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Anatomy of the Male Reproductive System • Clinical Compartmentalization of the Prostate

Based on Digital Rectal Exam and Cytoscopic
TOPIC OUTLINE Appearance
I. Prostate
A. Zonal Anatomy Made up of Two (2) Lateral lobes, separated by a
B. Related Structures Central Sulcus, and One (1) Middle Lobe
C. Practical and Surgical Considerations This would be very apparent when
II. Seminal vesicle assisting in a cystourethroscopy (you get
III. Vas deferens to see the prostrate through the urethra)
A. Vasculature and Innervation You get to appreciate it when you do
IV. Scrotum cystoscopy because that is where the
A. Layers lateral lobes are readily visualized
B. Contents
C. Vasculature, Lymphatics, Innervation
D. Additional Notes
The Middle Lobe may become hyperplastic and may
V. Penis extend into the bladdder neck with age
A. Location and Description
B. Vasculature and Lymphatics A. ZONAL ANATOMY OF THE PROSTATE
VI. Spermatic cord
A. Structures
B. Coverings
VII. Testis
A. Vasculature and Lymphatics
VIII. Epididymis
A. Vasculature
B. Clinical Correlates
Review Questions
References
Appendices

I. PROSTATE
• Shaped more or less like a trapezoid depending on the
size. As the prostate enlarges, it becomes more heart-
shaped
• PERIPHERAL Zone
• Zonal Anatomy of the Prostate Constitutes the bulk of the apical, posterior, and
According to McNeal (1981), the prostate has Four lateral aspects of the prostate
(4) basic anatomic regions. Largest zone
Urethra serves as the central anatomic reference 70 % of the glandular tissue of the prostate is
point for this classification. comprised of this zone.
The anatomic/zonal regions are the following: 70% of prostate cancers are found in this zone.
Peripheral Zone, Tansition zone, Central zone, and Most commonly affected by chronic prostatitis
Anterior Fibromuscular stroma
• TRANSITION Zone
• Microanatomic/Histologic Architecture Surrounds the urethra proximal to the ejaculatory
The prostate is composed of 70% Glandular tissue ducts
and 30% Fibromuscular stroma Smallest of the zones
Benign Prostatic Hyperplasia (BPH) most
The stroma contribute more to the symptoms of commonly occurs in this zone
Benign Prostatic Hyperplasia (BPH)
• CENTRAL Zone
Stroma is contiguous with the capsule and contracts Surrounds the ejaculatory ducts and projects under
during ejaculation the bladder base in a shape of a cone
Glands of the central zone are thought to be of
The prostate is surrounded by a capsule that is made Wolffian Duct origin because they differ
up of collagen and smooth muscle immunohistochemically and structurally from the
Actually, this is not a true capsule. In a other prostate glands
sense, it’s just where the fascia of the
pelvic floor and the covering of the • ANTERIOR FIBROMUSCULAR STROMA
prostate converge to form, what Extends from the bladder neck to the striated
anatomist and histologists would call, a urethral sphincter
PSEUDOCAPSULE Directly continuous with prostatic capsule
Rarely invaded by carcinoma

