1.      Adrenal glands. Structure and topography of ureter and urnary bladder.

2.      Male reproductive organs. Structure of testis and epididimis. Spermatic ducts and accessory reproductive glands.

3.      External reproductive organs. Spermatic cord. Layers of scrotal wall. Structure of masculine urethra. Topography of small pelvis organs on male

Lesson No 16

Theme 1. Adrenal glands. Structure and topography of ureter and urnary bladder

The Adrenal gland is a pair endocrine gland, which lies on superior extremity of right and left kidneys on level of the Th 11 Th 12 vertebrae. Each adrenal gland has triangle shape and has anterior surface, posterior surface and renal surface and superior margin and medial margin, and also has the hilus and consists of cortex and medulla matter. Cortex produces mineralocorticoids (aldosterone), glucocorticoids and androgens. Medulla of adrenal glands produces adrenalin and noradrenalin.

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Suprarenal glands viewed from the front.

 

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Suprarenal glands viewed from behind.

 

 

 

 

 

The urogenital apparatus consists of (a) the urinary organs for the secretion and discharge of the urine, and (b) the genital organs, which are concerned with the process of reproduction.

Development of the Urinary and Generative OrgansThe urinary and generative organs are developed from the intermediate cell-mass which is situated between the primitive segments and the lateral plates of mesoderm. The permanent organs of the adult are preceded by a set of structures which are purely embryonic, and which with the exception of the ducts disappear almost entirely before the end of fetal life. These embryonic structures are on either side; the pronephros, the mesonephros, the metanephros, and the Wolffian and Müllerian ducts. The pronephros disappears very early; the structural elements of the mesonephros mostly degenerate, but in their place is developed the genital gland in association with which the Wolffian duct remains as the duct of the male genital gland, the Müllerian as that of the female; some of the tubules of the metanephros form part of the permanent kidney.

The Pronephros and Wolffian Duct.In the outer part of the intermediate cell-mass, immediately under the ectoderm, in the region from the fifth cervical to the third thoracic segments, a series of short evaginations from each segment grows dorsalward and extends caudalward, fusing successively from before backward to form the pronephric duct. This continues to grow caudalward until it opens into the ventral part of the cloaca; beyond the pronephros it is termed the Wolffian duct.

 The original evaginations form a series of transverse tubules each of which communicates by means of a funnel-shaped ciliated opening with the celomic cavity, and in the course of each duct a glomerulus also is developed. A secondary glomerulus is formed ventral to each of these, and the complete group constitutes the pronephros. The pronephros undergoes rapid atrophy and disappears.

The Mesonephros, Müllerian Duct, and Genital Gland.On the medial side of the Wolffian duct, from the sixth cervical to the third lumbar segments, a series of tubules, the Wolffian tubules, is developed; at a later stage in development they increase in number by outgrowths from the original tubules. These tubules first appear as solid masses of cells, which later become hollowed in the center; one end grows toward and finally opens into the Wolffian duct, the other dilates and is invaginated by a tuft of capillary bloodvessels to form a glomerulus. The tubules collectively constitute the mesonephros or Wolffian body. By the fifth or sixth week this body forms an elongated spindle-shaped structure, termed the urogenital fold, which projects into the celomic cavity at the side of the dorsal mesentery, reaching from the septum transversum in front to the fifth lumbar segment behind; in this fold the reproductive glands are developed. The Wolffian bodies persist and form the permanent kidneys in fishes and amphibians, but in reptiles, birds, and mammals, they atrophy and for the most part disappear coincidently with the development of the permanent kidneys. The atrophy begins during the sixth or seventh week and rapidly proceeds, so that by the beginning of the fifth month only the ducts and a few of the tubules remain.

  In the male the Wolffian duct persists, and forms the tube of the epididymis, the ductus deferens and the ejaculatory duct, while the seminal vesicle arises during the third month as a lateral diverticulum from its hinder end. A large part of the head end of the mesonephros atrophies and disappears; of the remainder the anterior tubules form the efferent ducts of the testis; while the posterior tubules are represented by the ductuli aberrantes, and by the paradidymis, which is sometimes found in front of the spermatic cord above the head of the epididymis.

  In the female the Wolffian bodies and ducts atrophy. The remains of the Wolffian tubules are represented by the epoöphoron or organ of Rosenmüller, and the paroöphoron, two small collections of rudimentary blind tubules which are situated in the mesosalpinx. The lower part of the Wolffian duct disappears, while the upper part persists as the longitudinal duct of the epoöphoron or duct of Gärtner.

The Müllerian Ducts.Shortly after the formation of the Wolffian ducts a second pair of ducts is developed; these are named the Müllerian ducts. Each arises on the lateral aspect of the corresponding Wolffian duct as a tubular invagination of the cells lining the celom. The orifice of the invagination remains patent, and undergoes enlargement and modification to form the abdominal ostium of the uterine tube. The ducts pass backward lateral to the Wolffian ducts, but toward the posterior end of the embryo they cross to the medial side of these ducts, and thus come to lie side by side between and behind the latterthe four ducts forming what is termed the genital cord. The Müllerian ducts end in an epithelial elevation, the Müllerian eminence, on the ventral part of the cloaca between the orifices of the Wolffian ducts; at a later date they open into the cloaca in this situation.

  In the male the Müllerian ducts atrophy, but traces of their anterior ends are represented by the appendices testis (hydatids of Morgagni), while their terminal fused portions form the utriculus in the floor of the prostatic portion of the urethra.

  In the female the Müllerian ducts persist and undergo further development. The portions which lie in the genital core fuse to form the uterus and vagina; the parts in front of this cord remain separate, and each forms the corresponding uterine tubethe abdominal ostium of which is developed from the anterior extremity of the original tubular invagination from the celom. The fusion of the Müllerian ducts begins in the third month, and the septum formed by their fused medial walls disappears from below upward, and thus the cavities of the vagina and uterus are produced. About the fifth month an annular constriction marks the position of the neck of the uterus, and after the sixth month the walls of the uterus begin to thicken. For a time the vagina is represented by a solid rod of epithelial cells. A ring-like outgrowth of this epithelium occurs at the lower end of the uterus and marks the future vaginal fornices; about the fifth or sixth month the lumen of the vagina is produced by the breaking down of the central cells of the epithelium. The hymen represents the remains of the Müllerian eminence.

Kidney

Kidney

he kidneys are bean-shaped excretory organs in vertebrates. Part of the urinary system, the kidneys filter wastes (especially urea) from the blood and excrete them, along with water, as urine. The medical field that studies the kidneys and diseases affecting the kidney is called nephrology, from the Ancient Greek name for kidney; the adjective meaning "kidney-related" is renal, from Latin.

In humans, the kidneys are located in the posterior part of the abdomen. There is one on each side of the spine; the right kidney sits just below the liver, the left below the diaphragm and adjacent to the spleen. Above each kidney is an adrenal gland (also called the suprarenal gland). The asymmetry within the abdominal cavity caused by the liver results in the right kidney being slightly lower than the left one.

The kidneys are retroperitoneal, which means they lie behind the peritoneum, the lining of the abdominal cavity. They are approximately at the vertebral level T12 to L3. The upper parts of the kidneys are partially protected by the eleventh and twelfth ribs, and each whole kidney is surrounded by two layers of fat (the perirenal and pararenal fat) which help to cushion it. Congenital absence of one or both kidneys, known as unilateral or bilateral renal agenesis occurs. In very rare cases, it is possible to have developed three or even four kidneys.[1]

In a normal human adult, each kidney is about 12 cm long and about 5 cm thick, weighing 150 grams. Kidneys weigh about 0.5% of a person's total body weight. The kidneys are "bean-shaped" organs, and have a concave side facing inwards (medially). On this medial aspect of each kidney is an opening, called the hilum, which admits the renal artery, the renal vein, nerves, and the ureter.

The outer portion of the kidney is called the renal cortex, which sits directly beneath the kidney's loose connective tissue/fibrous capsule. Deep to the cortex lies the renal medulla, which is divided into 10-20 renal pyramids in humans. Each pyramid together with the associated overlying cortex forms a renal lobe. The tip of each pyramid (called a papilla) empties into a calyx, and the calices empty into the renal pelvis. The pelvis transmits urine to the urinary bladder via the ureter.

Blood supply

Each kidney receives its blood supply from the renal artery, two of which branch from the abdominal aorta. Upon entering the hilum of the kidney, the renal artery divides into smaller interlobar arteries situated between the renal papillae. At the outer medulla, the interlobar arteries branch into arcuate arteries, which course along the border between the renal medulla and cortex, giving off still smaller branches, the cortical radial arteries (sometimes called interlobular arteries). Branching off these cortical arteries are the afferent arterioles supplying the glomerular capillaries, which drain into efferent arterioles. Efferent arterioles divide into peritubular capillaries that provide an extensive blood supply to the cortex. Blood from these capillaries collects in renal venules and leaves the kidney via the renal vein. Efferent arterioles of glomeruli closest to the medulla (those that belong to juxtamedullary nephrons) send branches into the medulla, forming the vasa recta. Blood supply is intimately linked to blood pressure.

