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TOPIC: Pelvic Contents Peculiar to Male and Female
LECTURER: Sammy Wong, MD
4.2
JANUARY 25, 2016
PELVIC CONTENTS PECULIAR TO MALES
- Prostate
- Seminal vesicle
- Vas deferens
PROSTATE
- fibromuscular glandular organ that surrounds theprostatic urethra
- 1.25 in. (3 cm) long, conical in shape- lies between the neck of the bladder above and the
urogenital diaphragm below - Parts:
o base - lies against the bladder neck above
o apex - liesagainst the urogenital diaphragmbelow
- Produces a thin, milky, alkaline fluid containing citricacid and acid phosphatase that is added to the
seminal fluid at the time of ejaculation to helpneutralize the acidity in the vagina.
RELATIONS
Superior The base of the prostate is continuous with
the neck of the bladder
Inferior The apex lies on the upper surface of the
urogenital diaphragm.
Anterior
Symphysis pubis, separated from it by the
extraperitoneal fat in the retropubicspace(cave of Retzius)
Puboprostatic ligaments – connects thefibrous sheath of the prostrate to the posterioraspect of the pubic bones
Posterior
anterior surface of the rectal ampulla
rectovesical septum/Fascia ofDenonvilliers separates the prostrate from
the rectal ampulla
Lateral anterior fibers of the levator ani as they run
posteriorly from the pubis
SNELL:- The urethra enters the center of the base of the prostateand leaves
the prostrate just above the apex on the anterior surface.
- Rectovesical Septum (Fascia of Denonvillier) – formed in fetal lifeby the fusion of the walls of the lower end of the rectovesical pouch of
peritoneum, which originally extended down to the perineal body
COVERINGS OF THE PROSTATE- Covered by a fibrous capsule, a part of the visceral
layer of the pelvic fascia. It is continuous with the
fibromuscular septa around the glandular tissue
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LOBES OF THE PROSTATE
- Incompletely divided into 5 lobes:
Anterior (Isthmus)- lies in front of the urethra - devoid of glandular tissue
Median (Middle)
- wedge-shaped; situated betweenthe urethra and the ejaculatoryducts.
- Its upper surface is related to thetrigone of the bladder
- Rich in glands
Posterior- situated behind the urethra and
below the ejaculatory ducts - contains glandular tissue
Right and LeftLateral
- lie on either side of the urethra - separated from one another by a
shallow vertical groove on theposterior surface of the prostate.
- contain many glands
BLOOD SUPPLY- Inferior vesical artery- Middle rectal artery- Internal pudendal artery (Dr. Wong’s ppt, 20171D)
**All 3 arteries arise from the internal iliac artery
VENOUS DRAINAGE
Prostatic venous plexus
LocationLies outside the capsule of the prostate(base)
Tributaries Deep dorsal vein of the penis
Vesical veins
Drainage Internal iliac vein
Communications(2017 1D)
Superiorly: Vesical venous plexus (drains the
urinary bladder) Posteriorly: Internal pudendal vein (Internal
vertebral venous plexus, acc. to Moore)
Doc Wong/Snell Clinical Notes: Connects withvertebral veins (extradural plexuses) whichserves as a pathway for mestastasis to thevertebral column
LYMPHATIC DRAINAGE- Internal iliac nodes (Snell)
- Sacral and External iliac nodes (included in 20171D, Dr.
Wong’s ppt)
IN SNELL (not in the objectives):
Nerve Supply: Inferior hypogastric plexuses The sympathetic nerves stimulate the smooth muscle of the
prostate during ejaculation
Prostatic urethrao begins at the neck of the bladder; 1.25 in. (3 cm
longo passes through the prostate from the base to the
apexo becomes continuous with the membranous part o
the urethrao prostatic urethra is the widest and mos
dilatableportion of the entire urethra o Urethral crest - longitudinal ridge on the posterio
wallo Prostaticsinus- a groove on each side of the
crest; the prostatic glands open into thesegrooves.
o Prostatic utricle- depression on the summit of theurethral crest; an analog of the uterus andvaginain females.
o On the edge of the mouth of the utricle are theopenings of the two ejaculatory ducts.
