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Lab 17 – Male Reproductive System IUSM – 2016 I. Introduction Male Reproductive System II. Keywords III. Slides A. Testis 1. General structure 2. Seminiferous tubules 3. Rete testis B. Epididymis 1. Efferent ductules 2. Ductus epididymis C. Ductus Deferens D. Glands 1. Seminal vesicle 2. Prostate gland E. Penis 1. General structure 2. Erectile tissue 3. Urethra IV. Summary Fig 21-1, Junqueira, 13th ed. Lab 17 – Male Reproductive System IUSM – 2016 I. Introduction II. Keywords Keywords III. Slides A. Testis 1. General structure Corpora amylacea Prostate gland Corpora cavernosa Rete testis 2. Seminiferous tubules Corpus spongiosum Seminal vesicle 3. Rete testis Ductus (Vas) deferens Seminiferous tubules B. Epididymis Ductus epididymis Sertoli cells 1. Efferent ductules Efferent ductules Spermatids 2. Ductus epididymis Epididymis Spermatogenesis C. Ductus Deferens Helicine arteries Spermatogonia D. Glands Interstitial cells (Leydig cells) Spermatozoa 1. Seminal vesicle Interstitial tissue Spermatozoon 2. Prostate gland Myofibroblasts (myoid cells) Spermiogenesis E. Penis Paraurethral glands Testis 1. General structure Penis Tunica albuginea Primary spermatocytes Urethra 2. Erectile tissue 3. Urethra IV. Summary Lab 17 – Male Reproductive System IUSM – 2016 Slide 119: Testis, H&E I. Introduction II. Keywords III. Slides tunica albuginea A. Testis (capsule) 1. General structure 2. Seminiferous tubules septum 3. Rete testis B. Epididymis 1. Efferent ductules seminiferous tubules 2. Ductus epididymis C. Ductus Deferens D. Glands rete testis (ree-tee) 1. Seminal vesicle within the 2. Prostate gland mediastinum testis E. Penis 1. General structure 2. Erectile tissue 3. Urethra IV. Summary each testis (Lt. “witness”) is surrounded by a dense CT capsule called the tunica albuginea (Lt. “white coat”); CT septa extend from the mediastinum testis, a thickened portion of the tunica albuginea, and divide each testis into ~250 lobules, each containing 1-4 long, highly-convoluted seminiferous tubules; spermatozoa produced in the seminiferous tubules drain into the net-like collection of ducts called the rete testis within the mediastinum testis Lab 17 – Male Reproductive System IUSM – 2016 Slide (A215): Testis, H&E I. Introduction II. Keywords III. Slides A. Testis 1. General structure tunica albuginea 2. Seminiferous tubules (capsule) 3. Rete testis B. Epididymis 1. Efferent ductules seminiferous tubules 2. Ductus epididymis C. Ductus Deferens D. Glands rete testis within the 1. Seminal vesicle mediastinum testis 2. Prostate gland ductus deferens E. Penis 1. General structure 2. Erectile tissue ductus epididymis 3. Urethra IV. Summary spermatozoa produced in the seminiferous tubules drain via short tubuli recti into the rete testis which drains into the efferent ductules which drain into the singular ductus epididymis; upon ejaculation, spermatozoa within the ductus epididymis are rapidly conducted through the long, muscular ductus deferens to the ejaculatory duct near the urinary bladder Lab 17 – Male Reproductive System IUSM – 2016 Slide 162 (NW): Testis, H&E I. Introduction II. Keywords III. Slides A. Testis 1. General structure 2. Seminiferous tubules 3. Rete testis B. Epididymis 1. Efferent ductules 2. Ductus epididymis Leydig cell C. Ductus Deferens peritubular myoid cell D. Glands (myofibroblast) 1. Seminal vesicle 2. Prostate gland E. Penis 1. General structure 2. Erectile tissue 3. Urethra IV. Summary Leydig (interstitial) cells are large, round cells with central nuclei and eosinophilic cytoplasm – often containing lipid droplets – found in the interstitial tissue between the seminiferous tubules; they are responsible for testosterone production in response to luteinizing hormone (LH) from the pituitary gland; also in the interstitial tissue, several layers of myoid cells surround the seminiferous