bladder neck in the one o’clock to five o’clock positions and the seven o’clock to eleven • The Presacral group or infrequently. as far as their Alpha blockade venous drainage is concerned. Iliac nodes may receive a small portion of the initial ─ These branches supply the urethra. and the transition zone of the prostate So when we do radical prostetectomy for ─ One that supplies the adenoma (BPH) prostate carcinoma. the External o’clock positions. VENOUS AND LYMPHATIC DRAINAGE. we not only remove the prostate and seminal vesicles. the Inferior Iliac Vein.ARTERIAL SUPPLY. they relax the prostate to allow smooth passage of urine. drains into the deep We think of drugs that are used in lower dorsal vein of the penis urinary tract symptoms In general. So in biopsy we usually do this: ─ Pelvic Plexus Block Anesthesia of the prostate during biopsy . In general. the prostate is “painful” . we also go after CAPSULAR Arteries the obturator and the internal iliac lymph nodes ─ This artery yield small branches that supply the anterior prostatic capsule Nerve Supply ─ The capsular branches enter the prostate in a 90 • The Cavernous Nerves provide sympathetic and degree angle and provide arterial supply to parasympathetic innervation to the prostate from the the glandular tissues pelvic plexus Sympathetic fibers innervate the smooth muscle of Venous Drainage the capsule and stroma for contraction The venous drainage of the prosate converges along Parasympathetic nerves promote secretory function with that of the bladder. the perivesical plexus by terminating in the acini Both the bladder and the prostate. • INFERIOR VESICAL Artery The Periprostatic plexus anastomoses with the deep It is the typical arterial supply to the prostate dorsal vein of the penis and the internal iliac (also Branches into Capsular and Urethral group of known as hypogastric) veins arteries Lymphatic Drainage URETHRAL Arteries ─ Enter the prostatovesical junction • Very important to remember especially in treating posterolaterally and course in a perpendicular malignancy route to the urethra ─ They travel toward the bladder neck with the • The Obturator and Internal Iliac nodes are the largest branches posteriorly approaching the primary sites of lymphatic drainage from the prostate. AND INNERVATION • PERIPROSTATIC PLEXUS This plexus drains to the Vesical plexus and Arterial Supply eventually. periurethral lymphatic drainage glands. The “capsule” is actually the sensitive part of the prostate.

Denonvilliers fascia (DF). Plate 367. neurovascularbundle (NVB). posterior lamina of Denonvilliers fascia Toward the apex: Puboprostatic ligaments suspends (PDF). • Not palpable on physical examination • Vasculature and innervation is similar with vas deferens Secrete a thick alkaline fluid with fructose (an energy for sperms). • Ureter enters the bladder medial to the tip of the SV • Denonvillier’s fascia separates the posterior surface of SV from rectum. and a coagulating agent that mixes with the sperms as they pass into the ejaculatory ducts and urethra Bulbar Part of Spongy Urethra Schematically Extended • Lateral prostatic fascia Close association with the cavernosal nerves • Neurovascular bundle Nerve bundles coursing along the prostate laterally and anteriorly to the cavernosal nerves Figure 6. it lies posterior to the bladder. posterior.368) . RELATED STRUCTURES OF THE PROSTATE • Prostatic urethra Closest to the anterior surface of the prostate (fibromuscular stroma) and lined by transitional epithelium At the level of this part of the urethra. anterior lamina of blends with endopelvic fascia Denonvilliers fascia (ADF). endopelvic fascia (EPF). levator ani fascia (LAF). SEMINAL VESICLES its fascia • Lateral outpouching of the vas deferens • Approximately 5 cm long • Does NOT store sperm!!! • Contributes the largest portion (85%) of fluid the ejaculate • With the ampulla of the vas deferens. the prostate • Cradled by pubococcygeal portion of the levator ani and II. Cross section of prostate with prostatic fascial layers outlined Anterior and anterolateral surface of the prostate including the lateral prostatic fascia (LPF). and lateral nerves (LN). B. and lateral surfaces Narrow apex inferiorly Broad base superiorly • Enclosed in a “capsule” Continuous with the stroma Fuse with Denovillier’s Fascia Figure 5. one can see the prostatic utricle Prostatic utricle is where the sperm exits because this is where the ejaculatory ducts also open • Anterior. Vas deferens (Source: Netters 6th ed.

