Anatomy of the Male Reproductive System
Based on Digital Rectal Exam and Cytoscopic
TOPIC OUTLINE
I. Prostate
A. Zonal Anatomy
B. Related Structures
C. Practical and Surgical Considerations
II. Seminal vesicle
III. Vas deferens
A. Vasculature and Innervation
IV. Scrotum
A. Layers
B. Contents
C. Vasculature, Lymphatics, Innervation
D. Additional Notes
V. Penis
A. Location and Description
B. Vasculature and Lymphatics
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
Zonal Anatomy of the Prostate
According to McNeal (1981), the prostate has Four
(4) basic anatomic regions.
Urethra serves as the central anatomic reference
point for this classification.
The anatomic/zonal regions are the following:
Peripheral Zone, Tansition zone, Central zone, and
Anterior Fibromuscular stroma
Microanatomic/Histologic Architecture
The prostate is composed of 70% Glandular tissue
and 30% Fibromuscular stroma
The stroma contribute more to the symptoms of
Benign Prostatic Hyperplasia (BPH)
Stroma is contiguous with the capsule and contracts
during ejaculation
The prostate is surrounded by a capsule that is made
up of collagen and smooth muscle
Actually, this is not a true capsule. In a
sense, its just where the fascia of the
pelvic floor and the covering of the
prostate converge to form, what
anatomist and histologists would call, a
PSEUDOCAPSULE
Clinical Compartmentalization of the Prostate
Appearance
Made up of Two (2) Lateral lobes, separated by a
Central Sulcus, and One (1) Middle Lobe
This would be very apparent when
assisting in a cystourethroscopy (you get
to see the prostrate through the urethra)
You get to appreciate it when you do
cystoscopy because that is where the
lateral lobes are readily visualized
The Middle Lobe may become hyperplastic and may
extend into the bladdder neck with age
A. ZONAL ANATOMY OF THE PROSTATE
PERIPHERAL Zone
Constitutes the bulk of the apical, posterior, and
lateral aspects of the prostate
Largest zone
70 % of the glandular tissue of the prostate is
comprised of this zone.
70% of prostate cancers are found in this zone.
Most commonly affected by chronic prostatitis
TRANSITION Zone
Surrounds the urethra proximal to the ejaculatory
ducts
Smallest of the zones
Benign Prostatic Hyperplasia (BPH) most
commonly occurs in this zone
CENTRAL Zone
Surrounds the ejaculatory ducts and projects under
the bladder base in a shape of a cone
Glands of the central zone are thought to be of
Wolffian Duct origin because they differ
immunohistochemically and structurally from the
other prostate glands
ANTERIOR FIBROMUSCULAR STROMA
Extends from the bladder neck to the striated
urethral sphincter
Directly continuous with prostatic capsule
Rarely invaded by carcinoma
ARTERIAL SUPPLY, VENOUS AND LYMPHATIC
DRAINAGE, AND INNERVATION

Arterial Supply
INFERIOR VESICAL Artery
It is the typical arterial supply to the prostate
Branches into Capsular and Urethral group of
arteries
URETHRAL Arteries
Enter the prostatovesical junction
posterolaterally and course in a perpendicular
route to the urethra
They travel toward the bladder neck with the
largest branches posteriorly approaching the
bladder neck in the one oclock to five oclock
positions and the seven oclock to eleven
oclock positions.
These branches supply the urethra, periurethral
glands, and the transition zone of the prostate
One that supplies the adenoma (BPH)
CAPSULAR Arteries
This artery yield small branches that supply the
anterior prostatic capsule
The capsular branches enter the prostate in a 90
degree angle and provide arterial supply to
the glandular tissues
Venous Drainage
The venous drainage of the prosate converges along
with that of the bladder, the perivesical plexus
PERIPROSTATIC PLEXUS
This plexus drains to the Vesical plexus and
eventually, the Inferior Iliac Vein.
The Periprostatic plexus anastomoses with the deep
dorsal vein of the penis and the internal iliac (also
known as hypogastric) veins
Lymphatic Drainage
Very important to remember especially in treating
malignancy
The Obturator and Internal Iliac nodes are the
primary sites of lymphatic drainage from the prostate.
The Presacral group or infrequently, the External
Iliac nodes may receive a small portion of the initial
lymphatic drainage
So when we do radical prostetectomy for
prostate carcinoma, we not only remove the
prostate and seminal vesicles, we also go after
the obturator and the internal iliac lymph nodes
Nerve Supply
The Cavernous Nerves provide sympathetic and
parasympathetic innervation to the prostate from the
pelvic plexus
Sympathetic fibers innervate the smooth muscle of
the capsule and stroma for contraction
Parasympathetic nerves promote secretory function
by terminating in the acini

