PENIS - Free fold of skin covering the Glans Penis - In the inner surface of the prepuce there is Sebaceous gland that secretes a substance called SMEGMA PREPUTI. * It is the reason why circumcision is done. Because in an uncircumcised male, this secretion of the sebaceous gland called SMEGMA can be carcinogenic and it can be a cause of cancer of the penis. *It is very important that all male should be circumcised so as to eliminate the carcinogenic effect of this Smegma. oh ung mga supot pa dyan, magpacircumcise na pero siguro sa age nyo ngayon, chain saw na ang kailangan dyan, hindi na pwede gunting! doc pagi N FRENULUM - Medial hole of the skin on the interior surface of glans penis extending from the deep surface of the Prepuce up to the point beneath the external urethral orifice. - if cut during circumcision, it will prevent penis from becoming straight during erection. (magiging baluktot na so beware if you re doing circumcision, be careful not to cut the frenulum, or else you would be sued for damages) SUPERFICIAL FASCIA - Made up of areolar tissue but completely devoid of fat - Form a loose layer beneath the skin - The one giving the skin great mobility

BUCK S FASCIA/ DEEP FASCIA - Thin fibrous membrane immediately beneath the superficial fascia - One that envelops/surround the body of the penis SUSPENSORY LIGAMENT of Penis - Strong, triangular band of fibrous tissue - Extending from the front of the symphysis pubis up to the fascial sheath of the penis to which it becomes continuous - The elastic fiber of this ligament pass from the lower part of the linea alba and it joins the suspensory ligament. FASCIAL LAYER of the Penis: contains 4 important structures 1. Dorsal nerve of the penis - Made up of 2 nerves lying on each side of the medial line - lie lateral to the artery - terminal branches of the pudendal nerve - supply the skin of the body of the Penis and the Glans Penis 2. Dorsal arteries of the penis - Also are 2, they lie on each side of the medial line and they lie between the nerve and the vein - They are the terminal branches of the internal pudendal artery Superficial dorsal vein of the penis - Just a single vein along the median line of superficial fascia It resists tributaries from the skin and the prepuce, and then terminating posteriorly as it divides into a right and a left branch, which will ultimately drain to the external pudendal veins in the thigh Deep dorsal vein of the penis - Beneath the deep fascia between the dorsal arteries along the medial line, it passes between the suspensory ligament and it enters the pelvis, where it joins the venous plexuses around the prostate gland

3.

4.

CORPORA CAVERNOSA - 2 elongated bodies lying alongside each other on the dorsal part of the body of the penis; Each corpora is made up of erectile tissue

*Erectile Tissue - Characterized by the presence of cavities that are filled with blood - Surrounded by a dense layer of fibrous connective tissue called Tunica Albogenia y SEPTUM OF THE PENIS - At the medial part of the fibrous capsule and fuses with the septum coming from the other side - It forms an incomplete partition between the corpora cavernosa penis - So being incomplete, the cavernous tissue of the right and the cavernous tissue of the left, communicate with each other DEEP ARTERY of the Penis - terminal branch of the internal pudendal artery - It enters the corpora cavernosa penis - It runs along the whole length, along the center of the corpora cavernosa. CRURA OF THE PENIS - Proximal end of the corpora cavernosa penis, as oppose to the distal end which is the glans penis - They separate then diverge posteriorly to form the crura of the penis - Attached to the medial surface of the pubic arch CORPORA SPONGIOSA - Sometimes called Corpora Cavernosa Urethra - Smaller column of erectile tissue which lies in the ventral side of the corpora cavernosa - Provided with a thinner and less dense fibrous tissue. - Traversed by the urethra - Both ends of the Corpora Spongiosum presents an expansion and an enlargement: - distal end: Glans Penis - Terminates into a cup-like expansion into which the blunted ends of the corpora cavernosa are received

CORONA GLANDI - prominent margin on posterior part of glans penis - It projects backwards towards the end of corpora spongiosa NECK OF THE PENIS - Part of body of penis immediately behind the corona glandi BULB OF THE URETHRA - The posterior expanded end of the corpora spongiosum - Attached to the inferior fascia of the urogenital diaphragm of the pelvis - The urethra enters the bulb of the urethra immediately in front of the posterior end.

y y

NERVE SUPPLY - anterior scrotal branches coming from the ilioinguinal nerve - perineal branches and dorsal nerve to the penis from the pudendal nerve

sympathetic fibers from the hypogastric plexus, and the pudendal plexuses and the parasympathetic fibers All come from the nervous erigentes, which comes from S3 and S4 spinal nerve

