  System of organs within the organism which work together for the purpose of reproduction It includes non-living substances such as fluids, hormones and pheromones Pheromones –unique; depends on the person - Innervated by sympathetic nerves responsible for the wrinkling of the overlying skin *should be wrinkled –if not, boys have a problem with their sympathetic nervous system *CAMPER’S FASCIA –converted to DARTOS MUSCLE in the scrotum innervated by sympathetic nerves which gives a wrinkled appearance *SCARPA’S FASCIA- converted to COLLES’ FASCIA in the scrotum and can even cover the distal part of the penis aside from the scrotum 3. Spermatic fascia (remember: ICE TIE) - 3 layers derived from anterior abdominal wall -covers both the testes and the entire length of the spermatic cord - Includes: - EXTERNAL SPERMATIC FASCIA  EXTERNAL OBLIQUE APONEUROSIS - CREMASTERIC FASCIA  INTERNAL OBLIQUE MUSCLE - INTERNAL SPERMATIC FACIA TRANSVERSALIS FASCIA **CREMASTERIC MUSCLE pulls testes during cold environments near pelvic brim for the survival of the developing sperm which is sensitive to temperature. **warm temperature –cremasteric muscle relaxes **from this point: 6 layers


MALE - Refers to the sex of the organism that can produce small mobile gametes called spermatozoa - Includes: Testes Scrotum, Epididymis, Spermatic cord, Vas deferens, Seminal vesicle, Ejaculatory duct, Glands, Penis Urethra **TESTIS  capable of producing sperm and is carried to the ductal system up to area of ejaculatory duct SCROTUM - Out pouching/out-pocketing of the lower part of the anterior abdominal wall - Extension of the abdominal wall - Homologue of Labia majora (female) **Difference between scrotum and labia majora? Scrotum: wrinkled; labia majora: not wrinkled CONTENTS OF THE SCROTAL SAC -testis -epididymis -lower end of spermatic cord 3 LAYERS OF THE SCROTAL SAC 1. Skin - Thin, wrinkled and pigmented part of scrotum - Raised ridge in the midline indicates the fusion of the two lateral labio-scrotal swelling **LATERAL LABIO-SCROTAL SWELLINGS IN FEMALES– remain unfused **Fusion is indicated by the midline **Color will depend on genetic disposition 2. Superficial fascia - Continuous with the fatty and membranous layer of the anterior abdominal wall

BLOOD SUPPLY OF THE SCROTAL SAC 1. Posterior scrotal artery - from INTERNAL PUDENDAL ARTERY which is a branch of the ANTERIOR DIVISION OF THE INTERNAL ILIAC ARTERY - supplies posterior surface of scrotum which is also responsible in supplying area of the pelvis

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** Common iliac dividing to external and internal; internal divides to anterior and posterior division; anterior divisionyou will see IIOUVM branches 2. Anterior scrotal artery - from EXTERNAL PUDENDAL ARTERY from FEMORAL ARTERY - supplies anterior surface of the scrotum 3. Cremasteric artery from INFERIOR EPIGASTRIC ARTERY **majority of male reproductive system is supplied by INTERNAL PUDENDAL ARTERY

TESTIS - Firm mobile organ lying within the scrotum - Surrounded by the TUNICA VAGINALIS except on the posterior side - Main testis is covered by the TUNICA ALBUGINEA except on the mediastinum -suspended into the scrotum by the SPERMATIC CORD **Usually, the left testis is LOWER than the right testis for unknown reasons. TUNICA VAGINALIS - Deficient posteriorly (covers the testis except the posterior surface) - Located external to the tunica albuginea - Lower expanded portion of the PROCESSUS VAGINALIS - With PARIETAL LAYER and VISCERAL LAYER **TUNICA VAGINALIS  remnant of the embryonic PROCESSUS VAGINALAS **PROCESSUS VAGINALIS embryonic peritoneum *GUBERNACULUM a cord-like structure that guides the testis to descend in the scrotal sac. Without the gubernaculums, the testis will not descend into the scrotal sac. **processus vaginalis also guides testis into the scrotal sac. While the testis is descending, the processus vaginalis is also starting to close, and weeks prior to birth, it should closed. When closed, it is now called TUNICA VAGINALIS **PARIETAL LAYER more superficial VISCERAL LAYER  attached to testis and is in close contact with the tunica albuginea **plus 2 more layers added (parietal and visceral layer of tunica vaginalis) except for posterior aspect TUNICA ALBUGINEA - White, tough fibrous outer covering of the testis - Will invaginate the substance of the testis - Extends inward to form compartments that will contain the SEMINIFEROUS TUBULES