SEMINAL VESICLE
- Two lobulated organs about 2 in.(5 cm) long lying on theposterior surface of the bladder
- Each seminal vesicle consists of a much-coiledtubeembedded in connective tissue
- The terminal part of the vas deferens lies on the media
side of each vesicle
.
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RELATIONS OF THE SEMINAL VESICLE
Anterior Posterior surface of the urinary bladder, from
near the termination of ureter to base ofprostrate
Posterior Rectum separated by rectovesical fasciaMedial Ampulla of the vas deferens
Lateral Veins of prostatic plexus
SECRETIONS OF THE SEMINAL VESICLE - the secretions are added to the seminal fluid and are
composed of the following:
1. Fructose – nourishment for the sperm cells2. Proteins – for coagulation3. Enzymes – destroys abnormal sperm cells4. Prostaglandins – induce contractions to help in the
transport of sperm through the female reproductivetract
BLOOD SUPPLY/VENOUS/LYMPHATIC DRAINAGE
Blood SupplyInferior vesicle arteryMiddle rectal arteries
Venous DrainageInternal Iliac veins (Snell)Inferior vesicle and Middle rectalveins (2017 1D)
Lymphatic Drainage Internal iliac nodes
TERMINATION OF THE SEMINAL DUCT
- Inferiorly, each seminal vesicle narrows and joins the vas
deferens of the same side to form the ejaculatory duct.
VAS (DUCTUS) DEFERENS
- thick-walled tube about 18 in. (45 cm) long- conveys mature sperm from the epididymis to the
ejaculatory duct and the urethra.
COURSE OF THE VAS DEFERENS
Arises from the lower end or tail of the epididymis(globus minor)
passes through the inguinal canal
emerges from the deep inguinal ring
passes around the lateral margin of the inferiorepigastric artery
passes downward and backward on the lateral wall of thepelvis
crosses the ureter in the region of the ischial spine.
runs medially and downward on the posteriorof thebladder
Dilates terminally to form the ampulla of the vas deferens
The inferior end of the ampulla narrows down and joinsthe duct of the seminal vesicle to form the ejaculatory duct
BLOOD SUPPLY/VENOUS/LYMPHATIC DRAINAGE
Blood supply
Deferential artery (artery to theductus deferens) which arises fromeither a superior (SNELL: inferior)vesical artery or the internal iliac artery
Venous drainageSuperior or inferior vesical veins which drain into the internal iliac vein
Lymphatic drainage Internal and external iliac nodes
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EJACULATORY DUCT
- each <1 in. (2.5 cm) long and- formed by the union of the vas deferens and the duct of
the seminal vesicle - pierce the posterior surface of the prostate and open into
the prostatic part of the urethra, close to the margins of theprostatic utricle
- functions by draining the seminal fluid into the prostatic
urethra
PELVIC CONTENTS PECULIAR TO FEMALES
- Ovary (paired)
- Fallopian tube/uterine tube/oviduct (paired)
- Uterus (unpaired)
OVARY
- paired, almond-shaped organ
- 1.5 x 0.75 in. (4x2 cm)
- responsible for the production of female germ cells (ova), and
female sex hormones (estrogen and progesterone)
- surrounded by tunica albuginea (thin, fibrous capsule)
which is covered externally by a modified area of
peritoneum called germinal epithelium (this layer does
not give rise to the ova)
- lies against the lateral wall of the pelvis in a deep
depression called ovarian fossa
- variable in position but commonly found hanging down in
the rectouterine pouch (pouch of Douglas)
- bounded:
o above by the external iliac vessels
o behind by the internal iliac vessels and
ureter
- posterior in relation to the uterus and obliterated umbilical
artery
- Oophoritis – inflammation of the ovaries, often seen with
salpingitis (inflammation of the fallopian tube)
LIGAMENTS OF THE OVARY
Mesovarium
o attaches the ovary to the posterior surface of the
broad ligament of the uterus
o derived from the peritoneum
Suspensory ligament (infundibulopelvic ligament)
o part of the broad ligament between the
attachment of the mesovarium and lateral wall of
