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ANAT ● ANATOMY Gross Anatomy of the Male Reproductive System TRANS 3 MODULE 13 Joven Amor T. Mostajo, MD, FPSA March 27, 2023 LECTURE OUTLINE I Review A. Urinary Bladder B. Bladder Trigone II. Male Urethra A. Intramural Part (Preprostatic) B. Prostatic Urethra C. Intermediate Part (Membranous) D. Spongy Urethra E. Clinical Correlation II. Male Internal Genital Organs A. Testes B. Spermatic Cord C. Scrotum D. Epididymis E. Ductus Deferens F. Seminal Glands G. Ejaculatory Duct H. Prostate Glands IV. Prostate Gland A. Prostate Gland B. Lobes of the Prostate Gland C. Zones of the Prostate Gland D. Blood Supply of the Prostate Gland V Bulbourethral Glands VI. Penis VII Urogenital Triangle LECTURE OBJECTIVES 1. Given a clinical condition involving the gross anatomy of the male reproductive system, the student must be able to create a correct anatomical explanation. 2. Use Anatomical landmarks in performing a physical examination of the male reproductive system. 3. Rationalize common clinical procedures of the male reproductive system using anatomical structures and their relationship with one another. I. REVIEW A. URINARY BLADDER ● Hollow, viscous organ ● Characterized by its distensibility ● Serve as a reservoir of urine ● Walls are made up of detrusor muscle B. BLADDER TRIGONE ● The 2 Ureteric Orifice and the Internal Urethral Orifice forms the angle of Trigone ● Triangular smooth surface, found within the bladder wall 1. Ureteric Orifice (2) ● Surrounded by loops of Detrusor Muscle that will tighten when the bladder contracts to prevent reflux of urine 2. Internal Urethral Orifice ● Towards the neck of the male bladder ● Surrounded by muscle fibers to form the involuntary internal urethral sphincter ● Prevents retrograde ejaculation or Ejaculatory reflux of the bladder Figure 1. Urinary Bladder. Lecture Video Male Reproductive System Part 1 II. MALE URETHRA ● 18-22 cm long ○ Approx. 7-8 inches from the internal urethral orifice of the urinary bladder up to the external urethral orifice (Glans Penis) ● Exit for both Urine and Semen Figure 2. Urethra. Lecture Video Male Reproductive System Part 1 PART LENGTH I INTRAMURAL (Prepostatic) 1.5 P PROSTATIC Urethra 3 I INTERMEDIATE (Membranous) 1.5 S SPONGY Urethra 15 **MNEMONIC - IPIS Group 19B & 20B | Gross Anatomy of the Male Reproductive System 1
A. INTRAMURAL PART (Preprostatic) ● Approx. 1.5cm ● Located at the neck of the bladder ● Surrounded by the Internal Urethral Sphincter that will help control the flow of urine Figure 3. Intramural Part (Preprostatic). Lecture Video Male Reproductive System Part 1 B. PROSTATIC URETHRA ● Approx. 3cm ● Descends through the anterior prostate ● Widest and MOST distensible part of the urethra ● The most prominent feature is the urethral crest with seminal colliculus in the middle. ● Flanked by the openings of prostatic ducts within the prostatic sinuses. ● The slit-like orifice is called prostatic utricle, a vestigial remnant of the embryonic utero vaginal canal. Figure 4. Enlarged photo of prostatic urethra. Lecture Video Male Reproductive System Part 1 ● The ejaculatory ducts also open the seminal colliculus hence, the urinary and reproductive tracts will merge in this part. NOTE: From the prostatic urethra up to the distal spongy urethra will serve as a common conduit for urine and semen. C. INTERMEDIATE PART (MEMBRANOUS) Figure 5. Intermediate part of male urethra. Lecture Video Male Reproductive System Part 1 ● The intermediate or the membranous part of male urethra will pierce or penetrate the perineal membrane. ● Surrounded by the external urethral sphincter. ● Approx. 1.5 cm ● Narrowest and LEAST distensible part ADDITIONAL INFORMATION FROM BATCH 2025 TRANS: ● Intermediate part ○ Most likely are of rupture ○ Pelvic injury and bloody urine ● Insertion indwelling Foley Catheter ○ Hold the glans penis ○ Lubricate before inserting ○ Resistance is normal; slightly lift to insert smoothly D. SPONGY URETHRA Figure 6. Spongy urethra. Lecture Video Male Reproductive System Part 1 ● Courses through the CORPUS SPONGIOSUM which is one of the erectile tissues of male genitals ● From the Bulb of the penis up to the Glans Penis ● Opening of the BULBOURETHRAL Glands is found proximal part of the spongy urethra ● Spongy urethra is the longest and most mobile part of male urethra ○ Approx. 15 cm ○ Because of the length and mobility of this structure, male urethra have the privilege of redirecting the urine. Group 19B & 20B | Gross Anatomy of the Male Reproductive System 2