Both the bladder and the prostate, as far as their Alpha blockade
venous drainage is concerned, drains into the deep We think of drugs that are used in lower
dorsal vein of the penis urinary tract symptoms
In general, they relax the prostate to
allow smooth passage of urine.

In general, the prostate is painful . The capsule

is actually the sensitive part of the prostate. So in
biopsy we usually do this:
Pelvic Plexus Block
Anesthesia of the prostate during biopsy
 B. 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, one can see

the prostatic utricle
Prostatic utricle is where the sperm exits
because this is where the ejaculatory ducts
also open

Anterior, posterior, and lateral surfaces

Narrow apex inferiorly
Broad base superiorly

Enclosed in a capsule
Continuous with the stroma
Fuse with Denovilliers Fascia Figure 5. Cross section of prostate with prostatic fascial layers outlined
Anterior and anterolateral surface of the prostate including the lateral prostatic fascia (LPF), endopelvic fascia (EPF),
levator ani fascia (LAF), Denonvilliers fascia (DF), anterior lamina of
blends with endopelvic fascia
Denonvilliers fascia (ADF), posterior lamina of Denonvilliers fascia
Toward the apex: Puboprostatic ligaments suspends (PDF), neurovascularbundle (NVB), and lateral nerves (LN).
the prostate

Cradled by pubococcygeal portion of the levator ani and
its fascia
II. SEMINAL VESICLES
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, it lies posterior to
the bladder.
Ureter enters the bladder medial to the tip of the SV
Denonvilliers fascia separates the posterior surface of
SV from rectum.
Not palpable on physical examination
Vasculature and innervation is similar with vas deferens
Secrete a thick alkaline fluid with fructose (an
energy for sperms), 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. Vas deferens (Source: Netters 6th ed, Plate 367,368)

 III. VAS DEFERENS/ DUCTUS DEFERENS
About 18 inches long
Carries sperm from the testis to the urethra
Arises from the tail of the epididymis
Tortuous for the first 2 to 3 cm
Runs posterior to the vessels of the spermatic cord
Emerges from the deep inguinal ring & passes around the
lateral margin of the inferior epigastric vessels
Crosses the ureter in the region of the ischial spine
Diverges from the testicular vessels at the internal ring
Dilated part ampulla (capable of storing sperm)
Joins the duct of the seminal vescicle to form the
ejaculatory duct
IV. SCROTUM
A. LAYERS
SKIN
has a midline ridge indicating line of fusion
SUPERFICIAL FASCIA (Dartos Muscle & Colles Fascia)
Continuous with the fatty & membranous layers of the
anterior abdominal wall. The fat however is replaced
by the dartos muscle. The wrinkling of the skin is
due to this muscle (innervated by sympathetic nerve
fibers).
The membranous layer (Colles fascia) is derived from
Scarpas fascia.

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. Ampulla of ductus deferens the femoral branch of the genitofemoral nerve (L1-
(Source: Moores 7th ed, page 378)
L2). The reflex is elicited by stroking the skin on the
medial aspect of the thigh.
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, medial & lateral surface of
Scrotal vas deferens: deferential vein which drains into each testis.
the pampiniform plexus
Pelvic vas deferens: pelvic venous plexus

LYMPHATIC DRAINAGE
External and internal iliac nodes

INNERVATION:
Pelvic plexus, (sympathetic) hypogastric nerves provides
the major excitatory efferents