The basic functional unit of the kidney is the nephron, of which there are more than a million within the cortex and medulla of each normal adult human kidney. Nephrons regulate water and soluble matter (especially electrolytes) in the body by first filtering the blood under pressure, and then reabsorbing some necessary fluid and molecules back into the blood while secreting other, unneeded molecules. Reabsorption and secretion are accomplished with both cotransport and countertransport mechanisms established in the nephrons and associated collecting ducts.

Collecting duct system

The fluid flows from the nephron into the collecting duct system. This segment of the nephron is crucial to the process of water conservation by the organism. In the presence of antidiuretic hormone (ADH; also called vasopressin), these ducts become permeable to water and facilitate its reabsorption, thus concentrating the urine and reducing its volume. Conversely, when the organism must eliminate excess water, such as after excess fluid drinking, the production of ADH is decreased and the collecting tubule becomes less permeable to water, rendering urine dilute and abundant. Failure of the organism to decrease ADH production appropriately, a condition known as syndrome of inappropriate ADH (SIADH), may lead to water retention and dangerous dilution of body fluids, which in turn may cause severe neurological damage. Failure to produce ADH (or inability of the collecting ducts to respond to it) may cause excessive urination, called diabetes insipidus (DI).

A second major function of the collecting duct system is the maintenance of acid-base homeostasis.

After being processed along the collecting tubules and ducts, the fluid, now called urine, is drained into the bladder via the ureter, to be finally excluded from the organism.

Excretion of waste products

The kidneys excrete a variety of waste products produced by metabolism, including the nitrogenous wastes: urea (from protein catabolism) and uric acid (from nucleic acid metabolism).

Homeostasis

 

Embryology

The mammalian kidney develops from intermediate mesoderm. Kidney development, also called nephrogenesis, proceeds through a series of three successive phases, each marked by the development of a more advanced pair of kidneys: the pronephros, mesonephros, and metanephros.[2] (The plural forms of these terms end in -oi.)

Pronephros

During approximately day 22 of human gestation, the paired pronephroi appear towards the cranial end of the intermediate mesoderm. In this region, epithelial cells arrange themselves in a series of tubules called nephrotomes and join laterally with the pronephric duct, which does not reach the outside of the embryo. Thus the pronephros is considered nonfunctional in mammals because it cannot excrete waste from the embryo.

Mesonephros

Each pronephric duct grows towards the tail of the embryo, and in doing so induces intermediate mesoderm in the thoracolumbar area to become epithelial tubules called mesonephric tubules. Each mesonephric tubule receives a blood supply from a branch of the aorta, ending in a capillary tuft analogous to the glomerulus of the definitive nephron. The mesonephric tubule forms a capsule around the capillary tuft, allowing for filtration of blood. This filtrate flows through the mesonephric tubule and is drained into the continuation of the pronephric duct, now called the mesonephric duct or Wolffian duct. The nephrotomes of the pronephros degenerate while the mesonephric duct extends towards the most caudal end of the embryo, ultimately attaching to the cloaca. The mammalian mesonephros is similar to the kidneys of aquatic amphibians and fishes.

Metanephros

During the fifth week of gestation, the mesonephric duct develops an outpouching, the ureteric bud, near its attachment to the cloaca. This bud, also called the metanephrogenic diverticulum, grows posteriorly and towards the head of the embryo. The elongated stalk of the ureteric bud, the metanephric duct, later forms the ureter. As the cranial end of the bud extends into the intermediate mesoderm, it undergoes a series of branchings to form the collecting duct system of the kidney. It also forms the major and minor calyces and the renal pelvis.

The portion of the intermediate mesoderm in contact with the tips of the branching ureteric bud is known as the metanephrogenic blastema. Signals released from the ureteric bud induce the differentiation of the metanephrogenic blastema into the renal tubules. As the renal tubules grow, they come into contact and join with connecting tubules of the collecting duct system, forming a continuous passage for flow from the renal tubule to the collecting duct. Simultaneously, precursors of vascular endothelial cells begin to take their position at the tips of the renal tubules. These cells differentiate into the cells of the definitive glomerulus.

 

The URETERS are pair organ length 25-0 cm, which lies retroperitoneally. Ureter has abdominal part, pelvic part and intramural part. Last lies in the wall of urinary bladder and opens on its fundus by foramen. Ureters wall consists of external membrane, muscular membrane and mucous membrane. Muscular membrane has external circular and internal longitudinal layers.

Ureter has follow narrow places:

at transition of renal pelvis into ureter;

at transition of abdominal part into pelvic part;

at transition of ureters into urinary bladder.

 

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Posterior abdominal wall, after removal of the peritoneum, showing kidneys, suprarenal capsules, great vessels and ureters.

 

The URINARY BLADDER lies in cavity of lesser pelvis behind pubic symphysis. It has an apex, body and fundus, which is directed down and posterior. Inferior part forms neck, which continues into urethra. Empty urinary bladder lies extraperitoneally. Full bladder covered by peritoneum anteriorly, laterally and posteriorly - mesoperitoneal position. Fundus of the bladder in male adjoins from below to prostate gland, seminal vesicles and ampoule of ductus deferens, and behind - to ampoule of rectum. In female urinary bladder behind adjoins to vagina and uterus.

The urinary bladder is a musculomembranous sac which acts as a reservoir for the urine; and as its size, position, and relations vary according to the amount of fluid it contains, it is necessary to study it as it appears (a) when empty, and (b) when distended.) In both conditions the position of the bladder varies with the condition of the rectum, being pushed upward and forward when the rectum is distended.

 The Empty Bladder.When hardened in situ, the empty bladder has the form of a flattened tetrahedron, with its vertex tilted forward. It presents a fundus, a vertex, a superior and an inferior surface. The fundus is triangular in shape, and is directed downward and backward toward the rectum, from which it is separated by the rectovesical fascia, the vesiculæ seminales, and the terminal portions of the ductus deferentes. The vertex is directed forward toward the upper part of the symphysis pubis, and from it the middle umbilical ligament is continued upward on the back of the anterior abdominal wall to the umbilicus. The peritoneum is carried by it from the vertex of the bladder on to the abdominal wall to form the middle umbilical fold. The superior surface is triangular, bounded on either side by a lateral border which separates it from the inferior surface, and behind by a posterior border, represented by a line joining the two ureters, which intervenes between it and the fundus.

The lateral borders extend from the ureters to the vertex, and from them the peritoneum is carried to the walls of the pelvis. On either side of the bladder the peritoneum shows a depression, named the paravesical fossa. The superior surface is directed upward, is covered by peritoneum, and is in relation with the sigmoid colon and some of the coils of the small intestine. When the bladder is empty and firmly contracted, this surface is convex and the lateral and posterior borders are rounded; whereas if the bladder be relaxed it is concave, and the interior of the viscus, as seen in a median sagittal section, presents the appearance of a V-shaped slit with a shorter posterior and a longer anterior limbthe apex of the V corresponding with the internal orifice of the urethra. The inferior surface is directed downward and is uncovered by peritoneum. It may be divided into a posterior or prostatic area and two infero-lateral surfaces. The prostatic area is somewhat triangular: it rests upon and is in direct continuity with the base of the prostate; and from it the urethra emerges. The infero-lateral portions of the inferior surface are directed downward and lateralward: in front, they are separated from the symphysis pubis by a mass of fatty tissue which is named the retropubic pad; behind, they are in contact with the fascia which covers the Levatores ani and Obturatores interni.

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Median sagitta section of male pelvis.

 

 

1, corpus cavernosum 2, corpus spongiosum (bulb of the penis) 3, ramus ischium 4, ischiocavernosus m. 5, anal canal 6, sphincter ani externus m. 7, gluteus maximus m.

 

  When the bladder is empty it is placed entirely within the pelvis, below the level of the obliterated hypogastric arteries, and below the level of those portions of the ductus deferentes which are in contact with the lateral wall of the pelvis; after they cross the ureters the ductus deferentes come into contact with the fundus of the bladder. As the viscus fills, its fundus, being more or less fixed, is only slightly depressed; while its superior surface gradually rises into the abdominal cavity, carrying with it its peritoneal covering, and at the same time rounding off the posterior and lateral borders.

