Download Male internal genital Organ - Ductus Deferens, Seminal Vesicles

Male internal genital Organ - Ductus
Deferens, Seminal Vesicles & Prostate
Learning Objectives
By the end of this presentation, the students should be able to understand:
1. The gross features of male internal organs: Epididymis, Ductus Deferens, Seminal Vesicles &
Prostate
2. Their blood supply , nerve supply & lymphatic drainage.
3. Know clinical correlation: Benign Prostatic Hyperplasia
and clinical significance of High PSA levels.
Male Internal Genitalia
•
Include.
1. Epididymis .
2. Ductus deferens.
3. Seminal vesicle.
4. Ejaculatory ducts.
5. Prostate.
6. Male urethra.
Epididymis
1. Epididymis is an organ made up of highly coiled tube.
2. At as reservoir for spermatozoa.
3. Parts .
1. Head .
2. Body.
3. Tail
4. Tail become continuous with ductus deferens.
Ductus deferens (vas deferens or deferent duct
Definition:
•
Thick wall muscular tube.
•
Transmit the spermatozoa from epididymus to ejaculatory duct.
•
Has narrow lumen.
•
Terminal dilated part called ampulla.
Location of ductus deferens
1. Length.

45 cm when straightened.
2. Course. Lies successively.

Within scrotum along the posterior border of
testis.

In inguinal canal as part of spermatic cord.

Location of ductus deferens
3. In greater pelvis.
4. In lesser pelvis.
Course & relation of ductus deferens
1. Begins as continuation of tail of epididymus.
2. Along posterior border of the testis .

At 1st very tortuous .

Gradually straightens as ascend along the posterior border of testis.

Medial to epididymis.
3. In spermatic cord.

Lies vertically in posterior part of spermatic cord.

Runs upward to superficial inguinal ring.

Traverse inguinal canal.
4. Course in greater pelvis.

Leaves spermatic cord at deep inguinal ring.

Hooks round lateral side of inferior epigastric
artery.

Passes backwards & medially crosses external
iliac vessels.

Enter the lesser pelvis
5. Course in lesser pelvis.

Runs on lateral wall of pelvis deep to peritoneum.

Crosses the obliterated umbilical artery , obturator nerve & vessels & vesical vessels

Crosses ureter blends medially at right angle .

Enter the sacrogenital fold of peritoneum.
6. Reaching the base of urinary bladder.
7.Medial to seminal vesicle.
8. Approaches the opposite duct.
9. Reaches base of prostate
10. At base of prostate ductus deferens is joined at an acute
angle by :

Duct of seminal vesicle to form ejaculatory duct.

Dilated part of ductus behind base of bladder is known
ampula.
Arterial supply of ductus deferens
1. Supplied usually by terminal branch of superior vesical
artery.
2. Occasionally by inferior vesical artery.
3. Anastomosis with testicular artery.
Venous & lymphatic drainage
1. Veins join the vesical venous plexus which open into the internal
iliac vein.
2. Lymphatics accompany the blood vessels to nearest iliac nodes.
Nerve supply
1. Smooth muscles of ductus & seminal vesicles receive fibres from
inferior hypogastic plexus.
2. They are mainly sympathetic fibres from 1st lumbar ganglion & are
motor .
3. Paralysis produce sterility.
4. There is no emission or ejaculation.
Clinical Correlation
•
Vasectomy:

Removal of part of vas deferens .

Done for purposes of family planning.
Seminal vesicles

Thin walled lobulated sacs situated b/w bladder &
rectum.

Each vesicle is about 5 cm long. Applied base of bladder above prostate.

Directed upwards & laterally.

Produce 60% of seminal fluid.

Their tops are just covered by peritoneum of rectovesical pouch.

Rectovesical fascia lies behind them.

Each lies lateral to ampulla of the ductus deferens of its own side.

At lower end of ampulla behind prostate the duct of seminal vesicle join ductus to form
ejaculatory ductus.
Arterial supply of seminal vesicle
1. Supplied by branches from.

Inferior vesical arteries.

Middle rectal arteries
Prostate
Definition

Accessory gland of male reproduction .

Secretion of prostate , seminal vesicles & bulbourethral
glands form seminal fluid.