Figure 9. Layers of the scrotum

B. CONTENTS
Testis
Firm, mobile organ lying within the scrotum
Left is usually lower than right
Left testicle descends slightly earlier than the
right.
Upper pole is slightly tilted forward
Surrounded by tunica albuginea
Must be 3oC lower than abdominal temp
For spermatogenesis to occur
Figure 8. Blood supply of Vas deferens an Seminal Vesicle Formation of varicoceles (dilated veins) around
the testis may result to infertility
 Epididymis (head, tail, body)
Lobules
Seminiferous tubules
Rete testis
Efferent ductules
Vas deferens
C. VASCULATURE, LYMPHATICS, 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.
INNERVATION
Ilioinguinal nerves & the genital branch of the
genitofemoral nerves & posterior cutaneous nerves of
the thigh
Figure 10. Arteries of the male perineum
D. ADDITIONAL NOTES
Median raphe: septum
Lymphatics does not crossover from one side to the other
Anterior scrotal wall is supplied by external pudendal
vessels and ilioinguinal and genitofemoral nerve.
Posterior scrotal wall is supplied by the posterior scrotal
branches of the perineal vessels and nerves.
Spermatic fascia has a different supply (cremasteric,
vasal, testicular) from the scrotal wall.*
V. PENIS
Found in the male urogenital triangle together with
the scrotum
Common outlet for passage of both semen and urine
A. LOCATION AND DESCRIPTION
Has a fixed root and a body that hangs free
Figure 11. Root and body of the penis
ROOT OF THE PENIS
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
penis and assist in the process of erection of the
penis
Forms the corpora cavernosa
BODY OF THE PENIS
Composed of 3 cylinders of erectile tissue enclosed in
a tubular sheath of fascia (Bucks fascia)
2 corpora cavernosa dorsally
1 corpus spongiosum ventrally
expands to form the glans penis, which covers
the distal ends of the corpora cavernosa
houses the urethra
 On the tip of the glans penis is the external urethral
meatus, the slitlike orifice of the urethra
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 12. Cross section of the penis, demonstrating the relationship
between the corporal bodies, penile fascia, vessels, and nerves
LIGAMENTS
Fundiform ligament
Composed of collagenous and elastic fibers from the
rectus sheath blending with and surrounding Buck
fascia
Attaches above, in the linea alba
Suspensory ligament
Made up of deeper fibers from the pubis
Attaches the other end of the penis to the symphysis
pubis
Deep to the muscles of the corpora cavernosa, the
tunica albuginea and the Buck fascia fuse
B. VASCULATURE AND LYMPHATICS
ARTERIES
Branches of the internal pudendal artery
Deep arteries of the penis corpora cavernosa
Artery of the bulb corpus spongiosum
Dorsal artery of the penis
Figure 13. Arterial supply of the penis
VEINS
Drain into the internal pudendal veins
Figure 14. Dorsal vasculature of the penis (Source: Campbells page 514)
LYMPH DRAINAGE
Medial group of superficial inguinal nodes
skin of the penis
Internal iliac nodes deep structures of the penis
NERVE SUPPLY
Pudendal nerve and the pelvic plexuses
VI. SPERMATIC CORD
A. STRUCTURES OF THE SPERMATIC CORD
Vas deferens
- thick-walled muscular duct from the epididymis to
the urethra
Testicular artery
- branch of the abdominal aorta (at the of L2)
Testicular veins (pampiniform plexus)
- leaves posterior border of testis, plexus becomes a
single vein at the level of the deep inguinal ring,
drains into the left renal vein on the left side,
directly to the inferior vena cava on the right
Lymph vessels
- reach the para-aortic lymph nodes at the level on
the side of the aorta at the level of the L1.
Autonomic nerves
- sympathetics run with the testicular artery from the
renal or aortic plexuses; affterents sensory
accompany efferent sympathetics
Remains of the processus vaginalis
Cremasteric artery
a branch of the inferior epigastric artery
Artery of the vas deferens
- branch of the inferior vesical artery
Genital branch of the genitofemoral nerve
- supplies the cremaster muscle
 B. COVERINGS OF THE SPERMATIC CORD VENOUS DRAINAGE
External spermatic fascia Right: inferior vena cava
- 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
- from the fascia transversalis The testicular veins emerge from the testis and the
epididymis as a venous network, the pampiniform
VII. TESTIS plexus.
Testis: 4 to 5 cm long, 3 cm wide, 2.5 cm deep; volume of
30 ml. 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, each
containing one or more seminiferous tubules.
Seminiferous tubules open into a network of channels
called rete testis
Small efferent ductules connect rete testis to upper
end of epididymis
Figure 15. Testis and Epididymis (Source: Netters plate 368)
VIII. EPIDIDYMIS
A firm structure lying posterior to the testis, with the vas
deferens lying on its medial side
Composed of tightly coiled ducts which is
continuous with vas deferens at distal cauda
epididymis