  When the bladder is moderately full it contains about 0.5 liter and assumes an oval form; the long diameter of the oval measures about 12 cm. and is directed upward and forward. In this condition it presents a postero-superior, an antero-inferior, and two lateral surfaces, a fundus and a summit. The postero-superior surface is directed upward and backward, and is covered by peritoneum: behind, it is separated from the rectum by the rectovesical excavation, while its anterior part is in contact with the coils of the small intestine. The antero-inferior surface is devoid of peritoneum, and rests, below, against the pubic bones, above which it is in contact with the back of the anterior abdominal wall. The lower parts of the lateral surfaces are destitute of peritoneum, and are in contact with the lateral walls of the pelvis. The line of peritoneal reflection from the lateral surface is raised to the level of the obliterated hypogastric artery. The fundus undergoes little alteration in position, being only slightly lowered. It exhibits, however, a narrow triangular area, which is separated from the rectum merely by the rectovesical fascia. This area is bounded below by the prostate, above by the rectovesical fold of peritoneum, and laterally by the ductus deferentes. The ductus deferentes frequently come in contact with each other above the prostate, and under such circumstances the lower part of the triangular area is obliterated. The line of reflection of the peritoneum from the rectum to the bladder appears to undergo little or no change when the latter is distended; it is situated about 10 cm. from the anus. The summit is directed upward and forward above the point of attachment of the middle umbilical ligament, and hence the peritoneum which follows the ligament, forms a pouch of varying depth between the summit of the bladder, and the anterior abdominal wall.

The Bladder in the ChildIn the newborn child the internal urethral orifice is at the level of the upper border of the symphysis pubis; the bladder therefore lies relatively at a much higher level in the infant than in the adult. Its anterior surface is in contact with about the lower two-thirds of that part of the abdominal wall which lies between the symphysis pubis and the umbilicus. Its fundus is clothed with peritoneum as far as the level of the internal orifice of the urethra. Although the bladder of the infant is usually described as an abdominal organ, Symington has pointed out that only about one-half of it lies above the plane of the superior aperture of the pelvis. Disse maintains that the internal urethral orifice sinks rapidly during the first years, and then more slowly until the ninth year, after which it remains sta when it again slowly descends and reaches its adult position.

 

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Sagittal section through the pelvis of a newly born male child.

 

 

 

1, rectus abdominis m. 2, bladder 3, pubis 4, ischium 5, testis 6, corpus cavernosum

 

 

1, rectus abdominis m. 2, symphysis pubis 3, corpus cavernosum 4, corpus spongiosum 5, prostate 6, bladder 7,seminal vesicle 8, rectum 9, sacrum

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Sagittal section through the pelvis of a newly born female child.

 

 

The Female BladderIn the female, the bladder is in relation behind with the uterus and the upper part of the vagina. It is separated from the anterior surface of the body of the uterus by the vesicouterine excavation, but below the level of this excavation it is connected to the front of the cervix uteri and the upper part of the anterior wall of the vagina by areolar tissue. When the bladder is empty the uterus rests upon its superior surface. The female bladder is said by some to be more capacious than that of the male, but probably the opposite is the case.

 

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Median sagittal section of female pelvis.

 Ligaments.The bladder is connected to the pelvic wall by the fascia endopelvina. In front this fascial attachment is strengthened by a few muscular fibers, the Pubovesicales, which extend from the back of the pubic bones to the front of the bladder; behind, other muscular fibers run from the fundus of the bladder to the sides of the rectum, in the sacrogenital folds, and constitute the Rectovesicales.

  The vertex of the bladder is joined to the umbilicus by the remains of the urachus which forms the middle umbilical ligament, a fibromuscular cord, broad at its attachment to the bladder but narrowing as it ascends.

  From the superior surface of the bladder the peritoneum is carried off in a series of folds which are sometimes termed the false ligaments of the bladder. Anteriorly there are three folds: the middle umbilical fold on the middle umbilical ligament, and two lateral umbilical folds on the obliterated hypogastric arteries. The reflections of the peritoneum on to the side walls of the pelvis form the lateral false ligaments, while the sacrogenital folds constitute posterior false ligaments.

 Interior of the BladderThe mucous membrane lining the bladder is, over the greater part of the viscus, loosely attached to the muscular coat, and appears wrinkled or folded when the bladder is contracted: in the distended condition of the bladder the folds are effaced. Over a small triangular area, termed the trigonum vesicæ, immediately above and behind the internal orifice of the urethra, the mucous membrane is firmly bound to the muscular coat, and is always smooth. The anterior angle of the trigonum vesicæ is formed by the internal orifice of the urethra: its postero-lateral angles by the orifices of the ureters. Stretching behind the latter openings is a slightly curved ridge, the torus uretericus, forming the base of the trigone and produced by an underlying bundle of non-striped muscular fibers. The lateral parts of this ridge extend beyond the openings of the ureters, and are named the plicæ uretericæ; they are produced by the terminal portions of the ureters as they traverse obliquely the bladder wall. When the bladder is illuminated the torus uretericus appears as a pale band and forms an important guide during the operation of introducing a catheter into the ureter.

 

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The interior of bladder.

 

  The orifices of the ureters are placed at the postero-lateral angles of the trigonum vesicæ, and are usually slit-like in form. In the contracted bladder they are about 2.5 cm. apart and about the same distance from the internal urethral orifice; in the distended viscus these measurements may be increased to about 5 cm.

  The internal urethral orifice is placed at the apex of the trigonum vesicæ, in the most dependent part of the bladder, and is usually somewhat crescentic in form; the mucous membrane immediately behind it presents a slight elevation, the uvula vesicæ, caused by the middle lobe of the prostate.

 

StructureThe bladder is composed of the four coats: serous, muscular, submucous, and mucous coats.

  The serous coat (tunica serosa) is a partial one, and is derived from the peritoneum. It invests the superior surface and the upper parts of the lateral surfaces, and is reflected from these on to the abdominal and pelvic walls.

  The muscular coat (tunica muscularis) consists of three layers of unstriped muscular fibers: an external layer, composed of fibers having for the most part a longitudinal arrangement; a middle layer, in which the fibers are arranged, more or less, in a circular manner; and an internal layer, in which the fibers have a general longitudinal arrangement.

  The fibers of the external layer arise from the posterior surface of the body of the pubis in both sexes (musculi pubovesicales), and in the male from the adjacent part of the prostate and its capsule. They pass, in a more or less longitudinal manner, up the inferior surface of the bladder, over its vertex, and then descend along its fundus to become attached to the prostate in the male, and to the front of the vagina in the female. At the sides of the bladder the fibers are arranged obliquely and intersect one another. This layer has been named the Detrusor urinæ muscle.

  The fibers of the middle circular layer are very thinly and irregularly scattered on the body of the organ, and, although to some extent placed transversely to the long axis of the bladder, are for the most part arranged obliquely. Toward the lower part of the bladder, around the internal urethral orifice, they are disposed in a thick circular layer, forming the Sphincter vesicæ, which is continuous with the muscular fibers of the prostate.

  The internal longitudinal layer is thin, and its fasciculi have a reticular arrangement, but with a tendency to assume for the most part a longitudinal direction. Two bands of oblique fibers, originating behind the orifices of the ureters, converge to the back part of the prostate, and are inserted by means of a fibrous process, into the middle lobe of that organ. They are the muscles of the ureters, described by Sir C. Bell, who supposed that during the contraction of the bladder they serve to retain the oblique direction of the ureters, and so prevent the reflux of the urine into them.

  The submucous coat (tela submucosa) consists of a layer of areolar tissue, connecting together the muscular and mucous coats, and intimately united to the latter.

 

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Vertical section of bladder wall.

 

 

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  The mucous coat (tunica mucosa) is thin, smooth, and of a pale rose color. It is continuous above through the ureters with the lining membrane of the renal tubules, and below with that of the urethra. The loose texture of the submucous layer allows the mucous coat to be thrown into folds or rugæ when the bladder is empty. Over the trigonum vesicæ the mucous membrane is closely attached to the muscular coat, and is not thrown into folds, but is smooth and flat. The epithelium covering it is of the transitional variety, consisting of a superficial layer of polyhedral flattened cells, each with one, two, or three nuclei; beneath these is a stratum of large club-shaped cells, with their narrow extremities directed downward and wedged in between smaller spindle-shaped cells, containing oval nuclei. The epithelium varies according as the bladder is distended or contracted. In the former condition the superficial cells are flattened and those of the other layers are shortened; in the latter they present the appearance described above. There are no true glands in the mucous membrane of the bladder, though certain mucous follicles which exist, especially near the neck of the bladder, have been regarded as such.

 

Vessels and Nerves.The arteries supplying the bladder are the superior, middle, and inferior vesical, derived from the anterior trunk of the hypogastric. The obturator and inferior gluteal arteries also supply small visceral branches to the bladder, and in the female additional branches are derived from the uterine and vaginal arteries.