the pelvis
o
where the blood supply, lymph drainage, andnerve supply of the ovary pass over the pelvic
inlet
Round ligament of the ovary
o remains of the proximal part of the gobernaculum
ovary
o connects the inferomedial margin of the ovary to
the upper end of the lateral wall of the uterus
BLOOD SUPPLY
Ovarian artery – from abdominal aorta at the level of L1
VENOUS DRAINAGE
Ovarian vein – drains into inferior vena cava (right) and
renal vein (left)
LYMPHATIC DRAINAGE
Paraaortic nodes – at the level of L1
NERVE SUPPLY Aortic plexus
Sympathetic fibers carry the afferent impulses from the
ovary and enter the T10 of the spinal cord
FALLOPIAN TUBE
- also called uterine tube, salpinges or oviducts - pair of tubes about 10 cm (4 in) long- lies on the upper border of the broad ligament- connects the peritoneal cavity laterally (in the region of the ovary)
with the uterine cavity medially- main organ that conveys the egg from the ovary to the uterus- two very fine tubeslined with ciliated epithelia leading from the
ovaries into the uterus via the utero-tubal junction - serves as a conduit along which the spermatozoa travel to reach
the ovum- divided into 4 parts:
o infundibulumo ampullao isthmuso intramural part
- to check the patency of the fallopian tube, air is injected andchecked with an X-ray to check for air in the peritoneal cavity
COMMUNICATIONS OF THE FALLOPIAN TUBE
Abdominal ostium – opening into peritoneal cavity
Uterine part of the tube or intramural – opening to the
uterus
PARTS OF THE FALLOPIAN TUBE
Infundibulum
o funnel-shaped lateral end that projects beyond
the broad ligament and overlies the ovary
o fimbriae – finger-like processes on the free edge
of the funnel and are draped over the ovary
Ampulla
o widest part of the tube
o most common site of fertilization
Isthmus
o narrowest part of the tube
o lateral to the uterus
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Intramural part
o segment that pierces the uterine wall
BLOOD SUPPLY
Uterine artery – from the internal iliac artery
Ovarian artery – from abdominal aorta
VENOUS DRAINAGE
Uterine vein
Ovarian vein
LYMPHATIC DRAINAGE
Internal iliac nodes
Paraaortic nodes
NERVE SUPPLY
sympathetic and parasympathetic nerves from the inferior
hypogastric plexus
TUBAL LIGATION
isthmus of fallopian tube
permanent form of birth control in which a woman’s
fallopian tubes are surgically cut or blocked off to prevent
pregnancy
usually restricted to woman who already have children
the ova that are discharged from the ovarian follicles
degenerate in the tube proximal to the obstruction
restoration of the continuity of the uterine tubes can be
attempted, and, in about 20% of women, fertilization
occurs
UTERUS
- entirely a pelvic organ (located in the lesser/true pelvis)
- a hollow pear-shaped organ with thick muscular walls
- dimensions of nullipara: 8 cm (l) x 5 cm (w) x 2.5 cm
(thickness)
- 30-40 g
- lies between urinary bladder in front and rectum behind
- serves as a site for the reception, retention, and nutrition
of fertilized ovum
RELATIONS OF THE UTERUS
POSITIONS OF THE UTERUS
Anteversion (most common) – long axis of the uterus is
bent forward on the long axis of the vagina, with an angle
of 90 degrees
Anteflexion (most common) – long axis of the uterus is
bent forward at the level of the internal os with the long
axis of the cervix, with an angle of 170 degrees
In erect position, with bladder empty, uterus lies in an
almost horizontal plane
Retroversion – fundus and body of the uterus are ben
backward on the vagina so that they lie in the rectouterine
pouch (pouch of Douglas)
Retroflexion – body of the uterus is bent backward on the
cervix
PARTS OF THE UTERUS
Funduso lies above the entrance of the uterine tube
Anteriorly Body of uterus: uterovesical pouchsuperior surface of the bladderSupravaginal cervix: superior surface of thebladderVaginal cervix: anterior fornix of the vagina
Posteriorly Body of the uterus: rectouterine pouch(pouch of Douglas), coils of ileum andsigmoid colon
