DOCSLIB.ORG

Abdominal Cavity Part Sixth

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Abdominopelvic cavity – sixth part Male urogenital system Hypogastric plexuses Internal iliac artery Testis An ovoid organ Is suspended (hangs) in the scrotum by the spermatic cord The left is suspended more inferiorly than the right Is covered with a tough fibrous coat – the tunica albuginea Produces sperms (spermatozoa; male germ cells) and hormones, principally testosterone Sperms (spermatozoa; male germ cells) Are formed in the long, convoluted seminiferous tubules that are joined by straight tubules to the rete testis The rete testis- a network of canals at the termination of the straight (seminiferous) tubules The efferent ductules transport the sperms from the rete testis to the epididymis where they are stored Tunica vaginalis A closed peritoneal sac partially surrounding the testis, which represents the closed-off distal part of the embryonic processus vaginalis Two layers: parietal and visceral The slitlike recess of its - the sinus of the epididymis - between the body of epididymis and the posterolateral surface of the testis Cavity of tunica vaginalis- with small amount of fluid allows the testis to move freely in the scrotum (hydrocele- an accumulation of fluid) The layers of tunica vaginalis The visceral layer covers the surface of each testis, except where the testis attaches to the epididymis and spermatic cord The visceral layer is closely applied to the testis, epididymis, and inferior part of the deferent duct The parietal layer adjacent the internal spermatic fascia is more extensive than the visceral layer and extends superiorly for a short distance into the distal part of the spermatic cord The testicular arteries Long and slender Arise from the abdominal aorta, just inferior to the renal arteries Pass retroperitoneally in an oblique direction, crossing over the ureters and the inferior parts of the external iliac arteries to reach the deep inguinal rings Enter the inguinal canals through the deep rings, pass through the canals and exit them through the superficial inguinal rings Enter the spermatic cords to supply the testes The pampiniform plexus A venous network Emerge from the testis and the epididymis Consists of 8 to 12 veins, lying anterior to the deferent duct and surrounds the testicular artery in the spermatic cord The part of the termoregulatory system of the testis Drains into the testicular vein The left testicular vein empties into the left renal vein (almost a 90° angle- varicoceles because of unfavorable angle- leads to decreased fertility) The right testicular vein enters the inferior vena cava The lymphatic drainage of the testis To the lumbar lymph nodes The nerves of the testis Arise as the testicular plexus of nerves on the testicular artery, which contains vagal parasympathetic fibers and sympathetic fibers from the T7 segment of the spinal cord Epididymis The organ of storage and maturation for the spermatozoa Is formed by minute convolutions of the duct of the epididymis On the posterior surface of the testis The convoluted duct of the epididymis (epididymal duct) becomes progressively smaller as it passes from the head of its on the superior part of the testis to its tail The deferent duct begins at the tail of the epididymis The parts of the epididymis Head - the superior expanded part (composed of lobules formed by the coiled ends of 12 to 14 efferent ductules) Body - consists of the convoluted duct of the epididymis (the epididymal duct) Tail - continuous with the deferent duct (transports sperms from the epididymis to the ejaculatory duct for expulsion into the prostatic part of the urethra) Scrotum A cutaneous fibromuscular sac for testes and associated structures Is situated posteroinferior to the penis and inferior to the pubic symphysis The bilateral embryonic formation (labioscrotal swellings) of scrotum is indicated externally by the midline scrotal raphe, which is continuous on the ventral surface of the penis with the penile raphe and posteriorly along the median line of the perineum with the perineal raphe Scrotum Is divided internally by the septum of the scrotum into the right and left compartments Consists of two layers, heavily pigmented skin and the closely related dartos fascia Dartos fascia- a layer of smooth muscle fibers responsible for the rugose (wrinkled) appearance of the scrotum which is attached to the skin, its contraction helps to regulate the loss of heat through the skin of scrotum The superficial dartos fascia Scrotum of scrotum is devoid of fat Is continuous anteriorly with the membranous layer of subcutaneous tissue (Scarpa’s fascia) of the anterolateral abdominal wall Posteriorly is continuous with the subcutaneous tissue of the perineum (Colles’s fascia) The layers of scrotum and testis Are formed by the layers of the anterior abdominal wall during developmental descent of the testis As the testis descends it carries with it a finger-shaped process of peritoneum (vaginal process) through the inguinal canal The vaginal process becomes obliterated and separated from the peritoneal cavity at the internal (deep) inguinal ring Tunica vaginalis- a closed sac within the scrotum which is formed by the peritoneum The layers of scrotum and testis Tunica albuginea Tunica vaginalis Internal spermatic fascia Cremasteric fascia Cremaster muscle External spermatic fascia Subcutaneous tissue (dartos fascia) and dartos muscle Skin The arterial supply and venous drainage of the scrotum Arteries: Posterior scrotal arteries from perineal branch of the internal pudendal artery Anterior scrotal arteries from external pudendal branches of the femoral artery Cremasteric branch of the inferior epigastric artery Veins: Accompany the arteries Lymphatic drainage of the scrotum Lymphatic vessels Drain into the superficial inguinal lymph nodes The nerves of the scrotum Genital branch of the genitofemoral nerve (L1,L2), supplying the anterolateral surface Anterior scrotal nerves-branches of the ilioinguinal nerve (L1), supplying the anterior surface Posterior scrotal nerves-branches of the perineal branch of the pudendal nerve (S2 through S4)- supplying the posterior surface Perineal branches of the posterior femoral cutaneous nerve (S2,S3) supplying the inferior surface Spermatic cord Suspends the testis in the scrotum Contains structures running to and from the testis Begins at the deep inguinal ring Passes through the inguinal canal Exits at the superficial inguinal ring Ends in the scrotum at the posterior border of the testis Is surrounded by fascial coverings derived from the anterolateral abdominal wall during prenatal development The coverings of the spermatic cord Internal spermatic fascia- derived from the transversalis fascia Cremasteric fascia-derived from the fascia of the superficial and deep surfaces of the internal oblique muscle and transverse abdominal muscle, contains loops of the cremaster muscle (draws the testis superiorly) External spermatic fascia derived from the external oblique aponeurosis The constituents of the spermatic cord Deferent duct (ductus deferens) Testicular artery Artery of the deferent duct (from the inferior vesical artery) Cremasteric artery (from the inferior epigastric artery) Pampiniform plexus Sympathetic nerve fibers on arteries and sympathetic and parasympathetic nerve fibers on the ductus deferens Genital branch of the genitofemoral nerve Lymphatic vessels Ductus deferens (deferent duct) A muscular tube approximately 45 cm long Transports sperms from the epididymis to the ejaculatory duct during ejaculation The continuation of the duct of the epididymis Passes lateral to the inferior epigastric vessels- this relationship should be noted in operations on the inguinal ring Crosses over the external iliac vessels and enters the pelvis Passes along the lateral wall of the pelvis, external to the parietal peritoneum Ductus deferens (deferent duct) Crosses superior to the ureter near the posterolateral angle of the bladder, running between ureter and the peritoneum to reach the fundus of the bladder Posterior to the bladder at first lies superior to the seminal vesicle, then descends medial to the ureter and the seminal vesicle Enlarges to form the ampulla of the ductus deferens Narrows and joins the excretory duct of seminal vesicle to form the ejaculatory duct The nerves of the deferent duct Derived from the inferior hypogastric plexus Sympathetic nerve fibers richly innervate the smooth- muscle fibers of the duct thereby facilitating its rapid contraction for expulsion of sperms during ejaculation Seminal vesicle An elongated structure, approximately 5 cm long Between the fundus of the bladder and the rectum, superior to the prostate Does not store sperms! Secretes a slightly alkaline fluid (makes up 70% of the volume of the ejaculate) and is very high in fructose that mixes with the sperms The excretory duct joins the deferent duct to form the ejaculatory duct Seminal vesicles Posterior to the ureters Peritoneum of the rectovesical pouch separates superior ends from rectum Inferior ends are closely related to the rectum and are separated from rectum only by the rectovesical septum (membranous partition) Enlarged can be palpated during a rectal examination Ejaculatory ducts The union of the excretory duct of the seminal vesicle with the deferent duct Approximately 2.5 cm long Pass anteroinferiorly through the posterior part of the prostate and along the sides of the prostatic utricle Converge to open on the seminal colliculus or just within the opening of the prostatic utricle Prostate The firm, walnut-sized Approximately
Recommended publications
  • Te2, Part Iii