  The veins form a complicated plexus on the inferior surface, and fundus near the prostate, and end in the hypogastric veins.

    The nerves of the bladder are (1) fine medullated fibers from the third and fourth sacral nerves, and (2) non-medullated fibers from the hypogastric plexus. They are connected with ganglia in the outer and submucous coats and are finally distributed, all as non-medullated fibers, to the muscular layer and epithelial lining of the viscus.

 

Abnormalities.A defect of development, in which the bladder is implicated, is known under the name of extroversion of the bladder. In this condition the lower part of the abdominal wall and the anterior wall of the bladder are wanting, so that the fundus of the bladder presents on the abdominal surface, and is pushed forward by the pressure of the viscera within the abdomen, forming a red vascular tumor on which the openings of the ureters are visible. The penis, except the glans, is rudimentary and is cleft on its dorsal surface, exposing the floor of the urethra, a condition known as epispadias. The pelvic bones are also arrested in development.

 

Wall of urinary bladder is formed by mucous membrane and well developed submucous stratum, thanks it mucous membrane forms the numerous folds. Between orifices of ureters and internal urethral ostium submucous base absent, so there are no folds here. This place called as triangle of bladder. It is limited above interureteric fold of mucous membrane. Middle membrane of urinary bladder is a muscular membrane, where muscles are arranged in three layers: internal and external longitudinal and middle - circular. The muscular layers form in area of the body muscle-detrussor of bladder, and a circular layer most developed in area of internal urethral ostium, forms an internal urethral muscle-sphincter (involuntary).

The URINARY BLADDER lies in cavity of lesser pelvis behind pubic symphysis. It has an apex, body and fundus, which is directed down and posterior. Inferior part forms neck, which continues into urethra. Empty urinary bladder lies extraperitoneally. Full bladder covered by peritoneum anteriorly, laterally and posteriorly - mesoperitoneal position. Fundus of the bladder in male adjoins from below to prostate gland, seminal vesicles and ampoule of ductus deferens, and behind - to ampoule of rectum. In female urinary bladder behind adjoins to vagina and uterus.

The urinary bladder is a musculomembranous sac which acts as a reservoir for the urine; and as its size, position, and relations vary according to the amount of fluid it contains, it is necessary to study it as it appears (a) when empty, and (b) when distended.) In both conditions the position of the bladder varies with the condition of the rectum, being pushed upward and forward when the rectum is distended.

 The Empty Bladder.When hardened in situ, the empty bladder has the form of a flattened tetrahedron, with its vertex tilted forward. It presents a fundus, a vertex, a superior and an inferior surface. The fundus is triangular in shape, and is directed downward and backward toward the rectum, from which it is separated by the rectovesical fascia, the vesiculæ seminales, and the terminal portions of the ductus deferentes. The vertex is directed forward toward the upper part of the symphysis pubis, and from it the middle umbilical ligament is continued upward on the back of the anterior abdominal wall to the umbilicus. The peritoneum is carried by it from the vertex of the bladder on to the abdominal wall to form the middle umbilical fold. The superior surface is triangular, bounded on either side by a lateral border which separates it from the inferior surface, and behind by a posterior border, represented by a line joining the two ureters, which intervenes between it and the fundus.

The lateral borders extend from the ureters to the vertex, and from them the peritoneum is carried to the walls of the pelvis. On either side of the bladder the peritoneum shows a depression, named the paravesical fossa. The superior surface is directed upward, is covered by peritoneum, and is in relation with the sigmoid colon and some of the coils of the small intestine. When the bladder is empty and firmly contracted, this surface is convex and the lateral and posterior borders are rounded; whereas if the bladder be relaxed it is concave, and the interior of the viscus, as seen in a median sagittal section, presents the appearance of a V-shaped slit with a shorter posterior and a longer anterior limbthe apex of the V corresponding with the internal orifice of the urethra. The inferior surface is directed downward and is uncovered by peritoneum. It may be divided into a posterior or prostatic area and two infero-lateral surfaces. The prostatic area is somewhat triangular: it rests upon and is in direct continuity with the base of the prostate; and from it the urethra emerges. The infero-lateral portions of the inferior surface are directed downward and lateralward: in front, they are separated from the symphysis pubis by a mass of fatty tissue which is named the retropubic pad; behind, they are in contact with the fascia which covers the Levatores ani and Obturatores interni.

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Median sagitta section of male pelvis.

 

 

1, corpus cavernosum 2, corpus spongiosum (bulb of the penis) 3, ramus ischium 4, ischiocavernosus m. 5, anal canal 6, sphincter ani externus m. 7, gluteus maximus m.

 

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Posterior abdominal wall, after removal of the peritoneum, showing kidneys, suprarenal capsules, great vessels and ureters.

 

The URINARY BLADDER lies in cavity of lesser pelvis behind pubic symphysis. It has an apex, body and fundus, which is directed down and posterior. Inferior part forms neck, which continues into urethra. Empty urinary bladder lies extraperitoneally. Full bladder covered by peritoneum anteriorly, laterally and posteriorly - mesoperitoneal position. Fundus of the bladder in male adjoins from below to prostate gland, seminal vesicles and ampoule of ductus deferens, and behind - to ampoule of rectum. In female urinary bladder behind adjoins to vagina and uterus.

The urinary bladder is a musculomembranous sac which acts as a reservoir for the urine; and as its size, position, and relations vary according to the amount of fluid it contains, it is necessary to study it as it appears (a) when empty, and (b) when distended.) In both conditions the position of the bladder varies with the condition of the rectum, being pushed upward and forward when the rectum is distended.

 The Empty Bladder.When hardened in situ, the empty bladder has the form of a flattened tetrahedron, with its vertex tilted forward. It presents a fundus, a vertex, a superior and an inferior surface. The fundus is triangular in shape, and is directed downward and backward toward the rectum, from which it is separated by the rectovesical fascia, the vesiculæ seminales, and the terminal portions of the ductus deferentes. The vertex is directed forward toward the upper part of the symphysis pubis, and from it the middle umbilical ligament is continued upward on the back of the anterior abdominal wall to the umbilicus. The peritoneum is carried by it from the vertex of the bladder on to the abdominal wall to form the middle umbilical fold. The superior surface is triangular, bounded on either side by a lateral border which separates it from the inferior surface, and behind by a posterior border, represented by a line joining the two ureters, which intervenes between it and the fundus.

The lateral borders extend from the ureters to the vertex, and from them the peritoneum is carried to the walls of the pelvis. On either side of the bladder the peritoneum shows a depression, named the paravesical fossa. The superior surface is directed upward, is covered by peritoneum, and is in relation with the sigmoid colon and some of the coils of the small intestine. When the bladder is empty and firmly contracted, this surface is convex and the lateral and posterior borders are rounded; whereas if the bladder be relaxed it is concave, and the interior of the viscus, as seen in a median sagittal section, presents the appearance of a V-shaped slit with a shorter posterior and a longer anterior limbthe apex of the V corresponding with the internal orifice of the urethra. The inferior surface is directed downward and is uncovered by peritoneum. It may be divided into a posterior or prostatic area and two infero-lateral surfaces. The prostatic area is somewhat triangular: it rests upon and is in direct continuity with the base of the prostate; and from it the urethra emerges. The infero-lateral portions of the inferior surface are directed downward and lateralward: in front, they are separated from the symphysis pubis by a mass of fatty tissue which is named the retropubic pad; behind, they are in contact with the fascia which covers the Levatores ani and Obturatores interni.

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Median sagitta section of male pelvis.

 

 

1, corpus cavernosum 2, corpus spongiosum (bulb of the penis) 3, ramus ischium 4, ischiocavernosus m. 5, anal canal 6, sphincter ani externus m. 7, gluteus maximus m.

 

  When the bladder is empty it is placed entirely within the pelvis, below the level of the obliterated hypogastric arteries, and below the level of those portions of the ductus deferentes which are in contact with the lateral wall of the pelvis; after they cross the ureters the ductus deferentes come into contact with the fundus of the bladder. As the viscus fills, its fundus, being more or less fixed, is only slightly depressed; while its superior surface gradually rises into the abdominal cavity, carrying with it its peritoneal covering, and at the same time rounding off the posterior and lateral borders.