The fat however is replaced • Joins the duct of the seminal vescicle to form the by the dartos muscle. SCROTUM • About 18 inches long Carries sperm from the testis to the urethra A. (sympathetic) hypogastric nerves provides the major excitatory efferents Figure 9. LAYERS • Arises from the tail of the epididymis • Tortuous for the first 2 to 3 cm SKIN • Runs posterior to the vessels of the spermatic cord • has a midline ridge indicating line of fusion • Emerges from the deep inguinal ring & passes around the lateral margin of the inferior epigastric vessels SUPERFICIAL FASCIA (Dartos Muscle & Colle’s Fascia) • Crosses the ureter in the region of the ischial spine • Continuous with the fatty & membranous layers of the • Diverges from the testicular vessels at the internal ring • Dilated part – ampulla (capable of storing sperm) anterior abdominal wall. EXTERNAL SPERMATIC FASCIA • derived from external oblique CREMASTERIC FASCIA • derived from internal oblique • cremaster muscle is supplied by the genital branch of the genitofemoral nerve • The fibers that mediate the cremasteric reflex travel in Figure 7. the pampiniform plexus  Pelvic vas deferens: pelvic venous plexus LYMPHATIC DRAINAGE • External and internal iliac nodes INNERVATION: • Pelvic plexus. The reflex is elicited by stroking the skin on the medial aspect of the thigh. CONTENTS • Testis Firm. page 378) L2). VAS DEFERENS/ DUCTUS DEFERENS IV. Upper pole is slightly tilted forward Surrounded by tunica albuginea Must be 3oC lower than abdominal temp ─ For spermatogenesis to occur Figure 8. III. • The membranous layer (Colle’s fascia) is derived from Scarpa’s fascia. The wrinkling of the skin is ejaculatory duct due to this muscle (innervated by sympathetic nerve fibers). Layers of the scrotum B. Blood supply of Vas deferens an Seminal Vesicle ─ Formation of varicoceles (dilated veins) around the testis may result to infertility . medial & lateral surface of  Scrotal vas deferens: deferential vein which drains into each testis. Ampulla of ductus deferens the femoral branch of the genitofemoral nerve (L1- (Source: Moore’s 7th ed. mobile organ lying within the scrotum Left is usually lower than right Left testicle descends slightly earlier than the right. A. VASCULATURE AND INNERVATION INTERNAL SPERMATIC FASCIA BLOOD SUPPLY: • from fascia transversalis • VESICULODEFERENTIAL artery (from superior vesical artery) TUNICA VAGINALIS • lies within the spermatic fasciae VENOUS DRAINAGE: • closed sac that covers anterior.

Composed of 3 cylinders of erectile tissue enclosed in a tubular sheath of fascia (Buck’s fascia) • Posterior scrotal wall is supplied by the posterior scrotal 2 corpora cavernosa – dorsally branches of the perineal vessels and nerves. INNERVATION ARTERIAL SUPPLY • External pudendal branches of the femoral artery & scrotal branches of the internal pudendal arteries VENOUS DRAINAGE • accompany the corresponding arteries LYMPH DRAINAGE Wall – to the medial group of superficial inguinal lymph nodes Testis & epididymis – ascends in the spermatic cord & ends in the lumbar (para-aortic) lymph nodes at the level of L1. body) V. LYMPHATICS. PENIS • Lobules Found in the male urogenital triangle together with • Seminiferous tubules the scrotum • Rete testis Common outlet for passage of both semen and urine • Efferent ductules • Vas deferens A. Arteries of the male perineum penis and assist in the process of erection of the penis D. testicular) from the scrotal wall. Root and body of the penis INNERVATION • Ilioinguinal nerves & the genital branch of the genitofemoral nerves & posterior cutaneous nerves of ROOT OF THE PENIS the thigh Made up of 3 masses of erectile tissue Bulb of the penis Right crura Left crura BULB of the penis  Situated in the midline and is attached to the undersurface of the urogenital diaphragm  Traversed by the urethra  Covered on its outer surface by the bulbospongiosus muscle functions to compress the penile part of the urethra and empty it of residual urine or semen  Forms the corpus spongiosum CRURA of the penis  Attached to the side of the pubic arch & is covered on its outer surface by the ischiocavernosus muscle the action of each muscle is to compress the crus Figure 10. ADDITIONAL NOTES • Median raphe: septum  Forms the corpora cavernosa • Lymphatics does not crossover from one side to the other • Anterior scrotal wall is supplied by external pudendal BODY OF THE PENIS vessels and ilioinguinal and genitofemoral nerve. the distal ends of the corpora cavernosa vasal. LOCATION AND DESCRIPTION Has a fixed root and a body that hangs free C. tail.* ─ houses the urethra . 1 corpus spongiosum – ventrally ─ expands to form the glans penis. which covers • Spermatic fascia has a different supply (cremasteric. VASCULATURE. Figure 11.• Epididymis (head.

