Male genital system

Topography of pelvis

P. Hájek
 Study informations
• dissecting kit
• dissection registration
• re-tests
 Sex differences
- primary :
developed in intrauterine life based on genetic code
(genital organs)
- secondary:
in puberty, based on different effect of male and female hormones
(growth of brests, pubescence, shape of body, pitch of voice,..)
 Homology of genital organs
♀ ← embryonal source → ♂
ovary ← anlage of gonads → testicle
Gartner’s canal ← Wolffian duct → deferential duct
Fallopian tube, ←Müllerian duct → appendix testis,
uterus, vagina utriculus prostaticus
clitoris ← genital tubercle → penis
labia majora ← genital ridges → scrotum

Division of genital organs:

A) by gender
B) by perceptibility on body surface - external X internal
C) by number – paired X unpaired
 Testicle = testis
- paired, tough, elastic organ of a plum size, localized in scrotum,
- separated by septula testis to lobules → seminiferous tubules
- function: production of spermatozoa, of testosterone (Leydig cells)
 Testicle – anatomic description

appendix testis tunica albuginea

 Tubuli of testicle
Cells:
• In lobules: spermatogonia
seminiferous tubuli Sertoli cells
Leydig cells

• Next to hilum:
rete testis

• Into epididymidis:
ductuli efferentes
 Descent of testicles
• Anlage of testis (and ovary too) - L2,
• It shifts caudally in fetal life,
• In last 1/3 of pregnancy it passes through inguinal canal.
• Mechanisms: fixation by gubenaculum testis,
relative and finally real shortening of ligament.
• Present testis in scrotum = sign of maturity of a
newborn
 Blood & nerve supply of testicle
• derived from level of anlage
• different from supply of scrotum or ductus deferens !!

• Arteries: testicular a. (L2)

• Veins: pampiniform plexus → testicular vein →
vena cava inf. (R) x renal vein (L) .
• Lymphatic nodes: n.l. lumbales
• Nerves: mixed plexus testicularis

• Testicle – most caudal organ innervated by [Link].

 Congenital anomalies of testicle
• Variation of number – monorchism, polyorchidism
• Cryptorchidism = the testis is not present in scrotum.
Cause:
1) retention – stop within the normal descent, usually in
inguinal canal
2) ectopia testis – atypical position, placement e.g. in
femoral triangle.
• Inversio testis – congenital untypical position of testis and
epididymis in scrotum. 1) 2)
 Pathology of testicle
and anatomic basis

• Testicular torsion – rotation of testis around

vessels, it blocks mainly veins, strong pain in
scrotum, it impends by loss of testis.
• Varicocele – congestion of blood in extended
pampiniform plexus, usually on left side (see
different venous drainage!) → if bilateral it can
caused infertility
 Epididymis
GEN case = epididymidis

lobuli epididymidis ← caput

corpus
ductus epididymidis ←

cauda

Common for epidydimis and testis:

placement, surface of epiorchium, descent, vessels
 Scrotum
Cutaneous sac,
divided by septum to 2 spaces,
contains testicles with their coverings

Developmental relation:
Scrotal layer: Abdominal wall:
tunica dartos fascia Scarpae
m. cremaster m. transversus abd.
& int. oblique abd.
periorchium pariet. peritoneum
epiorchium ≈ visc. peritoneum
 Scrotal sac
• paired cavity, originally processus vaginalis of peritoneal cav.,
contains testicle & epididymis.
• both organs widely growth with posterior wall of scrotum.
 Scrotum – blood & nerve supply.
• Skin of scrotum x covering of testis x testicle !
• Arteries: - ventrally ext. pudendal aa. ← femoral a.,
- dorsally int. pudendal a. ← int. iliac a.
Veins: ext. pudendal vv. (→ greater saphenous v.),
int. pudendal v.
• Lymphatic nodes – superficial inguinal nodes!
• Nerves:
- sensory - [Link], [Link], [Link].
- motor for cremaster m. - n. genitofemoralis,
- for tunica dartos – symp. fibers of plex. hypogastricus inf.
 Spermatic cord =
= funiculus spermaticus
• Bundle of structures around ductus deferens
• Extent: cauda epididymidis – deep inguinal ring
• Cranially - content of inguinal canal in ♂
• Coverings – the same like for testicle (cremaster)
• Contains: ductus deferens, vessels and nerves for
testicle,..
 Contains of spermatic cord
dorsally ductus deferens
artery to ductus deferens
deferential nervous plexus