  When the bladder is moderately full it contains about 0.5 liter and assumes an oval form; the long diameter of the oval measures about 12 cm. and is directed upward and forward. In this condition it presents a postero-superior, an antero-inferior, and two lateral surfaces, a fundus and a summit. The postero-superior surface is directed upward and backward, and is covered by peritoneum: behind, it is separated from the rectum by the rectovesical excavation, while its anterior part is in contact with the coils of the small intestine. The antero-inferior surface is devoid of peritoneum, and rests, below, against the pubic bones, above which it is in contact with the back of the anterior abdominal wall. The lower parts of the lateral surfaces are destitute of peritoneum, and are in contact with the lateral walls of the pelvis. The line of peritoneal reflection from the lateral surface is raised to the level of the obliterated hypogastric artery. The fundus undergoes little alteration in position, being only slightly lowered. It exhibits, however, a narrow triangular area, which is separated from the rectum merely by the rectovesical fascia. This area is bounded below by the prostate, above by the rectovesical fold of peritoneum, and laterally by the ductus deferentes. The ductus deferentes frequently come in contact with each other above the prostate, and under such circumstances the lower part of the triangular area is obliterated. The line of reflection of the peritoneum from the rectum to the bladder appears to undergo little or no change when the latter is distended; it is situated about 10 cm. from the anus. The summit is directed upward and forward above the point of attachment of the middle umbilical ligament, and hence the peritoneum which follows the ligament, forms a pouch of varying depth between the summit of the bladder, and the anterior abdominal wall.

The Bladder in the ChildIn the newborn child the internal urethral orifice is at the level of the upper border of the symphysis pubis; the bladder therefore lies relatively at a much higher level in the infant than in the adult. Its anterior surface is in contact with about the lower two-thirds of that part of the abdominal wall which lies between the symphysis pubis and the umbilicus. Its fundus is clothed with peritoneum as far as the level of the internal orifice of the urethra. Although the bladder of the infant is usually described as an abdominal organ, Symington has pointed out that only about one-half of it lies above the plane of the superior aperture of the pelvis. Disse maintains that the internal urethral orifice sinks rapidly during the first years, and then more slowly until the ninth year, after which it remains sta when it again slowly descends and reaches its adult position.

 

 

 

Theme 2. Male reproductive organs. Structure of testis and epididimis. Spermatic ducts and accessory reproductive glands

 

MASCULINE GENITAL subdivide into internal male sexual organs (testicles, epididymis, spermatic cord, ductus deferens, seminal vesicles, prostate gland and bulbourethral gland) and external genital organs (scrotum and penis). Masculine urethra is not only for passing of urine also for passing of sperm.

The Testicle is a pair parenchymatic organ, which is situated in scrotum and produces sperm and masculine sexual hormones. Each testicle has superior extremity and inferior extremity, medial surface and lateral surface, anterior margin and posterior margin.

Testicle is covered by tunica albuginea which on posterior margin to get in testicle parenchyma and forms testicle mediastinum. Last gives off septula testis, which subdivide organ into 150-200 lobules. In each lobule the tubuli seminiferi contorti are situated (1-2), where masculine sexual cells - spermatozoon produced. Tubuli seminiferi contorti continue into tubuli seminiferi recti [straight], and last run into rete testis in mediastinum. Efferent ductuli (15 - 20) pass from testicle rete transfixing albuginea membrane, continue into head of epididymis and form there the lobules of epididymis. Then spermatozoon runs sufficiently rolled duct of epididymis, which reaches into length 2 m. Duct of epididymis passes down to its tail, where continues into ductus deferens.

The Epididymis adjoins to posterior testicle margin. There are head of epididymis, body and tail of epididymis. Sinus of epididymis is situated between testicle and body of epididymis.

The male genitals include the testes, the ductus deferentes, the vesiculæ seminales, the ejaculatory ducts, and the penis, together with the following accessory structures, viz., the prostate and the bulbourethral glands.

 

VIDEO

 

1. The Testes are two glandular organs, which secrete the semen; they are suspended in the scrotum by the spermatic cords. At an early period of fetal life the testes are contained in the abdominal cavity, behind the peritoneum. Before birth they descend to the inguinal canal, along which they pass with the spermatic cord, and, emerging at the subcutaneous inguinal ring, they descend into the scrotum, becoming invested in their course by coverings derived from the serous, muscular, and fibrous layers of the abdominal parietes, as well as by the scrotum.

  The coverings of the testes are, the

Skin

Scrotum.

Cremaster.

Dartos tunic

Infundibuliform fascia.

Intercrural fascia.

Tunica vaginalis.

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The scrotum. On the left side the cavity of the tunica vaginalis has been opened; on the right side only the layers superficial to the Cremaster have been removed.

 

  The Scrotum is a cutaneous pouch which contains the testes and parts of the spermatic cords. It is divided on its surface into two lateral portions by a ridge or raphé, which is continued forward to the under surface of the penis, and backward, along the middle line of the perineum to the anus. Of these two lateral portions the left hangs lower than the right, to correspond with the greater length of the left spermatic cord. Its external aspect varies under different circumstances: thus, under the influence of warmth, and in old and debilitated persons, it becomes elongated and flaccid; but, under the influence of cold, and in the young and robust, it is short, corrugated, and closely applied to the testes.

  The scrotum consists of two layers, the integument and the dartos tunic.

  The Integument is very thin, of a brownish color, and generally thrown into folds or rugæ. It is provided with sebaceous follicles, the secretion of which has a peculiar odor, and is beset with thinly scattered, crisp hairs, the roots of which are seen through the skin.

  The Dartos Tunic (tunica dartos) is a thin layer of non-striped muscular fibers, continuous, around the base of the scrotum, with the two layers of the superficial fascia of the groin and the perineum; it sends inward a septum, which divides the scrotal pouch into two cavities for the testes, and extends between the raphé and the under surface of the penis, as far as its root.

 

 

 

Figure 2

 

(a) Axial T2- and (b) T1-weighted MR images demonstrating homogenous high T2 and homogenous intermediate T1 signal intensity in both testes (arrows). (c) Axial T1-weighted MRI image following administration of IV gadolinium showing decreased enhancement of the left testis (arrow) compared to the right (arrowhead). (d) Coronal T1-weighted MRI image demonstrating torsion of left spermatic cord (arrow).

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The scrotum. The penis has been turned upward, and the anterior wall of the scrotum has been removed. On the right side, the spermatic cord, the infundibuliform fascia, and the Cremaster muscle are displayed; on the left side, the infundibuliform fascia has been divided by a longitudinal incision passing along the front of the cord and the testicle, and a portion of the parietal layer of the tunica vaginalis has been removed to display the testicle and a portion of the head of the epididymis, which are covered by the visceral layer of the tunica vaginalis.

 

  The dartos tunic is closely united to the skin externally, but connected with the subjacent parts by delicate areolar tissue, upon which it glides with the greatest facility.

  The Intercrural Fascia (intercolumnar or external spermatic fascia) is a thin membrane, prolonged downward around the surface of the cord and testis (see page 411). It is separated from the dartos tunic by loose areolar tissue.

  The Cremaster consists of scattered bundles of muscular fibers connected together into a continuous covering by intermediate areolar tissue (see page 414).

  The Infundibuliform Fascia (tunica vaginalis communis [testis et funiculi spermatici]) is a thin layer, which loosely invests the cord; it is a continuation downward of the transversalis fascia (see page 418).

  The Tunica Vaginalis is described with the testes.

 

Vessels and Nerves.The arteries supplying the coverings of the testes are: the superficial and deep external pudendal branches of the femoral, the superficial perineal branch of the internal pudendal, and the cremasteric branch from the inferior epigastric. The veins follow the course of the corresponding arteries. The lymphatics end in the inguinal lymph glands. The nerves are the ilioinguinal and lumboinguinal branches of the lumbar plexus, the two superficial perineal branches of the internal pudendal nerve, and the pudendal branch of the posterior femoral cutaneous nerve.

  The Inguinal Canal (canalis inguinalis) is described on page 418.

  The Spermatic Cord (funiculus spermaticus) extends from the abdominal inguinal ring, where the structures of which it is composed converge, to the back part of the testis. In the abdominal wall the cord passes obliquely along the inguinal canal, lying at first beneath the Obliquus internus, and upon the fascia transversalis; but nearer the pubis, it rests upon the inguinal and lacunar ligaments, having the aponeurosis of the Obliquus externus in front of it, and the inguinal falx behind it. It then escapes at the subcutaneous ring, and descends nearly vertically into the scrotum. The left cord is rather longer than the right, consequently the left testis hangs somewhat lower than its fellow.

 Structure of the Spermatic Cord.The spermatic cord is composed of arteries, veins, lymphatics, nerves, and the excretory duct of the testis. These structures are connected together by areolar tissue, and invested by the layers brought down by the testis in its descent.

  The arteries of the cord are: the internal and external spermatics; and the artery to the ductus deferens.

  The internal spermatic artery, a branch of the abdominal aorta, escapes from the abdomen at the abdominal inguinal ring, and accompanies the other constituents of the spermatic cord along the inguinal canal and through the subcutaneous inguinal ring into the scrotum. It then descends to the testis, and, becoming tortuous, divides into several branches, two or three of which accompany the ductus deferens and supply the epididymis, anastomosing with the artery of the ductus deferens: the others supply the substance of the testis.