tubules; they are specialized contractile cells that assist in propelling spermatozoa and fluid from the tubules into the rete testis Lab 17 – Male Reproductive System IUSM – 2016 Slide 155: Testis, H&E I. Introduction II. Keywords III. Slides A. Testis 1. General structure interstitial tissue 2. Seminiferous tubules (tunica propria) 3. Rete testis between tubules B. Epididymis 1. Efferent ductules seminiferous tubule 2. Ductus epididymis C. Ductus Deferens central lumen D. Glands of tubule 1. Seminal vesicle 2. Prostate gland E. Penis 1. General structure 2. Erectile tissue the separation of the interstitial tissue from the 3. Urethra tubules is an artifact IV. Summary seminiferous tubules (Lt. “seed bearing”) compose the majority of the parenchyma of the testis and are the site of spermatogenesis (sperm production); each seminiferous tubule is ~2ft long, thus the combined total length of the tubules within each testis is approximately 1800ft; between the tubules is a delicate interstitial stroma composed of sparse CT and vasculature within which are clusters of Leydig cells Lab 17 – Male Reproductive System IUSM – 2016 Slide 155: Testis, H&E I. Introduction II. Keywords III. Slides A. Testis 1. General structure 2. Seminiferous tubules 3. Rete testis B. Epididymis 1. Efferent ductules 2. Ductus epididymis C. Ductus Deferens D. Glands 1. Seminal vesicle 2. Prostate gland E. Penis Sertoli cell with nucleus toward the 1. General structure basement membrane; nucleus is 2. Erectile tissue triangular or ovoid in shape with a 3. Urethra prominent nucleolus and dispersed IV. Summary chromatin each Sertoli cell surrounds and nourishes 30-50 developing spermatozoa; they extend from the basement membrane to the lumen of the tubule, however their nuclei are generally located in the basal aspect of the cells near the basement membrane; they are responsible for the formation of the blood-testis barrier (the tightest blood-tissue barrier in humans), have phagocytic functions, and secrete numerous factors (e.g., AMH and ABP) Lab 17 – Male Reproductive System IUSM – 2016 Slide 155: Testis, H&E I. Introduction II. Keywords III. Slides A. Testis 1. General structure 2. Seminiferous tubules spermatozoon, adjacent to lumen, 3. Rete testis with small, pointed nucleus B. Epididymis 1. Efferent ductules spermatid, located closer to lumen, 2. Ductus epididymis with more condensed nucleus C. Ductus Deferens primary spermatocyte, located off D. Glands membrane in adluminal compartment, 1. Seminal vesicle with large nucleus containing clumps 2. Prostate gland or threads of chromatin E. Penis 1. General structure spermatogonium, located on basement 2. Erectile tissue membrane, have a variable appearance 3. Urethra of the nucleus depending upon subtype IV. Summary of cell (A or B) seminiferous tubules consist of a highly-specialized stratified epithelium of various spermatogenic cells: spermatogonia primary spermatocyte secondary spermatocyte (rarely seen) spermatids spermatozoa; in total, each spermatozoon takes over 80 days to develop and mature; it takes ~74 days to form in the tubule and 10 days pass through and mature in the epididymis; despite the slow development, on average 2x108 sperm develop each day (2300 sperm/sec) due to the extreme length of tubules and vast numbers of cells Lab 17 – Male Reproductive System IUSM – 2016 Slide 155: Testis, H&E I. Introduction II. Keywords III. Slides A. Testis 1. General structure 2. Seminiferous tubules 3. Rete testis rete testis B. Epididymis 1. Efferent ductules 2. Ductus epididymis tubulus rectus C. Ductus Deferens D. Glands 1. Seminal vesicle seminiferous tubule 2. Prostate gland E. Penis 1. General structure 2. Erectile tissue 3. Urethra IV. Summary short, straight tubules called tubuli recti join the seminiferous tubules to the rete testis; they are continuations of the seminiferous tubules but lack the