testicular a.
pampiniform plexus (venous)
lymphatic vessels of testicle
testicular plexus (nervous)
ventrally

Coverings: m. cremaster with fascias

 Ductus deferens
about 40 cm long paired tube, passes through inguinal canal,
→ lateromedially in pelvis to dorsal side of urinary bladder
→ meets the prostate.

- pars scrotalis,
- pars funicularis,
- pars inguinalis,
- pars pelvina,
- ampulla ductus deferentis,
- ductus ejaculatorius (union with excretory duct of [Link]
 Secondary genital glands
• Seminal vesicle, prostata, bulbourethral gland
• Size and activity depends on level of testosterone.
• Funct.: contribute to composition of semen: nutrition and
motility of spermatozoa, ease of fertilization
• Semen is fluid containing spermatozoa and products of:
Sertoli cells,
epithelium of rete testis,
epididymis,
seminal vesicles, prostata, bulbourethral glands
and mucinous gland of urethra.
 Seminal vesicle = vesicula seminalis
paired gland on dorsal side of urinary bladder

• Vessels – related to neighboring organs

• Excretory duct meets the last part of ductus deferens
 Bulbourethral gland
= Cowper’s gland
• paired gland
behind membranous
part of urethra,
impressed into the
urogenital diaphragm
 Prostate

• Unpaired gland, smooth, tough, size of sweet chestnut,

wide basis cranially, apex caudally
• Position: below bladder, lies on pelvic diaphragm, behind
pubic symphysis, frontaly to rectum
• It surrounds prostatic part of male urethra.
• Division: lobes (middle, left, right) and isthmus frontally.
 Different shades of pink, describe the zone.
Violet, periurethral zone
Red, outer zone

Prostate – structure
Cream: inner zone

• It contains glands opened into urethra

• Colliculus seminalis: ejaculatory duct, utriculus prostaticus
• Zones – periurethral, inner, outer
• Clinical tips: hypertrophy, carcinoma,
it can be reached per rectum
surgical approaches
 Examination per rectum, per vaginam
mucose and sphincter of rectum rectum
cervix of uterus
prostate & seminal vesicles cervix of uterus
anteflexed uterus + adnexa
coccyx Rectovesical excavation
coccyx+ fundus of bladder)
(urethra
„Douglas’s space in ♂“ Douglas’s
Douglas’s space
space
 Prostate – blood supply
• A. rectalis media,
a. vesicalis inferior,
a. pudenda interna.

• Venous pl. prostaticus

→ pl. vesicalis
→ v. iliaca interna.

• Nodi lymph. sacrales,

paravesicales
→ n.l. iliaci int. + ext.
• Nerv. veget. fibers from
pl. hypogastricus inf.
 Aorta
Blood supply of n.l. lumbales

♂ genital organs

n.l. iliaci ext.

n.l. iliaci int.
a. testicularis
a. d. deferentis
n.l. sacrales
n.l. paravesicales
a. vesicalis inf.
a. rectalis med.
n.l. inguinales
superficiales a. pudenda int.