  The external spermatic artery is a branch of the inferior epigastric artery. It accompanies the spermatic cord and supplies the coverings of the cord, anastomosing with the internal spermatic artery.

  The artery of the ductus deferens, a branch of the superior vesical, is a long, slender vessel, which accompanies the ductus deferens, ramifying upon its coats, and anastomosing with the internal spermatic artery near the testis.

 

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The spermatic cord in the inguinal canal.

 

  The spermatic veins emerge from the back of the testis, and receive tributaries from the epididymis: they unite and form a convoluted plexus, the plexus pampiniformis, which forms the chief mass of the cord; the vessels composing this plexus are very numerous, and ascend along the cord in front of the ductus deferens; below the subcutaneous inguinal ring they unite to form three or four veins, which pass along the inguinal canal, and, entering the abdomen through the abdominal inguinal ring, coalesce to form two veins. These again unite to form a single vein, which opens on the right side into the inferior vena cava, at an acute angle, and on the left side into the left renal vein, at a right angle.

  The nerves are the spermatic plexus from the sympathetic, joined by filaments from the pelvic plexus which accompany the artery of the ductus deferens.

  The scrotum forms an admirable covering for the protection of the testes. These bodies, lying suspended and loose in the cavity of the scrotum and surrounded by serous membrane, are capable of great mobility, and can therefore easily slip about within the scrotum and thus avoid injuries from blows or squeezes. The skin of the scrotum is very elastic and capable of great distension, and on account of the looseness and amount of subcutaneous tissue, the scrotum becomes greatly enlarged in cases of edema, to which this part is especially liable as a result of its dependent position.

  The Testes are suspended in the scrotum by the spermatic cords, the left testis hanging somewhat lower than its fellow. The average dimensions of the testis are from 4 to 5 cm. in length, 2.5 cm. in breadth, and 3 cm. in the antero-posterior diameter; its weight varies from 10.5 to 14 gm. Each testis is of an oval form compressed laterally, and having an oblique position in the scrotum; the upper extremity is directed forward and a little lateralward; the lower, backward and a little medialward; the anterior convex border looks forward and downward, the posterior or straight border, to which the cord is attached, backward and upward.

  The anterior border and lateral surfaces, as well as both extremities of the organ, are convex, free, smooth, and invested by the visceral layer of the tunica vaginalis. The posterior border, to which the cord is attached, receives only a partial investment from that membrane. Lying upon the lateral edge of this posterior border is a long, narrow, fiattened body, named the epididymis.

 

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Spermatic veins.

 

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The right testis, exposed by laying open the tunica vaginalis.

 

  The epididymis consists of a central portion or body; an upper enlarged extremity, the head (globus major); and a lower pointed extremity, the tail (globus minor), which is continuous with the ductus deferens, the duct of the testis. The head is intimately connected with the upper end of the testis by means of the efferent ductules of the gland; the tail is connected with the lower end by cellular tissue, and a reflection of the tunica vaginalis. The lateral surface, head and tail of the epididymis are free and covered by the serous membrane; the body is also completely invested by it, excepting along its posterior border; while between the body and the testis is a pouch, named the sinus of the epididymis (digital fossa). The epididymis is connected to the back of the testis by a fold of the serous membrane.

 

Appendages of the Testis and Epididymis.On the upper extremity of the testis, just beneath the head of the epididymis, is a minute oval, sessile body, the appendix of the testis (hydatid of Morgagni); it is the remnant of the upper end of the Müllerian duct. On the head of the epididymis is a second small stalked appendage (sometimes duplicated); it is named the appendix of the epididymis (pedunculated hydatid), and is usually regarded as a detached efferent duct.

  The testis is invested by three tunics: the tunica vaginalis, tunica albuginea, and tunica vasculosa.

  The Tunica Vaginalis (tunica vaginalis propria testis) is the serous covering of the testis. It is a pouch of serous membrane, derived from the saccus vaginalis of the peritoneum, which in the fetus preceded the descent of the testis from the abdomen into the scrotum. After its descent, that portion of the pouch which extends from the abdominal inguinal ring to near the upper part of the gland becomes obliterated; the lower portion remains as a shut sac, which invests the surface of the testis, and is reflected on to the internal surface of the scrotum; hence it may be described as consisting of a visceral and a parietal lamina.

  The visceral lamina (lamina visceralis) covers the greater part of the testis and epididymis, connecting the latter to the testis by means of a distinct fold. From the posterior border of the gland it is reflected on to the internal surface of the scrotum.

  The parietal lamina (lamina parietalis) is far more extensive than the visceral, extending upward for some distance in front and on the medial side of the cord, and reaching below the testis. The inner surface of the tunica vaginalis is smooth, and covered by a layer of endothelial cells. The interval between the visceral and parietal laminæ constitutes the cavity of the tunica vaginalis.

  The obliterated portion of the saccus vaginalis may generally be seen as a fibrocellular thread lying in the loose areolar tissue around the spermatic cord; sometimes this may be traced as a distinct band from the upper end of the inguinal canal, where it is connected with the peritoneum, down to the tunica vaginalis; sometimes it gradually becomes lost on the spermatic cord. Occasionally no trace of it can be detected. In some cases it happens that the pouch of peritoneum does not become obliterated, but the sac of the peritoneum communicates with the tunica vaginalis. This may give rise to one of the varieties of oblique inguinal hernia (page 1187). In other cases the pouch may contract, but not become entirely obliterated; it then forms a minute canal leading from the peritoneum to the tunica vaginalis.

  The Tunica Albuginea is the fibrous covering of the testis. It is a dense membrane, of a bluish-white color, composed of bundles of white fibrous tissue which interlace in every direction. It is covered by the tunica vaginalis, except at the points of attachment of the epididymis to the testis, and along its posterior border, where the spermatic vessels enter the gland. It is applied to the tunica vasculosa over the glandular substance of the testis, and, at its posterior border, is reflected into the interior of the gland, forming an incomplete vertical septum, called the mediastinum testis (corpus Highmori).

  The mediastinum testis extends from the upper to near the lower extremity of the gland, and is wider above than below. From its front and sides numerous imperfect septa (trabeculæ) are given off, which radiate toward the surface of the organ, and are attached to the tunica albuginea. They divide the interior of the organ into a number of incomplete spaces which are somewhat cone-shaped, being broad at their bases at the surface of the gland, and becoming narrower as they converge to the mediastinum. The mediastinum supports the vessels and duct of the testis in their passage to and from the substance of the gland.

  The Tunica Vasculosa is the vascular layer of the testis, consisting of a plexus of bloodvessels, held together by delicate areolar tissue. It clothes the inner surface of the tunica albuginea and the different septa in the interior of the gland, and therefore forms an internal investment to all the spaces of which the gland is composed.

 

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Vertical section of the testis, to show the arrangement of the ducts.

 

Structure.The glandular structure of the testis consists of numerous lobules. Their number, in a single testis, is estimated by Berres at 250, and by Krause at 400. They differ in size according to their position, those in the middle of the gland being larger and longer. The lobules are conical in shape, the base being directed toward the circumference of the organ, the apex toward the mediastinum. Each lobule is contained in one of the intervals between the fibrous septa which extend between the mediastinum testis and the tunica albuginea, and consists of from one to three, or more, minute convoluted tubes, the tubuli seminiferi. The tubules may be separately unravelled, by careful dissection under water, and may be seen to commence either by free cecal ends or by anastomotic loops. They are supported by loose connective tissue which contains here and there groups of interstitial cells containing yellow pigment granules. The total number of tubules is estimated by Lauth at 840, and the average length of each is 70 to 80 cm. Their diameter varies from 0.12 to 0.3 mm. The tubules are pale in color in early life, but in old age they acquire a deep yellow tinge from containing much fatty matter. Each tubule consists of a basement layer formed of laminated connective tissue containing numerous elastic fibers with flattened cells between the layers and covered externally by a layer of flattened epithelioid cells. Within the basement membrane are epithelial cells arranged in several irregular layers, which are not always clearly separated, but which may be arranged in three different groups. Among these cells may be seen the spermatozoa in different stages of development. (1) Lining the basement membrane and forming the outer zone is a layer of cubical cells, with small nuclei; some of these enlarge to become spermatogonia. The nuclei of some of the spermatogonia may be seen to be in process of indirect division (karyokineses, page 37), and in consequence of this daughter cells are formed, which constitute the second zone. (2) Within this first layer is to be seen a number of larger polyhedral cells, with clear nuclei, arranged in two or three layers; these are the intermediate cells or spermatocytes. Most of these cells are in a condition of karyokinetic division, and the cells which result from this division form those of the next layer, the spermatoblasts or spermatids. (3) The third layer of cells consists of the spermatoblasts or spermatids, and each of these, without further subdivision, becomes a spermatozoön. The spermatids are small polyhedral cells, the nucleus of each of which contains half the usual number of chromosomes. In addition to these three layers of cells others are seen, which are termed the supporting cells (cells of Sertoli). They are elongated and columnar, and project inward from the basement membrane toward the lumen of the tube. As development of the spermatozoa proceeds the latter group themselves around the inner extremities of the supporting cells. The nuclear portion of the spermatid, which is partly imbedded in the supporting cell, is differentiated to form the head of the spermatozoön, while part of the cell protoplasm forms the middle piece and the tail is produced by an outgrowth from the double centriole of the cell. Ultimately the heads are liberated and the spermatozoa are set free. The structure of the spermatozoa is described on pages 42, 43.