VENOUS DRAINAGE ** scrotal veins accompany the arteries **inverse order of the arterial drainage **drains primarily to the external pudendal veins INNERVATION 1. Anterior scrotal nerve -from ILIOINGUINAL NERVE and GENITAL BRANCH OF THE GENITOFEMORAL NERVE **INLIOINGUINAL NERVE  retroperitoneal nerve that will cross the transverses abdominis and the loop around iliac crest and supply MEDIAL part of ANTERIOR SCROTUM **GENITOFEMORAL NERVEretroperitoneal that will exit psoas muscle that will divide into genital and femoral branch genital (more medial branch) and will supply LATERAL portion of ANTERIOR SCROTUM 2. Posterior scrotal nerve - from the PUDENDAL NERVE - supplies the posterior scrotum **The pudendal nerve is the only nerve that re-enters through the lesser sciatic foramen to the provide innervations to the pelvis.

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**SEMINIFEROUS TUBULES coiled tubes responsible for the production of sperm **TUNICA ALBIGINEA same capsule that will cover the ovary SEMINIFEROUS TUBULUES - Highly coiled structure located in the compartments formed by the tunica albuginea - Capable of producing sperm - Each coiled structure will terminate as a straight duct called STRAIGHT TUBULE which will then connect the seminiferous tubules to the RETE TESTES **straight tubules DIRECTLY connects with the seminiferous tubules **RETE TESTES  network of ducts that connects the semiiferous tubules to epididymis and is located on mediastinum of the testicle EPIDIDYMIS - An elongated structure on the posterior surface of the testis - EFFERENT DUCTULES first duct that will leave testes which connects the rete testes to the epididymis and transport the newly formed sperm from the rete testes to the epididymis 3 PARTS OF THE EPIDIDYMIS 1. Head - Receives 12-14 efferent ductules 2. Body -Contains highly convoluted ducts -without efferent ductules 3. Tail - Single coiled structure which will be continuous with the VAS DEFERENS/ DUCTUS DEFERENS BLOOD SUPPLY OF THE EPIDIDYMIS 1. Testicular artery (Gonadal artery) - Branch of the abdominal aorta which lies inferior to the renal artery - Passes retroperitoneally crossing over the ureters ”water under the bridge” configuration VENOUS DRAINAGE 1. Pampiniform plexus - Network of veins collecting blood in the testis - Forms a single vein called testicular vein/gonadal vein 2. Testicular vein - Collects the paminiform plexus **Right testicular vein-drains DIRECTLY into IVC **Left testicular veindrains into the LEFT RENAL VEIN SPERMATIC CORD - Collection of structures that pass through the inguinal canal and from the testis - Also covered by the layers of the spermatic fascia CONTENTS OF THE SPERMATIC CORD (MEMORIZE!)

- Vas deferens - Testicular artery - Pampiniform plexus - Testicular lymph vessels - Autonomic nerves - Remains of the processus vaginalis - Genital branch of genitofemoral nerve (for the innervation cremaster muscle) **Important structures: VAS DEFERENS, TESTICULAR ARTERY, PAMPINIFORM PLEXUS