[Link] ext.
 Male urethra
= urethra masculina
• Pathway for urinary + genital system, about 20 cm
• Parts by course: intramural, prostatic,
membranous, spongious
• Curvatures: subpubic & prepubic
• Narrowings: see numbers
• Widenings: see capitals
• Recessus fossae navicularis

• Sphincters: - [Link] vesicae,

- m. sphincter urethrae int.
- m. sphincter urethrae ext.
 Penis
basis: erectile bodies
corpus cavernosum - paired, attached to pubic bone
corpus spongiosum - unpaired, contains urethra
bulbus
crura

radix
corpus
septum glans
raphe
dorsum
prepuce
Fine structure of penis skin
superficial fascia of penis
v. dorsalis penis superfic.
deep fascia
v. dorsalis penis profunda
a. dorsalis penis
n. dorsalis penis
tunica albuginea of
erectile bodies

a. + vv. profundae penis

aa. helicinae

a. urethralis
urethra
 Anomalies of penis
• hypospadia = urethra opened on lower surface of
penis.
 Sources for blood & nerve supply
• Arteries – all of them are branches of int. pudendal a.
• Veins – superficially as scrotum – ext. pudendal vv.
- deeply as prostate – plexus prostaticus.
• Nodes – n.l. inguinalis superfic.
n.l. iliaci int. + ext.
• Nerves – sensory - n. pudendus
- autonomic - nn. cavernosi penis
from pl. hypogastricus inf.
Physiology of coitus:
♥ Erection – funct psy: dilation of helicine aa. →
filling cavernae →  pressure → extension of penis
♥ Emisio – funct symp: contraction d. deferens → semen into urethra.
♥ Ejaculation – contraction m. bulbospongiosus → ejection of semen.
 Perineum
• Completely different to peritoneum !!
• Perineum = portion of the body between external
genital organs and anus

Regio
urogenitalis
• Regio perinealis – region limited
by projection of the pelvic outlet Regio
on body surface - including analis
external genitalia and anus
Muscles of pelvic floor

pelvic diaphragm

urogenital diaphragm
perineal muscles
 Pelvic diaphragm

m. coccygeus
m. levator ani m. iliococcygeus
m. puborectalis
 Perineal muscles
Perineal body
• Ischiocavernosus m.
• Bulbospongiosus m.
• Deep transverse perineal m.
+ Sphincter urethrae ext. m.
• Superficial transverse perineal m.
Innervation: n. pudendus

• Sphincter ani externus m.

Urogenital diaphragm
Musculo-fibrous layer
in extent of DTPM
 Perineal muscles
Differences in ♂ and ♀

muscular - deep transverse perineal m. – replaced by fibrous t.

absent - sphincter urethrovaginalis - under the bulbospongiosus
absent - compressor urethrae - under the ischiocavernosus
Fascias of lesser pelvis & perineum
v regio urogenitalis

pelvic fascia– parietal s.

pelvic fascia- visceral s.

sup. & inf. fascia of

pelvic diaphragm

sup. & inf. fascia of

urogenital diaphragm

superfic. perineal fascia

not present v regio analis
Spaces of lesser pelvis & perineum
peritoneum in regio urogenitalis

Subperitoneal space

Ischio-anal fossa
(ant. part)

Superfic. perineal space

Spaces of lesser pelvis & perineum
peritoneum in regio analis

Subperitoneal space

Ischio-anal fossa

Alcock’s canal
 Sources of pictures:
Netter F.H. - Interactive Atlas of Human Anatomy
Čihák R. – Anatomie 2
Grant’s Atlas of Anatomy
Gray’s Anatomy
Wolf-Heidegger’s Atlas of Human Anatomy
Kahle W., Leonhardt H., Platzer W. – Color Atlas and Textbook of Human Anatomy
Sobotta, Atlas der Anatomie des Menschen
Rohen J.W., Yokochi C. – Anatomie člověka
Wikipedia
Baskin L.S., Himes K., Colborn T. - Hypospadias and Endocrine Disruption: Is There a Connection?
Soomro A.A. – Treat Undescended Testis Earlier
Woody Allen – Everything you always wanted to know about sex (but were afraid to ask)