  In the apices of the lobules, the tubules become less convoluted, assume a nearly straight course, and unite together to form from twenty to thirty larger ducts, of about 0.5 mm. in diameter, and these, from their straight course, are called tubuli recti.

  The tubuli recti enter the fibrous tissue of the mediastinum, and pass upward and backward, forming, in their ascent, a close net-work of anastomosing tubes which are merely channels in the fibrous stroma, lined by flattened epithelium, and having no proper walls; this constitutes the rete testis. At the upper end of the mediastinum, the vessels of the rete testis terminate in from twelve to fifteen or twenty ducts, the ductuli efferentes; they perforate the tunica albuginea, and carry the seminal fluid from the testis to the epididymis. Their course is at first straight; they then become enlarged, and exceedingly convoluted, and form a series of conical masses, the coni vasculosi, which together constitute the head of the epididymis. Each cone consists of a single convoluted duct, from 15 to 20 cm. in length, the diameter of which gradually decreases from the testis to the epididymis. Opposite the bases of the cones the efferent vessels open at narrow intervals into a single duct, which constitutes, by its complex convolutions, the body and tail of the epididymis. When the convolutions of this tube are unravelled, it measures upward of 6 meters in length; it increases in diameter and thickness as it approaches the ductus deferens. The convolutions are held together by fine areolar tissue, and by bands of fibrous tissue.

  The tubuli recti have very thin walls; like the channels of the rete testis they are lined by a single layer of flattened epithelium. The ductuli efferentes and the tube of the epididymis have walls of considerable thickness, on account of the presence in them of muscular tissue, which is principally arranged in a circular manner. These tubes are lined by columnar ciliated epithelium.

 Peculiarities.The testis, developed in the lumbar region, may be arrested or delayed in its transit to the scrotum (cryptorchism). It may be retained in the abdomen; or it may be arrested at the abdominal inguinal ring, or in the inguinal canal; or it may just pass out of the subcutaneous inguinal ring without finding its way to the bottom of the scrotum. When retained in the abdomen it gives rise to no symptoms, other than the absence of the testis from the scrotum; but when it is retained in the inguinal canal it is subjected to pressure and may become inflamed and painful. The retained testis is probably functionally useless; so that a man in whom both testes are retained (anorchism) is sterile, though he may not be impotent. The absence of one testis is termed monorchism. When a testis is retained in the inguinal canal it is often complicated with a congenital hernia, the funicular process of the peritoneum not being obliterated. In addition to the cases above described, where there is some arrest in the descent of the testis, this organ may descend through the inguinal canal, but may miss the scrotum and assume some abnormal position. The most common form is where the testis, emerging at the subcutaneous inguinal ring, slips down between the scrotum and thigh and comes to rest in the perineum. This is known as perineal ectopia testis. With each variety of abnormality in the position of the testis, it is very common to find concurrently a congenital hernia, or, if a hernia be not actually present, the funicular process is usually patent, and almost invariably so if the testis is in the inguinal canal.

  The testis, finally reaching the scrotum, may occupy an abnormal position in it. It may be inverted, so that its posterior or attached border is directed forward and the tunica vaginalis is situated behind.

  Fluid collections of a serous character are very frequently found in the scrotum. To these the term hydrocele is applied. The most common form is the ordinary vaginal hydrocele, in which the fluid is contained in the sac of the tunica vaginalis, which is separated, in its normal condition, from the peritoneal cavity by the whole extent of the inguinal canal. In another form, the congenital hydrocele, the fluid is in the sac of the tunica vaginalis, but this cavity communicates with the general peritoneal cavity, its tubular process remaining pervious. A third variety known as an infantile hydrocele, occurs in those cases where the tubular process becomes obliterated only at its upper part, at or near the abdominal inguinal ring. It resembles the vaginal hydrocele, except as regards its shape, the collection of fluid extending up the cord into the inguinal canal. Fourthly, the funicular process may become obliterated both at the abdominal inguinal ring and above the epididymis, leaving a central unobliterated portion, which may become distended with fluid, giving rise to a condition known as the encysted hydrocele of the cord.

 

The Ductus deferens has scrotal part, funicular part, inguinal part and pelvic part. It enters to composition of spermatic cord, which passes in inguinal canal to internal ring. Here ductus deferens separates from seminal funiculus, then it runs under fundus of urinary bladder. Pelvic part joins with excretorial duct of seminal vesicles, forming ampoule of ductus deferens. Attaching ducts generate ejaculatory duct (length 2 cm), which passes over prostata and opens into prostatic part of urethra on top of seminal tubercle.

The Spermatic cord is a formation, which consists of arteries and testicle veins, arteries and veins of ductus deferens, pampiniform venous plexus, cremaster muscle, vaginal processes, nerves, lymphatic vessels and ductus deferens.

The Prostate is a muscul-secretory organ, for shape reminds the chestnut, has a base of prostate, which adjoins to urinary bladder, and top of prostate, which is contact with urogenital diaphragm. It has an anterior surface and posterior surface, right and left lobes of prostate and isthmus of prostate, that envelops a urethra. Prostate gland consists of 36 alveolar-tubular glandules, which produce prostate juice and open by numerous ductuli into prostate part of urethra on base of seminal tubercle. Muscular apparatus contributes to extrusion of secret from prostate gland during ejaculation and is as additional (involuntary) urethral sphincter, which withholds the urine in bladder. Gland in old age atrophies and its mass diminishes.

 

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Fundus of the bladder with the vesiculæ seminales.

 

The Seminal vesicles produces a seminal liquid, it communicate with ductus deferens. Seminal liquid together with secret of prostate composes part of sperm.

The Bulbourethral gland is a pair alveolar-tubular gland, which is situated in thickness of urogenital diaphragm. It has a duct of bulbourethral gland, which passes over bulb of penis and opens into spongy part of masculine urethra. Gland produces a secret, which protects mucous membrane of the urethra from irritation by urine.

 

 

 

Theme 3. External reproductive organs. Spermatic cord. Layers of scrotal wall. Structure of masculine urethra. Topography of small pelvis organs on male

 

The Scrotum is external organ, muscular and fascial sac which contains testicles and epididymis. Scrotal septum separates right and left halves. Scrotum is physiological thermostat, which keep temperature of testis at lower level then temperature of body (necessary for normal spermatogenesis).

Scrotal wall contains 7 membranes, which cover a testicle and derive from layers of anterior abdominal wall, namely:

1. Skin - has scrotal raphe, numerous folds, pigmented, with hair and contains specific sweat and sebaceous glands.

2. Under skin is situated a tunica dartos, which derives from hypodermic adipose tissue and grows together with skin.

3. External seminal fascia derives from superficial fascia of anterior abdominal wall.

4. Cremasteric fascia derives from proper abdominal fascia.

5. Musculus cremaster derives from internal oblique abdominis and transversal abdominal muscles.

6. Internal seminal fascia derives from transversal fascia of abdominal wall.

7. Vaginal tunica is serous membrane (derives from peritoneum) and consists of visceral plate and parietal plate. Last grows together with albuginea membrane and continues on epididymis. There is furrow-shaped space between both plates is a vaginal cavity, which is filled by small amount of serous liquid.

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Transverse section through the left side of the scrotum and the left testis. The sac of the tunica vaginalis is represented in a distended condition.

 

The Penis serves removal of the urine and ejaculation. It has a radix, corpus and head. Skin which covers the penis in base of head forms the fold preputium. Last thank to frenulum connects with skin of head. Penis formed by two cavernous bodies and spongious body. All bodies of penis covered by tunica albuginea. Spongious body contains male urethra.

The penis is a pendulous organ suspended from the front and sides of the pubic arch and containing the greater part of the urethra. In the flaccid condition it is cylindrical in shape, but when erect assumes the form of a triangular prism with rounded angles, one side of the prism forming the dorsum. It is composed of three cylindrical masses of cavernous tissue bound together by fibrous tissue and covered with skin. Two of the masses are lateral, and are known as the corpora cavernosa penis; the third is median, and is termed the corpus cavernosum urethræ.