PERINEUM - Region on the lower part of the trunk, between the proximo-median aspect of the thigh and the buttocks - Diamond-shaped area made up of the pelvic floor with all the associated structures Boundaries of the Perineum: Anteriorly Antero-laterally Laterally Postero-laterally Posteriorly Superiorly Inferiorly symphysis pubis arcuate pubic ligament rami of the pubis and the ischium ischial tuberosities by the sacro tuberose ligament. coccyx pelvic diaphragm skin

The male perineum, is described as follows:  Skin is characterized by a greater amount of pigmentation; otherwise it is similar to the other parts of the body.  Superficial fascia presents definite characteristics, in different parts of the perineum: o At lateral side of the anus, a great quantity of fat is found and this is continuous with the ischo-rectal fossa o Over the ischial tuberosities, they become fibrous and tough and become closely adherent to underlying deep fascia o Over the urogenital triangle, the 2 distinct layers of the superficial fascia can be distinguished. The superficial layer over the urogenital triangle is continuous with the fatty layer of the other parts of the body. But as it approaches the scrotum, the fat gradually disappears, and becomes replaced by DARTUS MUSCLE. o In the penis, the superficial fascia is totally devoid of fat  COLLES FASCIA deep membranous fascia layer - continuous with that of Scarpas Fascia of the lower abdominal wall - It is limited to the urogenital triangle attachments: o At base of triangle passes behind superficial transverse perineal muscle and fuses with interior fascia of urogenital diaphragm o Laterally attached to rami of ischium and pubis o Anteriorly continuous with Scarpa s fascia of abdominal wall - after it has covered the scrotum and penis, it passes to symphysis pubis SUPERFICIAL PERINEAL POUCH space enclosed by Colles fascia inferiorly and by the inferior fascia of urogenital diaphragm superiorly *Because of disposition and attachment of Colles fascia, the sac is closed at all sides except for a small communication over symphysis pubis, where the space will become continuous with area between superficial fascia and aponeurosis of external abdominal wall. There is also a septum that partially subdivides the superficial perineal pouch into 2 lateral compartments.

The perineum is divided into 2 by an imaginary line connecting the 2 Ischial Tuberosities: 1. Urogenital triangle - Anterior to this imaginary line - Contains the urethra and the root of the penis in the male. 2. Anal Triangle - Posterior to the line - Contains the anal canal MEDIAN RAPHE in the Perineum as an extension. - a cutaneous ridge along the medial line of male perineum - Extending from the front of the anus, it crosses the scrotum and goes forward along the ventral surface of penis *In female, the median raphe is short. It extends only from the anus up to the posterior commissure of the urogenital cleft.

Contents of Superficial Perineal Pouch: Muscles N Superficial transverse perineal muscle N Ischocavernosus muscle N Bulbocavernosus muscle Blood Vessels with accompanying veins N Transverse perineal artery N Posterior scrotal artery N Deep and dorsal artery to penis Nerves: N Scrotal branches of superficial division of perineal nerve N Perineal nerve branch of posterior cutaneous nerve of thigh Bulb of urethra Crura of penis SUPERFICIAL TRANSVERSE PERINEAL MUSCLE - a pair of slender muscle just in front of line of union of colles fascia and inferior fascia of urogenital diaphragm O: ramus of ischium in front of ischial tuberosity I: perineal body of central point of perineum A: fixes the central point of perineum - nerve supply: perineal division of pudendal nerve *PERINEAL BODY fibrous muscular structure along median plane midway between anus and roots of scrotum o formed by fibers and tendinous slips from the muscles of perineum and rectum o Lies in front of upper part of anal canal behind bulb of urethra and below posterior part of prostate gland ISCHIOCAVERNOSUS MUSCLE - Slender muscle enclosing crura of the penis O: medial side of ramus of ischium near ischial tuberosity I: aponeurosis of the inferior and lateral surfaces of the anterior portion of the crura of the penis A: for erection of crura of penis and of penis itself - Nerve supply: perineal division of pudendal nerve

BULBOCAVERNOSUS MUSCLE - Thin muscle that covers bulb of urethra - Unite in median raphe O: perineal body and median raphe I: inferior fascia of urogenital diaphragm and aponeurosis of upper surface of corpora spongiosa Anterior fibers also cover sides of corpora cavernosa penis and inserts into aponeurosis of dorsum of penis A: compresses the bulb of the urtethra in order to expel last drop of urine or semen - Nerve supply: perineal division of pudendal nerve

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