CLINICAL CORRELATIONS 1. Hypospadia Figure 7. Hypospadia. Lecture Video Male Reproductive System Part 1 ● CONGENITAL anomaly ● Opening of the Urethra is located ventrally ● Classified as: GLANULAR Ventrally opened in the glans penis PENILE HYPOSPADIAS Opening scene is observed in the body of the penis SCROTAL Within the scrotum or the scrotal area III. MALE INTERNAL GENITAL ORGANS A. TESTES Figure 8. Testes Lecture Video Male Reproductive System Part 1 ● Paired, ovoid reproductive glands considered as male gonads that produce sperms and hormones ● Suspended in the scrotum by the spermatic cord ● The left testes is LOWER than the right ● Covered by the TUNICA VAGINALIS (visceral) except for the area where the testes is attached to the epididymis ● The slit-like recess between the body of the epididymis and posterolateral surface of the testes is called the sinus of the epididymis ● The Parietal Layer of Tunica Vaginalis will extend superiorly in the distal part of the spermatic cord ● In between the visceral and parietal layer of the tunica vaginalis is the cavity of the tunica vaginalis with a small amount of fluid in the cavity allowing some mobility of the testes within the scrotum NOTE: To better understand the structures, try to remember the concepts that we have discussed previously in the lungs and pleura and the GIT with your peritoneum. This is basically the testes being covered by the tunica vaginalis. 1. Tunica Albuginea ● Tough fibrous outer surface of the testes. ● It will extend inward as a fibrous septa between the lobules of highly coiled seminiferous tubules in which the sperms are produced ● The sperm will travel: ○ From the seminiferous tubules to the straight tubules to the rete testis to the efferent tubules. ■ Mature sperm: will be received by the EPIDIDYMIS. CLINICAL CORRELATIONS 1. Testicular Torsion RECALL: Testis is covered by tunica vaginalis, the parietal and visceral layer. Between these two layers is a cavity with some amount of fluid for mobility. ● In testicular torsion, the testis will rotate on its axis of attachment. Because of this rotation, the blood vessels attached will start to coil leading to ISCHEMIA or lack of blood supply. ● Patients will complain of acute pain and swelling in the area of testis and scrotum. ● Surgical intervention should be within 6 hours and hopefully it can save the organ. ○ If the testis is already ischemic by the time of surgical intervention, we have no choice but to remove this structure. Figure 9. Testicular Torsion Lecture Video Male Reproductive System Part 1 Group 19B & 20B | Gross Anatomy of the Male Reproductive System 3
2. Nutcracker Syndrome ● Compression of the left renal vein that passes in between the abdominal aorta and superior mesenteric artery. Figure 10. Normal vs Compressed Left Renal Vein. Lecture Video Male Reproductive System Part 1 QUESTIONS ANSWER RATIONALIZATION Testicular artery is a direct branch of ___________. Abdominal Aorta The testicular artery of males is one of the lateral branches of the abdominal aorta. In females, this is called the ovarian artery. Veins from the Testis and Epididymis will form from what Plexus? (Hint: Part of the Thermoregulatory mechanism of the Testis) Pampiniform plexus The Pampiniform plexus will also contribute to the Thermoregulatory mechanism of the Testis. The Pampiniform plexus will ascend and converge superiorly as the ________. Testicular Vein The TESTICULAR VEIN on the RIGHT side will drain directly in the INFERIOR VENA CAVA and the LEFT will drain in the LEFT RENAL VEIN The LEFT RENAL VEIN will pass in between the ABDOMINAL AORTA and the SUPERIOR MESENTERIC ARTERY Because of this anatomical arrangement, the varicocele of pampiniform plexus or “bag of worms” is more common on the left side. B. SPERMATIC CORD Figure 11. Spermatic Cord. Lecture Video Male Reproductive System Part 1 ● Begins at the DEEP Inguinal ring of the abdominal ring ● Passes through the Inguinal Canal ● Exits at the SUPERFICIAL Inguinal Ring ● Ends at the scrotum 1. Coverings ● Mnemonic: ICE ← TIE ○ Internal spermatic fascia is derived from the; ■ Transversalis Fascia of the abdominal wall ○ Cremasteric fascia is from the ; ■ Internal oblique muscle ○ External spermatic fascia is derived from the; ■ External oblique muscle ● CREMASTERIC Fascia contains Loops of Cremasteric Muscle ○ Responsible for the CREMASTERIC REFLEX 2. Cremasteric Reflex ● To exhibit this reflex, the examiner/physician will lightly stroke the skin on the medial aspect of the thigh ● Which will then stimulate the Ilioinguinal Nerves lying in this area of the skin. ● The stimulus will cause a reflexive elevation of the testes on the same side by the contraction of cremaster muscle that is innervated by the genitofemoral nerve. 3. Cremaster Muscle ● Responsible for the Ascend & Descend of Testes together with the dartos muscle for temperature regulation or optimal formation of the sperm (Spermatogenesis): ○ Testes must be 2-3 °C cooler than the core body temperature. ● Has a protective response during sexual activity. ○ Cremaster muscle contracts during sexual intercourse to prevent the scrotum and testes from slapping on the woman’s perineum. ○ Without this protective contraction, sexual activity would be painful rather than pleasurable. Group 19B & 20B | Gross Anatomy of the Male Reproductive System 4