  The Corpora Cavernosa Penis form the greater part of the substance of the penis. For their anterior three-fourths they lie in intimate apposition with one another, but behind they diverge in the form of two tapering processes, known as the crura, which are firmly connected to the rami of the pubic arch. Traced from behind forward, each crus begins by a blunt-pointed process in front of the tuberosity of the ischium. Just before it meets its fellow it presents a slight enlargement, named by Kobelt the bulb of the corpus cavernosum penis. Beyond this point the crus undergoes a constriction and merges into the corpus cavernosum proper, which retains a uniform diameter to its anterior end. Each corpus cavernosum penis ends abruptly in a rounded extremity some distance from the point of the penis.

  The corpora cavernosa penis are surrounded by a strong fibrous envelope consisting of superficial and deep fibers. The superficial fibers are longitudinal in direction, and form a single tube which encloses both corpora; the deep fibers are arranged circularly around each corpus, and form by their junction in the median plane the septum of the penis. This is thick and complete behind, but is imperfect in front, where it consists of a series of vertical bands arranged like the teeth of a comb; it is therefore named the septum pectiniforme.

  The Corpus Cavernosum Urethræ (corpus spongiosum) contains the urethra. Behind, it is expanded to form the urethral bulb, and lies in apposition with the inferior fascia of the urogenital diaphragm, from which it receives a fibrous investment. The urethra enters the bulb nearer to the upper than to the lower surface. On the latter there is a median sulcus, from which a thin fibrous septum projects into the substance of the bulb and divides it imperfectly into two lateral lobes or hemispheres.

 

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The constituent cavernous cylinders of the penis.

The glans and anterior part of the corpus cavernosum urethræ are detached from the corpora cavernosa penis and turned to one side.

 

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Transverse section of the penis.

  

The portion of the corpus cavernosum urethræ in front of the bulb lies in a groove on the under surface of the conjoined corpora cavernosa penis. It is cylindrical in form and tapers slightly from behind forward. Its anterior end is expanded in the form of an obtuse cone, flattened from above downward. This expansion, termed the glans penis, is moulded on the rounded ends of the corpora cavernosa penis, extending farther on their upper than on their lower surfaces. At the summit of the glans is the slit-like vertical external urethral orifice. The circumference of the base of the glans forms a rounded projecting border, the corona glandis, overhanging a deep retroglandular sulcus, behind which is the neck of the penis.

 

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  For descriptive purposes it is convenient to divide the penis into three regions: the root, the body, and the extremity.

 

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Vertical section of bladder, penis, and urethra.

 

  The root (radix penis) of the penis is triradiate in form, consisting of the diverging crura, one on either side, and the median urethral bulb. Each crus is covered by the Ischiocavernosus, while the bulb is surrounded by the Bulbocavernosus. The root of the penis lies in the perineum between the inferior fascia of the urogenital diaphragm and the fascia of Colles. In addition to being attached to the fasciæ and the pubic rami, it is bound to the front of the symphysis pubis by the fundiform and suspensory ligaments. The fundiform ligament springs from the front of the sheath of the Rectus abdominis and the linea alba; it splits into two fasciculi which encircle the root of the penis. The upper fibers of the suspensory ligament pass downward from the lower end of the linea alba, and the lower fibers from the symphysis pubis; together they form a strong fibrous band, which extends to the upper surface of the root, where it blends with the fascial sheath of the organ.

  The body (corpus penis) extends from the root to the ends of the corpora cavernosa penis, and in it these corpora cavernosa are intimately bound to one another. A shallow groove which marks their junction on the upper surface lodges the deep dorsal vein of the penis, while a deeper and wider groove between them on the under surface contains the corpus cavernosum urethræ. The body is ensheathed by fascia, which is continuous above with the fascia of Scarpa, and below with the dartos tunic of the scrotum and the fascia of Colles.

  The extremity is formed by the glans penis, the expanded anterior end of the corpus cavernosum urethræ. It is separated from the body by the constricted neck, which is overhung by the corona glandis.

  The integument covering the penis is remarkable for its thinness, its dark color, its looseness of connection with the deeper parts of the organ, and its absence of adipose tissue. At the root of the penis it is continuous with that over the pubes, scrotum, and perineum. At the neck it leaves the surface and becomes folded upon itself to form the prepuce or foreskin. The internal layer of the prepuce is directly continuous, along the line of the neck, with the integument over the glans. Immediately behind the external urethral orifice it forms a small secondary reduplication, attached along the bottom of a depressed median raphé, which extends from the meatus to the neck; this fold is termed the frenulum of the prepuce. The integument covering the glans is continuous with the urethral mucous membrane at the orifice; it is devoid of haris, but projecting from its free surface are a number of small, highly sensitive papillæ. Scattered glands on the corona, neck, glans and inner layer of the prepuce, the preputial glands, have been described. They secrete a sebaceous material of very peculiar odor, which probably contains casein, and readily undergoes decomposition; when mixed with discarded epithelial cells it is called smegma.

  The prepuce covers a variable amount of the glans, and is separated from it by a potential sacthe preputial sacwhich presents two shallow fossæ, one on either side of the frenulum.

 

Structure of the Penis.

  From the internal surface of the fibrous envelope of the corpora cavernosa penis, as well as from the sides of the septum, numerous bands or cords are given off, which cross the interior of these corpora cavernosa in all directions, subdividing them into a number of separate compartments, and giving the entire structure a spongy appearance. These bands and cords are called trabeculæ, and consist of white fibrous tissue, elastic fibers, and plain muscular fibers. In them are contained numerous arteries and nerves. The component fibers which form the trabeculæ are larger and stronger around the circumference than at the centers of the corpora cavernosa; they are also thicker behind than in front. The interspaces (cavernous spaces), on the contrary, are larger at the center than at the circumference, their long diameters being directed transversely. They are filled with blood, and are lined by a layer of flattened cells similar to the endothelial lining of veins.

  The fibrous envelope of the corpus cavernosum urethræ is thinner, whiter in color, and more elastic than that of the corpora cavernosa penis. The trabeculæ are more delicate, nearly uniform in size, and the meshes between them smaller than in the corpora cavernosa penis: their long diameters, for the most part, corresponding with that of the penis. The external envelope or outer coat of the corpus cavernosum urethræ is formed partly of unstriped muscular fibers, and a layer of the same tissue immediately surrounds the canal of the urethra.

Vessels and Nerves.The arteries bringing the blood to the cavernous spaces are the deep arteries of the penis and branches from the dorsal arteries of the penis, which perforate the fibrous capsule, along the upper surface, especially near the forepart of the organ. On entering the cavernous structure the arteries divide into branches, which are supported and enclosed by the trabeculæ. Some of these arteries end in a capillary net-work, the branches of which open directly into the cavernous spaces; others assume a tendril-like appearance, and form convoluted and somewhat dilated vessels, which were named by Müller helicine arteries. They open into the spaces, and from them are also given off small capillary branches to supply the trabecular structure. They are bound down in the spaces by fine fibrous processes, and are most abundant in the back part of the corpora cavernosa.

 

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Diagram of the arteries of the penis.

 

  The blood from the cavernous spaces is returned by a series of vessels, some of which emerge in considerable numbers from the base of the glans penis and converge on the dorsum of the organ to form the deep dorsal vein; others pass out on the upper surface of the corpora cavernosa and join the same vein; some emerge from the under surface of the corpora cavernosa penis and receiving branches from the corpus cavernosum urethræ, wind around the sides of the penis to end in the deep dorsal vein; but the greater number pass out at the root of the penis and join the prostatic plexus.

  The nerves are derived from the pudendal nerve and the pelvic plexuses. On the glans and bulb some filaments of the cutaneous nerves have Pacinian bodies connected with them, and, according to Krause, many of them end in peculiar endbulbs (see page 1060).

 

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Veins of the penis.

 

Masculine urethra is a tube of length 16-22 cm, in which there distinguish prostatic part, membranous part and spongious part. On its tract a urethra makes a superior (fixed) bend and inferior (free) bend.

Prostatic part passes through the prostate. In this part on the urethral wall is situated seminal colliculus, on top of which prostatic utriculus disposed. Ejaculatory duct opens at last and prostatic ductuli opens on tubercle base. Intermediate (membranous) part of urethra shorter, it passes through urogenital diaphragm. Described two parts have to fixed position within pelvis and perineum. Spongy part of urethra lies in spongious body of penis and opens by external urethral ostium on head top.

Male urethra has following constrictions: external urethral ostium on head of penis; membranous part of urethra; internal urethral ostium. Also a urethra has such expansions: all prostatic part; expansion in bulb of penis; scaphoid fossa in head of penis.

Prepared by

A.V. MIZ