Largest male accessory gland

Located in lesser pelvis
Gross Features:
•
•
Conical shape with:

base (sup)

Apex (inf),
Surfaces:

Posterior

Anterior

right & left inferolateral
Relations
A. Attached inferiorly to urinary bladder by
B.
Posterior to pubic symphysis
C.
Surrounds superior portion of urethra
D.
Anterior to rectum
ligaments
Anterior Surface
•
Ant. Surface lies at the back of retropubic space
•
Connected to body of pubic bone by puboprostatic
ligament.
Posterior Surface:
•
Post.surface lies anterior to rectum
•
Separated from it by retrovesical
fascia(Denonvillier’s fascia)
•
Ejaculatory duct pierces this surface
Inferolateral surfaces are related to the inferior fibres
of levator ani
Base (aka:vesicular surface): superior

Attached to neck of urinary bladder

Prostatic urethra enters middle of base close to anterior surface
Apex: inferior

Prostatic urethra emerges from front of apex to become membranous urethra

Surrounded by sphincter urethrae

Contacts medial margins of levator ani
muscles
Capsule of prostate gland
Double Capsule:
True capsule: Formed by a thin layer of connective tissue at the periphery
False Capsule: Lies outside the true capsule and is formed by condensation of
the pelvic fascia
B/W these lies the prostatic plexus of veins
Lobes of the prostate gland
Anterior lobe
•
Connects the two lateral lobes in front of the urethra
•
Contains little or no glandular tissue
•
Rare site for adenoma
Posterior lobe
•
Connects the two lateral lobes behind the urethra
•
Lies behind median lobe
•
Site of origin for primary carcinoma
•
Adenoma never occurs here
Median lobe
•
Lies posterior and superior to prostatic utricle and
ejaculatory ducts
•
May project into urinary bladder
•
Utricle lies within lobe
•
Vestigial remains of uterine homolog
•
Sometimes called “uterus masculinis”
•
Common site for adenoma
Lateral lobe
•
Comprise the greatest mass of the gland
•
Contain most secretory tissue
•
Adenoma may arise in old age
LOBES
•
The "lobe" classification is more often used in anatomy.
Histological zones
•
Peripheral zone:
•
Upto 70% of prostate
•
Surrounds distal urethra
•
Accounts for 70-80% of prostatic cancer
•
Central zone:
•
Upto 25% of prostate
•
Surrounds ejaculatory duct
•
Accounts for 2.5% of prostate.cancers
•
Transition zone:
•
Upto 5% of prostate area
•
Surrounds proximal urethra
•
Accounts for 10-20% of prostatic cancers
Blood supply of Prostate
Arteries derived from:
a. Internal pudendal artery
b. Inferior vesical artery
c. Middle rectal artery
Veins
a. Form venous plexus
b. Drain into internal iliac veins
c. Communicate with vesical & vertebral
venous plexuses
Lymphatics
a. Most terminate in internal iliac & sacral nodes (unable to palpate)
b. From posterior: to external iliac nodes
Prostatic secretions
a. Thin, milky, alkaline (looks like skim milk)
b. Discharged at ejaculation
c. c. Make up ~ 1/3 of semen
Age changes in prostate
Grows throughout life
Responsible for BPH
1. Small at birth
2. Enlarges at puberty
3. Maximum at about 13
4. Progressive enlargement after 40
5. Sometimes: undergoes atrophy
Benign Prostatic Hyperplasia(BPH):
•
Affects ~90% of men >50 years of age
•
Characterizied by Hyperplasia of prostatic stromal and epithelial cells
•
Forming discrete nodules in the periurethral region of the prostate, compressing urethra and
causing symptoms of:

urinary hesitency

frequent urination

Dysuria

urinary retention
BPH
Diagnosis
•
Rectal examination
•
transrectal US (TRUS)
•
PSA level.
Drug treatment
•
Alpha blockers,5 alpha inhibitors.
•
Surgery…..TURP(Transurethral resection of prostate). Shown in the
diagram.
Prostate cancer
1. Most common cancer in males
2. Metastasizes via blood (hematogenous) or lymph (lymphogenous)
3. Common sites: vertebrae, pelvis
a. Via venous plexus surrounding prostate
b. Bone or direct metastasis most common
PSA (Prostate Specific Antigen)
•
Glycoprotein, kallikrein related serine protease
•
Produced by secretory epithelium, drains into ductal system
•
cleaves and liquefies seminal coagulum formed after ejaculation
•
The traditional PSA threshold level of 4.0 ng/mL is considered reasonable for further evaluation
of Prostate Cancer
Annual PSA testing recommended for:
•

men 50+

men 40+ at increased risk
The age to begin screening is linked to risk:
 At age 50 years for average-risk men
 At age 45 years for higher-risk men
(African American ethnicity or first-degree
relative with prostate cancer before age 65
years)
 At age 40 years for appreciably higher-risk
men (multiple family members diagnosed
with prostate cancer before age 65 years)
•
Prostate cancer screening is not recommended in
men with a life expectancy of less than 10 years
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