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Peen and related structures

Learn about the structure and function of the male reproductive organs such as testicles, prostate, seminal vesicles, and penis. Explore the arterial and venous supply, lymph drainage routes, and processes like erection and ejaculation.

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Peen and related structures

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  1. Peen and related structures Haddy Cosh and Amy Wood

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. EJACULATION (Score = Somatic = Pudendal = S2-4) • Contraction squeezes base of penis  ejaculation • Although brought about by somatic system, there is no control

  11. 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

  12. 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

  13. 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

  14. Catheterisation contd.. • Procedure: • See http://almostadoctor.co.uk/content/osces/skills-and-procedures/catheterization

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