VAS DEFERENS/ DUCTUS DEFERENS - Cordlike structure that can be palpated between the fingers and thumb in upper part of scrotum - Thick walled muscular duct that transports the spermatozoa from the testes to the urethra - Begins in the tail of epididymis and ends by joining seminal vesicle to form the EJACULATORY DUCT - Terminal portion of vas deferens is positioned POSTERIOR the bladder and SUPERIOR to the seminal vesicle ** AMPULLA OF THE DUCTUS DEFERENS dilated portion at the terminal end of the vas deferens BLOOD SUPPLY OF THE VAS DEFERENS 1. Artery to ductus deferens - branch of the SUPERIOR and INFERIOR VESICLE ARTERY **SUPERIOR VESICLE ARTERY embryonic umbilical artery **INFERIOR VESICLE ARTERY  direct branch of the anterior division of the INTERNAL ILIAC ARTERY VENOUS DRAINAGE 1. Pampiniform plexus - drains the proximal portion of the ductus deferens 2. Vesicular/ Prostatic venous plexus - drains the distal part of the ductus deferens SEMINAL VESICLE - 2 lobulated organs - 2 inches long -Located on the inferior portion of the ampulla of the vas deferens - Lies on the posterior surface of the bladder

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- Each vesicle consists of coiled tube embedded in connective tissue RELATIONS Anterior: related to posterior surface of urinary bladder Posterior: rectum Medial: terminal part of vas deferens FUNCTIONS - Secrete seminal fluid **SEMINAL FLUID thick alkaline fluid which produces fructose and a coagulating agent that mixes with the sperm as they pass to ejaculatory ducts and urethra EJACULATORY DUCT - Slender tube that arise from union of two ducts (seminal vesicle and ampulla of the ductus deferens) - Passes at the posterior surface of the PROSTATE GLAND - Pierces the prostate gland before it becomes urethra which means that the ejaculatory duct is embedded within the prostate gland - Ejaculatory ducts converge to open on the SEMINAL COLLICULUS -Will ONLY transmit seminal fluid and sperm **Urethra will transmit both urine and contents of ejaculatory duct ** movement of sperm is guided by peristalsis ** will open to the PROSTATIC UTRICLE BLOOD SUPPLY OF THE EJACULATORY DUCT Inferior vesicle artery Middle rectal artery VENOUS DRAINAGE Inferior vesicle vein Prostatic venous plexus PROSTATIC UTRICLE - Counterpart of the female uterus - With 2 apertures: - Opening of the EJACULATORY DUCT (inferior) - Blind aperture which represents the degenerated FALLOPIAN TUBE and UTERUS (superior) CLINICAL SIGNIFICANCE 1. CRYPTORCHIDISM - Undescended testis - Either 1 or both testes fails to descend into the scrotal sac - PROBLEM: Child can become STERILE due to the death of sperms because the temperature in the testicle is not regulated. (cremasteric muscles are not functioning well -Higher risk for the development of TESTICULAR CANCER in adulthood -surgical procedure: ORCHIOPEXY which pull the testicle after incising the scrotal sac 2. VARICOCELE - Abnormal engorgement of the pampiniform plexus 3. HYDROCELE - PROBLEM: Processus vaginalis fails to close and fluid formed in the abdominal cavity will be collected in the

scrotum since there is a direct relationship between the scrotum and abdominal cavity - diagnosed using pen light at the posterior scrotal sac - (+) trans-illumination - scrotum contains fluid *HEMATOCELE blood is contained in the scrotal sac 4. INGUINAL HERNIA - processus vaginalis contains intestines **MILD FORM OF INGUINAL HERNIA can be reduced by positioning the patient in the TRENDELENBURG POSITION so that the abdominal viscera will move upwards and pull herniated part. **ICE can also help since it causes the contraction of the abdominal viscera which pulls the abdominal viscera upwards ** INCARCERATED TYPE OF INGUINAL small intestine herniated up to the scrotum which created an obstruction in the GI tract. 5. TESTICULAR TORSION - aka TESTICULAR GANGRENE - Gangrenous tissue is secondary to necrosis since blood supply it cut off - Spermatic cord twists on its own axis which cuts off the blood supply to the testis (testicular artery) - Common to those people living in cold climates since the sudden drop of the testicles (when they seek for warmth) can cause twisting - MANAGEMENT: spermatic cord should be untwisted 6. TESTICULAR CANCER - “...a very ugly looking testicle (Doc JC, 2010).” 7. VASECTOMY - ligation of the vas deferens - Both sides should be ligated - Procedure: an incision is made on the mid-portion and look for the spermatic cord and then the vas deferens. Afterwards, tie it! PROSTATE GLAND - Largest accessory gland of the male reproductive system, - 3 x 4 x 2 cm - 2/3 of the prostate gland is glandular and 1/3 fibromuscular (particularly the peripheral part) - Walnut shaped - Surrounds both the prostatic urethra and ejaculatory duct (more posterior) - CAPSULE fibrous, dense and neurovascular containing the PROSTATIC PLEXUS and VEINS surrounding the area of the prostate - With surfaces, lobes and zones which is important in surgery SURFACES OF THE PROSTATE GLAND 1. Base closely related to NECK OF THE BLADDER 2. Apex related to URITHRAL SPHINCTER and deep perineal muscle 3. Anterior related to transversely oriented muscles of pelvis 4. Posterior related to RECTUM 5. Inferolateralrelated to LEVATOR ANI muscles