stratified seminiferous epithelium and spermatogenic cells; instead, they are composed solely of a simple layer of Sertoli cells which transitions into the simple cuboidal epithelium of the rete testis; due to their short lengths and the cross sectioning usually used for the testis, tubuli recti are not often seen Lab 17 – Male Reproductive System IUSM – 2016 Slide 55: Rete Testis, Trichrome I. Introduction II. Keywords III. Slides A. Testis CT septum extending from the mediastinum testis 1. General structure 2. Seminiferous tubules 3. Rete testis B. Epididymis seminiferous tubule 1. Efferent ductules 2. Ductus epididymis C. Ductus Deferens look here to see the D. Glands rete testis (ree-tee) 1. Seminal vesicle 2. Prostate gland E. Penis 1. General structure mediastinum testis 2. Erectile tissue 3. Urethra IV. Summary the rete testis (Lt. “net of the testis”) is an interconnected network of simple cuboidal epithelium-lined channels that conduct spermatozoa from the seminiferous tubules (via tubli recti) to the efferent ductules which drain into the ductus epididymis; the rete testis is surrounded by the dense CT of the mediastinum testis which is continuous with the connective tissue of the tunica albuginea Lab 17 – Male Reproductive System IUSM – 2016 Slide 155: Testis, H&E I. Introduction proximal ductus II. Keywords epididymis III. Slides A. Testis efferent ductules in head 1. General structure of the epididymis 2. Seminiferous tubules rete testis 3. Rete testis B. Epididymis 1. Efferent ductules plexus of spermatic veins which form the 2. Ductus epididymis pampiniform plexus within the spermatic cord C. Ductus Deferens D. Glands 1. Seminal vesicle 2. Prostate gland E. Penis 1. General structure 2. Erectile tissue 3. Urethra IV. Summary ductus epididymis with stored spermatozoa within lumen in body/tail
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  • Diagnosis and Management of Infertility Due to Ejaculatory Duct Obstruction: Summary Evidence ______

    Diagnosis and Management of Infertility Due to Ejaculatory Duct Obstruction: Summary Evidence ______

    Vol. 47 (4): 868-881, July - August, 2021 doi: 10.1590/S1677-5538.IBJU.2020.0536 EXPERT OPINION Diagnosis and management of infertility due to ejaculatory duct obstruction: summary evidence _______________________________________________ Arnold Peter Paul Achermann 1, 2, 3, Sandro C. Esteves 1, 2 1 Departmento de Cirurgia (Disciplina de Urologia), Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil; 2 ANDROFERT, Clínica de Andrologia e Reprodução Humana, Centro de Referência para Reprodução Masculina, Campinas, SP, Brasil; 3 Urocore - Centro de Urologia e Fisioterapia Pélvica, Londrina, PR, Brasil INTRODUCTION tion or perineal pain exacerbated by ejaculation and hematospermia (3). These observations highlight the Infertility, defined as the failure to conceive variability in clinical presentations, thus making a after one year of unprotected regular sexual inter- comprehensive workup paramount. course, affects approximately 15% of couples worl- EDO is of particular interest for reproduc- dwide (1). In about 50% of these couples, the male tive urologists as it is a potentially correctable factor, alone or combined with a female factor, is cause of male infertility. Spermatogenesis is well- contributory to the problem (2). Among the several -preserved in men with EDO owing to its obstruc- male infertility conditions, ejaculatory duct obstruc- tive nature, thus making it appealing to relieve the tion (EDO) stands as an uncommon causative factor. obstruction and allow these men the opportunity However, the correct diagnosis and treatment may to impregnate their partners naturally. This review help the affected men to impregnate their partners aims to update practicing urologists on the current naturally due to its treatable nature. methods for diagnosis and management of EDO.