Leydig (interstitial) cells lie in the loose tissue
surrounding the tubules
Responsible for testosterone production
A. VASCULATURE AND LYMPHATICS
BLOOD SUPPLY
Three arterial supplies of testis
Testicular (internal spermatic) artery
Main blood supply of the testis
Branch of abdominal aorta
Greater diameter compared to deferential and
cremasteric arteries combined
Artery of vas deferens (deferential) artery
Cremasteric (external spermatic) artery
Also: Vasal artery
Testicular artery Internal arteryinferior testicular
artery capital artery
is a much coiled tube nearly 20 ft (6 m) long,
embedded in connective tissue.
Its length is for storage and maturation of
spermatozoa
Comma shaped
It has an expanded upper end, the head, a body, and
a pointed tail inferiorly
Encapsulated within tunica vaginalis sheath
AREAS OF EPIDIDYMIS
Head (Caput)
Receives spermatozoa via the efferent ducts (8-12)
of the mediastiniumof the testis.
Thin myoepithelium.
Concentration of the sperm here is dilute.
Body (corpora)
Tail (Cauda)
Where sperm is stored, initially mature
Thicker myoepithelium than the head region
Involved in absorbing fluid to make the sperm
more concentrated.
 Sinus of epididymis REVIEW QUESTIONS
Between the testis and epididymis which is lined 1. In BPH, the blood supply to the adenoma arises
with inner visceral layer of tunica vaginalis from the:
A. Superior vesical artery
B. Urethral arteries extending down the urethra
from the bladder neck
C. Capsular arteries that arise laterally
D. Neurovascular bundle

2. Lymphatic drainage from the prostate flows to

the:
A. External iliac and common iliac nodes
B. Internal iliac and obturator nodes
C. Para-aortic nodes
D. Internal iliac and inguinal nodes

3. The internal spermatic fascia corresponds to

what layer in the abdomen?
A. External oblique
B. Internal oblique
Figure 16. Testis and epididymis, spermatic cord, and scrotum. Also C. Transversalis fascia
shown are the testis and epididymis cut across in horizontal section
D. Scarpas layer
A. VASCULATURE 4. The following statements about the vas
deferens are correct, except:
BLOOD SUPPLY A. Runs anterior to the vessels of the spermatic cord
Superior epididymal artery: from the testicular artery B. Diverges from the testicular vessels at the
Supplies caput and cauda epididymis external ring
C. Its dilated part is capable of storing sperm
Inferior epididymal artery: from the vasal artery D. Joins the duct of the seminal vesicle to form the
bulbourethral duct.
Deferential artery
Its bracnches supplies the cauda epididymis 5. 8-12 ductule efferentes from the testis comprise
the __________
Cremasteric artery A. Caput epididymis
B. Corpus epididymis
C. Cauda epididymis
VENOUS DRAINAGE D. None of the above
The corpus and cauda epididymis have their
venous drainage through the vena marginalis of
6. Epididymis is encapsulated within the __
Haberer, draining into the pampiniform plexus via
A. Tunica albuginea
the vena marginalis testis, or through deferential or
B. Tunica vaginalis
cremasteric veins
C. Tunica vasculosa
D. None of the above
B. CLINICAL CORRELATES
7. The corpora cavernosa expands distally to form
When infected: can compromise future fertility the:
A. Glans penis
Any surgery (excision of epididymalcyst) of the B. Prepuce
epididymis can compromise sperm transport on that C. Both A and B
side. D. None of the above

8. The internal spermatic fascia is a derivative of:

A. Rectus muscle
B. External oblique
C. Internal oblique
D. Fascia transversalis
Answers: B,B,C,C,A,B,D,D
 APPENDICES

Figure 1. Homologues of External Genitalia (Source: Netters, plate 366)

Figure 2. Homologues of Internal Genitalia (Source: Netters, plate 367)