Laterally Body of uterus: broad ligament, uterineartery and veinSupravaginal cervix: ureter
Vaginal cervix: lateral fornix of the vagina
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Bodyo lies below the entrance of the uterine tubes
Cervixo narrow part of the uterus
o pierces the anterior wall of vagina and divided into the
supravaginal and vaginal part of the cervix
Cavityo triangular in coronal section
o just a cleft in sagittal plane
o
cervical canal – cavity of the cervix whichcommunicates with the cavity of the body (internal os)
and with the vagina (external os)
o in nullipara (women who have never given birth),
external os is circular
o in para (women who have given birth at least once),
vaginal part of the cervix is wider and external os
becomes a transverse slit (possesses an anterior and
posterior lip)
Myometriumo muscular wall
o thick and made up of smooth muscle supported by the
connective tissue
o stretches during pregnancy to accommodate fetus
o contracts during labor (to deliver fetus and placenta)
and in recovery phase (to prevent blood loss and
uterine atony)
Endometriumo mucous membrane lining the body of the uterus
o continue above with the mucous membrane lining the
uterine tubes and below with the mucous membrane
lining the cervix
o no submucosa
o undergo extensive changes during menstrual cycle in
response to ovarian hormones
o site of embryo implantation
o shed in menstruation, if no pregnancy occurs
Parametriumo visceral pelvic fascia that surrounds the supravaginal
part of the cervix
o where uterine artery crosses the ureter on each side of
the cervix
Perimetriumo consists of loose connective tissue
SUPPORTS OF THE UTERUS
The uterus is upported mainly by the ton of levatores ani muscleand the subperineal condensation of pelvic fascia on the uppersurface of the levatores ani muscles, which form three importantligaments:
o pubocervicalo transverse cervicalo sacrocervical
Levatores ani muscles and pelvic fascia on their upper surfaceeffectively support the pelvic viscera and resist the intraabdominal
pressure transmitted downward through the pelvis Levatores ani and Perineal body
o form a broad muscular sheet stretching across the pelviccavity
o medial edges of the anterior parts are attached to the cervixof the uterus by the pelvic fascia
o some fibers are inserted into a fibromuscular structure calledperineal body (lies in the perineum between the vagina andanal canal, important in making the integrity of the pelvicfloor, supports the vagina, and indirectly, the uterus)
Pubocervical ligaments
o consist of 2 firm bands of connective tissue
that pass to the cervix from posterior surface
of the pubis
o positioned on either side of the neck of the
bladder, to which they give some support
(pubovesical ligaments)
o attaches the lateral cervix to the symphysis
pubis
Transverse cervical (cardinal) ligaments
o a.k.a. Mackenrodt’s ligament
o fibromuscular condensation of pelvic fascia
that passes to the cervix and the upper end
of vagina from the lateral walls of the pelvis
o located at the base of the broad ligament
o contains the uterine artery and the uterine
vein
o attaches the lateral cervix to the lateral pelvic
wall at the ischial spine
o strongest of the uterine ligaments
Sacrocervical ligaments
o a.k.a. uterosacral/rectouterine ligament
o
consist of two firm fibromuscular bands ofpelvic fascia that pass to the cervix and
upper end of vagina from the lower end of
the sacrum
o form two ridges, one on either side of the
rectouterine pouch
o helps in anteversion and anteflexion of the
uterus as it pulls the cervix backward,
therefore the uterus is bent forward
Lax structures with minor role in support: Round ligament
o remains of lower half of the gubernaculum ovary
o extends between superolateral angle of uterus,
through the deep inguinal ring and inguinal canal,to the subcutaneous tissue of labium majus
o helps keep the uterus anteverted and anteflexed
o considerably stretched during pregnancy