leaves posterior border of testis. Cross section of the penis. in the linea alba  Vas deferens . the slitlike orifice of the urethra  Drain into the internal pudendal veins • Prepuce or foreskin is a hoodlike fold of skin that covers the glans connected to the glans below the urethral orifice by the frenulum Figure 14. and nerves  Pudendal nerve and the pelvic plexuses LIGAMENTS VI. Arterial supply of the penis . plexus becomes a B.thick-walled muscular duct from the epididymis to Suspensory ligament the urethra Made up of deeper fibers from the pubis Attaches the other end of the penis to the symphysis  Testicular artery pubis .reach the para-aortic lymph nodes at the level on Artery of the bulb – corpus spongiosum the side of the aorta at the level of the L1. SPERMATIC CORD Fundiform ligament Composed of collagenous and elastic fibers from the A.branch of the inferior vesical artery  Genital branch of the genitofemoral nerve . STRUCTURES OF THE SPERMATIC CORD rectus sheath blending with and surrounding Buck fascia Attaches above.branch of the abdominal aorta (at the of L2) Deep to the muscles of the corpora cavernosa. drains into the left renal vein on the left side. Dorsal vasculature of the penis (Source: Campbell’s page 514) LYMPH DRAINAGE  Medial group of superficial inguinal nodes – skin of the penis  Internal iliac nodes – deep structures of the penis Figure 12. the tunica albuginea and the Buck fascia fuse  Testicular veins (pampiniform plexus) . Dorsal artery of the penis  Autonomic nerves . penile fascia. VASCULATURE AND LYMPHATICS single vein at the level of the deep inguinal ring. vessels. demonstrating the relationship NERVE SUPPLY between the corporal bodies.supplies the cremaster muscle Figure 13.sympathetics run with the testicular artery from the renal or aortic plexuses.• On the tip of the glans penis is the external urethral VEINS meatus. ARTERIES directly to the inferior vena cava on the right  Branches of the internal pudendal artery  Lymph vessels Deep arteries of the penis – corpora cavernosa . affterents sensory accompany efferent sympathetics  Remains of the processus vaginalis  Cremasteric artery  a branch of the inferior epigastric artery  Artery of the vas deferens .