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**bulging prostate gland can be palpated in the anterior surface of the rectum LOBES OF THE PROSTATE GLAND 1. Isthmus/Anterior lobe 2. Inferoposterior lobe posterior to EJACULATORY DUCT and closely related to RECTUM 3. Median/middle lobe between posterior to URETHRA and anterior to EJACULATORY DUCT 4. Lateral lobes lateral to urethra

(+) distended bladder - enlarged prostate (hormonal) - urethra is compressed—difficulty in urinating - Common to: Middle-aged men with difficulty in urinating; very distended urinary bladder - MANAGEMENT: Transurethral resection of the prostate -remove obstructed part in the urethra BULBOURETHRAL GLAND - aka COWPER’S GLAND - Embedded within external urethral sphincter - Homologous to BARTHOLIN’S GLAND in females - Pea-sized shape - Clear viscous secretion  PRE-EJACULATE - Capacity to lubricate urethra for passage of sperm and neutralize acidic urine in urethra PENIS - Male copulatory organ contained in urogenital triangle together with the scrotum - Covered with Dartos fascia (superficial fascia) which is equivalent to the Camper’s fascia in the abdomen - Also contains tunica albuginea PARTS OF THE PENIS - Root of the Penis (fixed) - Body of the penis (free and pendulus)

ZONES OF THE PROSTATE GLAND 1. Peripheral zone under the capsule (subcapsular) 2. Central zone encloses EJACULATORY DUCT 3. Transitional zone encloses the URETHRA 4. Anterioranterior fibromuscluar zone **enlargement of the prostate/ hypertrophy at the TRANSITIONAL ZONE difficulty in urinating PROSTATIC DUCTS - 20 to 30 prostatic ducts - Openings at the side of prostatic sinuses (minute openings at the side of the utricle; posterior urethra) PROSTATIC FLUID - Thin, milky fluid that is alkaline in nature - Alkalinity helps neutralize acidity of vagina - Provides 20% of the volume of semen - Plays role in activating sperm BLOOD SUPPLY OF THE PROSTATE GLAND 1.Prostatic Artery - Branch of INFERIOR VESICLE ARTERY, branch of the INFERIOR DIVISION OF THE INTERNAL ILIAC ARTERY VENOUS DRAINAGE 1. Prostatic venous plexus - Located on the capsule of the prostate - Drain directly into the INTERNAL ILIAC VEIN CLINICAL SIGNIFICANCE 1. Benign prostatic hypertrophy(BPH) - Pathological enlargement of the prostate gland - Direct rectal examination (DRE) - should be non-palpable (+) DRE: benign prostatic hypertrophy

