Class of 2009

Clinical Human Anatomy

11-16-05
2nd hour
Male Pelvic Anatomy

Embryology
Table 13-1 in Moore’s Developing Human textbook has a good chart of the adult
derivatives of embryonic structures and the differences between male and female
anatomy. The Mullerian System (paramesonephric) and Wolffian System
(mesonephrenic) were mentioned, but not discussed. These will be important for Devo.

External Anatomy
Penis
Prepuce (or foreskin) – fold of skin that covers the glans penis
Glans – expansion of corpus spongiosum that forms the head of the penis
Shaft – consists of the corpora cavernosa (blood filled sinuses), corpus
spongiosum (surrounds urethra), and urethra (Netter 364, 365)
Root – bulb of the penis, crura, fundiform ligament, and suspensory
ligament
Scrotum
Urethral meatus – external opening of the urethra from the head of the glans penis
Perineum – area between scrotum and anus
Anus
Bony Pelvis
The male pelvis is predominately android. The inlet is heart-shaped and the mid-
portion has prominent ischial spines. The outlet is narrow and the pubic arch is less than
90°. The male pelvis is convergent. Netter 342 and Moore 336 are good resources for
this.
Muscular Pelvis
General the same for both males and females. Moore page 393, figure 3.34 has a
comparison between males and females. In the male, bulbospongiosus covers the corpus
spongiosum and the bulb of the penis. The ischiocavernosus covers the corpora
cavernosa and crura of the penis.
Fascial Layers
The spermatic cord has three layers that we learned last block (Netter 251, he
pointed out the fundiform ligament in addition to the fascia). The scrotum/perineum has
two fascial layers: the superficial and the deep (Netter 370) Netter plate 363 shows the
superficial fascia. Pelvic injuries can result in blood filling the potential spaces between
layers, as shown by the green in Netter plate 377.
Penis
In an ultrasound, the male fetus is indicated by the “turtle” sign and a female by
the “hamburger” sign.
Foreskin – circumcision is the most common surgical procedure on male children.
Dorsal nerve block is used during the procedure.
Male Urethra (Netter 368 wasn’t mentioned in class, but is a good picture)
Pre-prostatic – before the prostate, surrounded by internal urethral sphincter
Prostatic – goes through the prostate
Membranous – runs through UG diaphragm and is surrounded by external
urethral sphincter
Spongy – runs all the way to urethral orifice
Prostate (he challenged us to do a digital rectal exam)
Zonal Anatomy
Transitional – often enlarges with age (Benign Prostatic Hyperplasia
-BPH) and leads to irritation and obstruction of urinary flow. 25% of prostate cancer is
found here.
Central – the ejaculatory duct from seminal vesicles enters here
Peripheral – 75% of prostate cancer is found here
Anterior Fibromuscular Stroma – continuation of sphincter urethra
Lobes (Netter 367)
Not described in lecture, but discussed in Moore, page 369.
Seminal Colliculus (Netter 367)
Prostate Cancer
Incidence increases with age. Cancer can spread to the lymph nodes and
ascending lumbar veins and to the spine causing severe back pain (Netter 257).
Accessory Organs
“Water under the bridge.” The ureter is the water and the vas deferens is the
bridge. Neurovascular bundle runs right by prostate and is important for erection.
Vasectomy
Spermatic cord is isolated and given local anesthetic. An incision is made though
the scrotum and the vas deferens is cauterized chemically or thermally.
Testes (Netter 371)
Tunica Alburginea – tough covering
Seminiferous Tubules – where sperm is produced. Sperm travels to the rete testes
and then the ductules that form the epididymus
Epididymus
Ductus Deferens
Gubernaculum Testes – analogous to round ligament in women. It anchors the
testicle to the scrotum to prevent torsion of testicle. Improperly anchored testicles can
twist, cutting off the blood supply and is a urological emergency.
Testicular Self-Examination
Did not include a video like the breast lecture. Is important to teach males how to
do. Seminoma is a common cancer in young men that can easily be treated with early
intervention.
Indirect Hernia Exam (or the turn and cough maneuver)
Put finger in external inguinal ring and ask patient to cough. If you feel a bulge,
then there is a hernia. Hydracele of testes is associated with an indirect hernia. It is an
accumulation of fluid between the parietal and visceral layer of tunica vaginalis.
Detection is done by transillumination: shine a light on the scrotum and there will be a
red glow if there is a hydracele.
Vascular Pelvis (Netter 383)
 Testicular Blood Supply (Netter 381)
External pudendal artery not in notes, but mentioned in class. A varicocele
of the testes tends to occur more often on the left side.
Prostatic Blood Supply (Netter 383)
Remember neurovascular bundle that runs along prostate.
Penile Blood Supply (Netter 385)
Deep artery of penis (or the cavernosal artery) is important to maintaining
and erection. The urethral artery goes into the bulbospongiosus.
Neuro-Pelvis
Parasympathetic – Point, important for erection. In notes
Sympathetic – Shoot, important for ejaculation. In notes
Sensory (Netter 389 – sup. hypogastric plexus, 391 – pudendal n., 396 –
summarizes sympathetic and parasympathetic nerves)
There are two perineal nerves, but only one artery.
Motor
Erection
Deep artery dilates and fills sinuses with blood. Investing fascia prevents blood
flow out of the penis by collapsing veins. An erection lasting more than four hours
(priapism) results in ischemia from deoxygenated blood being unable to return through
the venous system. Can result in permanent impotence. In cases of erectile dysfunction,
phosphodiesterase inhibitors can be used to build up cGMP levels, which maintains
erection. The notes include a diagram of this.
GU tract
Male Incontinence – can result from radical prostatectomy (removal of muscles
surrounding prostate in addition to prostate), reason why it’s important to identify
neurovascular bundle.
Male Urinary Retention – mentioned earlier – BPH
Male Genito-Urinary Infections – more common in women, but when present in
males, tend to be quite significant
GI tract
Fecal Incontinence – also more common in women, can be caused by…….
Fistula in Ano
Hemorrhoids – can be a lecture of its own
Primum Non Nocere – First Do No Harm