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Peen and related structures . Haddy Cosh and Amy Wood. Testicles. Derive from intermediate mesoderm Development: High on posterior abdominal wall, drop down via gubernaculum Coverings: Skin Dartos External Spermatic Fascia

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peen and related structures

Peen and related structures

Haddy Cosh and Amy Wood

testicles
Testicles
  • Derive from intermediate mesoderm
  • Development:
  • High on posterior abdominal wall, drop down via gubernaculum
  • Coverings:
  • Skin
  • Dartos
  • External Spermatic Fascia
  • Cremasteric Fascia (Cremasta muscle, genitofemoral nerve, s2 reflex)
  • Internal spermatic fascia
  • Tunica vaginalis
  • Testicles

Some

Damn

Englishman

Called

It

The

Testes

spermatic cord
Spermatic Cord
  • Arteries
  • Testicular (Torsion)
  • Ducts deferens artery
  • Cremasteric artery
  • Nerves
  • Genital
  • Autonomic
  • Illioinguinal
  • The rule of 3’s:
  • Coverings:
  • Internal spermatic fascia
  • Cremasteric fascia
  • External spermatic fascia
  • Veins:
  • Pampiniform plexus (visible – varicocoele)
  • Ductus deferens
  • Lymphatics
ductus deferens
Ductus Deferens
  • Runs from?
  • Tail of Epidydimis to ejaculatory duct
  • Capable of peristalsis, controlled by which nervous system?
  • Sympathetic
  • Arterial supply:
  • Branches of vesical and testicular arteries
prostate
Prostate
  • Location?
  • Surrounds urethra, between bladder and levatorani muscles
  • Produces?
  • Prostatic fluid (20% seminal fluid) = Citric acid, prostaglandins, proteolytic enzymes
  • Zones?
  • Central, Transitional, Peripheral (most glandular so carcinoma site)
  • Lobes?
  • Anterior, posterior, median, 2 X lateral
  • Arterial supply:
  • Middle rectal and inferior vesical arteries
  • Venous supply:
  • Runs to prostatic venous plexus  vertebral veins
  • Valveless plexus, route of cancer spread
seminal vesicles
Seminal Vesicles
  • Accessory gland which produces?
  • Alkaline fluid rich in fructose, Prostaglandin E and semen clotting factors
  • Arterial supply?
  • Inferior vesicle and middle rectal
  • Venous supply?
  • Vesical and prostatic venous plexi
  • What do you need to warn men about vasectomies?
  • May be fertile for a couple of weeks as sperm can sill be in the vesicles
penis
Penis
  • Structure?
  • 2 X Corpus cavernosum (most erectile tissue)
  • 1 X Corpus spongiosum
  • Arterial supply
  • Internal iliac  Internal pudendal  Deep and dorsal penile arteries (Through Alcock’s canal LOL)
  • Venous supply
  • Superficial and deep dorsal veins  venous plexus  vertebral plexus
  • Problems:
  • Priapism
  • Persistant, painful, non-stimulated erection for +4 hours
  • Prepuce:
  • Phimosis / Paraphimosis
erection and ejaculation
Erection and Ejaculation
  • ERECTION: (Point = Parasympathetic = Cavernous Nerve = S234)
  • Straightening of coiled helicine arteries, relaxation of smooth muscle  blood flow to corpus cavernosum
  • Bulbospongiosus and Ischiocavernosus muscles compress venous plexi (blood remains in penis)
  • Flaccid penis: Arterio-venous anastomoses allow blood to bypass corpus cavernosum
slide9

EMISSION (Shoot = Sympathetic = Secretion = L1,2)

  • Internal urethral sphincter closes
  • Peristalsis of vas and seminal vesicles
  • Smooth muscle of prostate relaxes 
  • Ejaculate squeezed into penile bulb
slide10

EJACULATION (Score = Somatic = Pudendal = S2-4)

  • Contraction squeezes base of penis  ejaculation
  • Although brought about by somatic system, there is no control
lymph drainage routes
Lymph drainage routes
  • Testicles 
  • Para Aortic nodes (~L2)
  • Prostate 
  • Internal Iliac nodes
  • Seminal Vesicles 
  • Internal / External Iliac & sacral nodes
  • Ductus deferens 
  • Internal Iliac
  • Glans of penis 
  • Deep inuinal
  • Corpus cavernosum 
  • Internal iliac
per rectal examinations
Per rectal examinations

If you don’t put your finger in it, you stick your foot in it!

  • What can you feel (7)?
  • Walls of anal canal
  • Walls of inferior rectum
  • Bones: Sacrum, Coccyx
  • Sacral Lymph nodes
  • Prostate
  • Inferior bladder - possible
  • Seminal vesicles – possibly
catheterisation
Catheterisation
  • Indications (4)
  • Inability to void bladder (urinary retention)
  • Spinal injury
  • Incapacitated
  • Surgery
  • Difficulties (4)
  • Navicular fossa (mucosal fold superiorly)
  • Angle at penile bulb and membranous urethra
  • Prostate (crest / enlarged lobes)
  • Sphincters – nervous patient
catheterisation contd
Catheterisation contd..
  • Procedure:
  • See http://almostadoctor.co.uk/content/osces/skills-and-procedures/catheterization