ROOT OF THE PENIS - made up of three masses of erectile tissue: BULB OF PENIS - situated in the midline and is attached to the under surface of the urogenital diaphragm - traversed by the urethra - covered by BULBOSPONGIOSUS MUSCLE - continued forward to become the body of the penis and forms the CORPUS SPONGIOSUM RIGHT AND LEFT CRURA OF THE PENIS - each crus is attached to the side of the pubic arch -covered by ISCHIOCAVERNNOSUS MUSCLE (skeletal muscle) - two crura will converge anteriorly and lie side by side in the dorsal part of the body of the penis as the CORPORA CAVERNOSA BODY OF THE PENIS - essentially composed of three cylindrical erectile tissues enclosed in Buck’s fascia - attached to the anterior suspensory ligament of the penis - suspended from the pubic symphysis CONTENTS OF THE BODY OF THE PENIS Thin skin Connective Tissue Blood vessels Erectile tissue: - Corpora Cavernosa -two dorsally placed erectile tissue - Corpora Spongiosum -single, ventrally placed erectile tissue -pierced by the urethra posteriorly

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ERECTILE TISSUE - 3 expandable erectile tissue which is filled with blood - ERECTION: due to high content of nitric oxide in blood - 90% of the blood will fill the CORPORA CAVERNOSA while only 10% of the blood will fill the corpora spongiosum. Less amount of blood is delivered to the corpora spongiosum as not to compress the penile urethra which pierces it posteriorly. GLANS PENIS - expanded portion of the CORPORA SPONGIOSUM - covers the distal ends of the corpora cavernosa PARTS OF THE GLANS PENIS 1. Corona - dilated portion which overlies tip of corpora cavernosa - projected margin of the glans penis overlying the corpora cavernosa 2. Neck of glans - constricted portion of the glans penis 3. External urethral orifice - slit-like orifice of the urethra found on the tip of the glans penis 4. Prepuce/ Foreskin - hood-like fold of the skin 5. Frenulum of the prepuce - median fold on the inferior area of glans penis BLOOD SUPPLY OF THE PENIS ** mainly from the branches of INTERNAL PUDENDAL ARTERY which supplies the deep parts of the penis 1. Dorsal artery of penis - paired left and right dorsal artery of the penis - run on each side of the deep dorsal vein - supply the fibrous tissue, corpora spongiosum and penile urethra, areas in the shaft within the Buck’s fascia; - pierces the Buck’s fascia to supply everything EXCEPT the corpora cavernosa 2. Deep artery of penis - pierces the corpora cavernosa (supplied by parasympathetic nerves) - supplies the corpora cavernosa - during the flaccid state: arteries are coiled -aka HELCINE ATERIES (only during the flaccid state) ** Deep arteries of the penis sensitive to nitric oxide which will open up the helcine arteries and fill the arterie 3. Arteries of the bulb of penis - supply the posterior part of corpus carvernosa **Branches of superficial and deep branches of EXTERNAL PUDENDAL ARTERY will supply superficial areas of penile shaft VENOUS DRAINAGE 1. Deep dorsal vein -drains blood from structures confined within the Buck’s fascia

** Venous plexus -deep dorsal vein-prostatic venous plexusinternal iliac vein (under the Buck’s facia) 2. Superficial vein Superficial vein superficial external pudendal vein (superficial to/outside of the Buck’s fascia) INNERVATION - derived from S2-S4 1. Dorsal nerve of penis -branch of PUDENDAL NERVE - sensory and sympathetic innervations to supply skin and glans penis which is responsible for ejaculation 2. Ilioinguinal nerve Supplies the skin at the root of penis 3. Cavernous nerves -parasympathetic fibers to helicine arteries responsible for penile erection **point and shoot Point penile erection (parasympathetic nerves) Shoot ejaculation (Sympathetic nerves) PENILE ANGLE Common -60-85 degrees Lax suspensory ligamentpoint downward Tense Suspensory ligamentpoint upward

CLINICAL SIGNIFICANCE 1. Phemosis -prepuce has a small opening that covers the glans penis fully -good candidate for circumcision 2. Penile fracture -Impotent -Viagra –releases nitric oxide to the helicine arteries 3. Hypospadia -urethral opening is found dorsal to the glans penis 4. Chanker ulcer secondary to syphilis -due to herpes secondary to herpes simplex type 2 ** Simplex1-found in the oral cavity ** Average penis: 5.1 -5.9 inches in length; 4-5 inches in girth ----------------------------------- END OF TRANX --------------------------------------

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