Broad ligament
o strongest among the 5
o two layered folds of peritoneum with mesothelium
that extends across the pelvic cavity from lateral
margins of uterus to lateral pelvic walls
o superior: two layers are continuous and form the
upper free edge
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o inferior: separate to cover the pelvic floor
o holds uterus in its normal position
o connects the sides of the uterus to walls and
floors of pelvis
o serves as the mesentery for the uterus, the
uterine tubes, and the ovaries
o contents:- uterine tube (upper free border)
- round ligaments (of ovary and uterus)
- uterine and ovarian blood vessels, lymphvessels, and nerves
- Epoophoron - vestigial structure that lies in
the broad ligament above the attachment of
the mesovarium (remains of mesonephros)
- Paroophoron – vestigial structure that lies in
the broad ligament just lateral to the uterus
(remains of mesonephros)
o Parts: mesometrium, mesosalpinx, mesovariumo Mesometrium – largest part of the broad ligament;
ensheaths the uterus
o Mesosalpinx – most superior part of the broad
ligament; suspends the uterine tubes in the pelvic
cavity; between uterine tube and mesovarium
o Mesovarium – posterior extension of the broad
ligament; ensheaths the ovaryo Suspensory ligaments – form part of the broad
ligament that lies lateral to the attachment of
mesovarium
BLOOD SUPPLY
Uterine arterieso from internal iliac artery
o runs medially in the base of broad ligament
o crosses above the ureter at right angles
o reaches the cervix at the level of the internal os
o ascends along the lateral margin of the uterus within
the broad ligament
o ends by anastomosing with ovarian artery (assist in
supplying the uterus)
o gives off small descending branch that supplies the
cervix and vagina
VENOUS DRAINAGE
Uterine vein – drains into internal iliac vein
LYMPHATIC DRAINAGE
Paraaortic nodes (L1) – fundus
External and internal iliac nodes – body and cervix
Superficial inguinal nodes – round ligament
NERVE SUPPLY
sympathetic and parasympathetic nerves from
branches of the inferior hypogastric plexus (where
uterine nerves arise)
References:Snell, R. S. (2014). Clinical Anatomy by Regions, 9th Edition. Philadelphia:Lippincott Williams & Wilkins.
2017 1D Transcription 4.02 (lecture by Dr. Sammy Wong)2016 1C Transcription (lecture by Dr. De Jesus)
QUIZ:
1. Which of the following separates the prostate from its posterior
relation?
a. Puboprostatic Ligament
b. Fascia of Denonvilier ’s
c. Rectovesical septum
d. A and B
e. B and C
2. Which of the following is not a tributary of the prostatic venous
plexus?
a. Deep dorsal vein of the penis
b. Vesical vein
c. Internal Iliac vein
d. B and C
3. The terminal part of the ductus deferens is ___ to each seminal
vesicle.a. medial
b. lateral
c. posterior
d. anterior
4. The vas deferens takes these courses EXCEPT:
a. Passes through the superficial inguinal ring
b. Emerges from the deep inguinal ring
c. Passes around the lateral margin of the external iliac
artery
d. Runs medially and downward on the posterior surface
of the bladder
5. The deferential artery may arise from all of the following EXCEPT
a. Superior Vesical Artery
b. Inferior Vesical Artery
c. Internal iliac Arteryd. External iliac Artery
6. The opening of the salphinges is used to demarcate between:
a. corpus and cervix uterine
b. supravaginal and vaginal cervix
c. fundus and body of uterus
d. A and C
7. The following arises from the internal iliac artery EXCEPT:
a. ovarian artery
b. uterine artery
c. middle rectal artery
d. internal pudendal artery
8. Which of the following does not drain into the internal iliac nodes?
a. Seminal vesicle
b. Body of the uterus
c. Round ligament of the uterus
d. uterine tubes
9. This keeps the uterus bent forward:
a. Cardinal Ligament
b. Pubocervical ligament
c. Round ligament
d. Infundibulopelvic ligament
10. Most common site of fertilization:
a. Infundibulum
b. Ampulla
c. Isthmus
d. Intramural partAnswers: ECACDCACCB