EPIDIDYMIS Seminiferous tubules open into a network of channels • A firm structure lying posterior to the testis. surrounding the tubules embedded in connective tissue. the pampiniform VII. Cremasteric (external spermatic) artery • Body (corpora) Also: Vasal artery • Tail (Cauda) • Testicular artery Internal arteryinferior testicular Where sperm is stored. VASCULATURE AND LYMPHATICS Comma shaped It has an expanded upper end. B. . LYMPHATIC DRAINAGE • Para-aortic and interaortocaval nodes • Coverings: Tunica vaginalis Tunica albuginea ─ Composed of smooth muscle cells ─ Contraction of testicular capsule which impacts arterial flow into testis and flow of seminiferous tubule fluid out of the testis Tunica vasculosa • Appendix testis a small pedunculated or sessile body at the upper pole of testis • Epididymis attaches to the posterolateral aspect of the testis • Divided by septa to form 200 to 300 lobules. COVERINGS OF THE SPERMATIC CORD VENOUS DRAINAGE  External spermatic fascia • Right: inferior vena cava . the head. each Figure 15. 2.derived from the external oblique aponeurosis • Left: left renal vein  Cremasteric fascia Countercurrent heat exchange .from the internal oblique muscle Possible anastomoses: external pudendal. cremastericand vasalveins  Internal spermatic fascia . with the vas called rete testis deferens lying on its medial side Composed of tightly coiled ducts which is • Small efferent ductules connect rete testis to upper continuous with vas deferens at distal cauda end of epididymis epididymis • Leydig (interstitial) cells lie in the loose tissue is a much coiled tube nearly 20 ft (6 m) long. 3 cm wide. cremasteric arteries combined Thin myoepithelium. TESTIS plexus.from the fascia transversalis The testicular veins emerge from the testis and the epididymis as a venous network.5 cm deep. Testis and Epididymis (Source: Netter’s plate 368) containing one or more seminiferous tubules. Responsible for testosterone production ─ Its length is for storage and maturation of spermatozoa A. Artery of vas deferens (deferential) artery Concentration of the sperm here is dilute. VIII. and BLOOD SUPPLY a pointed tail inferiorly Encapsulated within tunica vaginalis sheath Three arterial supplies of testis Testicular (internal spermatic) artery AREAS OF EPIDIDYMIS ─ Main blood supply of the testis • Head (Caput) ─ Branch of abdominal aorta Receives spermatozoa via the efferent ducts (8-12) ─ Greater diameter compared to deferential and of the mediastiniumof the testis. • Testis: 4 to 5 cm long. a body. initially mature artery capital artery Thicker myoepithelium than the head region Involved in absorbing fluid to make the sperm more concentrated. volume of 30 ml.

Epididymis is encapsulated within the __ Haberer. Tunica albuginea the vena marginalis testis. External iliac and common iliac nodes B. Fascia transversalis Answers: B. Glans penis • Any surgery (excision of epididymalcyst) of the B. Both A and B side. Caput epididymis B. or through deferential or B.B. External oblique B. The corpora cavernosa expands distally to form • When infected: can compromise future fertility the: A. the blood supply to the adenoma arises with inner visceral layer of tunica vaginalis from the: A. Transversalis fascia shown are the testis and epididymis cut across in horizontal section D. Internal oblique Figure 16. External oblique C.C. None of the above B. Its dilated part is capable of storing sperm • Inferior epididymal artery: from the vasal artery D. draining into the pampiniform plexus via A.A. Joins the duct of the seminal vesicle to form the bulbourethral duct. Capsular arteries that arise laterally D. Tunica vaginalis cremasteric veins C. Sinus of epididymis REVIEW QUESTIONS Between the testis and epididymis which is lined 1. The following statements about the vas deferens are correct. None of the above The corpus and cauda epididymis have their venous drainage through the vena marginalis of 6. D. Internal iliac and obturator nodes C. Diverges from the testicular vessels at the Supplies caput and cauda epididymis external ring C. Corpus epididymis C. CLINICAL CORRELATES 7. Urethral arteries extending down the urethra from the bladder neck C. Scarpa’s layer A. Para-aortic nodes D. and scrotum.C. In BPH. Cauda epididymis VENOUS DRAINAGE D. Runs anterior to the vessels of the spermatic cord • Superior epididymal artery: from the testicular artery B. Prepuce epididymis can compromise sperm transport on that C. Also C. Testis and epididymis. Rectus muscle B. Superior vesical artery B. Internal oblique D. VASCULATURE 4.D. Internal iliac and inguinal nodes 3. Tunica vasculosa D. except: BLOOD SUPPLY A. spermatic cord. 8-12 ductule efferentes from the testis comprise the __________ • Cremasteric artery A. The internal spermatic fascia corresponds to what layer in the abdomen? A.B. Neurovascular bundle 2. Lymphatic drainage from the prostate flows to the: A.D . The internal spermatic fascia is a derivative of: A. • Deferential artery Its bracnches supplies the cauda epididymis 5. None of the above 8.

plate 366) . Homologues of External Genitalia (Source: Netter’s. APPENDICES Figure 1.

plate 367) .Figure 2. Homologues of Internal Genitalia (Source: Netter’s.