    Te2, Part Iii

    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
  • A Handy Guide to the Male and Female Reproductive Tracts

    A Handy Guide to the Male and Female Reproductive Tracts

    BASICS OF LIFE BY LES SELLNOW eproduction in all species borders on the miraculous. at the reproductive organs of both the mare and the stallion How else can one describe a process where two infini- and discuss just how they function in their effort to produce Rtesimal entities, one from the male, the other from the another “miracle.” Once again, sources are too numerous to female, join forces to produce living, breathing offspring? mention, other than to say that much of the basic informa- Reproductive capability or success varies by species. Mice tion on reproduction available today stems from research at and rabbits, for example, are prolific producers of offspring. such institutions as Colorado State University, Texas A&M Horses, on the other hand, fall into a category where it is University, and the University of Minnesota. There are many much more chancy. others involved in reproductive research, but much of the in- When horses ran wild, this wasn’t a serious problem. There formation utilized in this article emanated from those three were so many of them that their numbers continued to ex- institutions. pand even though birth rate often was dictated by the avail- ability of food and water. Once the horse was domesticated, The Mare however, organized reproduction became the order of the We’ll begin with the mare because her role in the repro- day. Stables that depend on selling the offspring of stallions ductive process is more complicated than that of the stallion. and mares have an economic stake in breeding success. Yet, Basically, the mare serves four functions: the process continues to be less than perfect, with success 1) She produces eggs or ova; rates hovering in the 65-70% range, and sometimes lower.
  • Impotence Due to External Iliac Steal Syndrome

    Impotence Due to External Iliac Steal Syndrome

    Case Report http://dx.doi.org/10.3348/kjr.2013.14.1.81 pISSN 1229-6929 · eISSN 2005-8330 Korean J Radiol 2013;14(1):81-85 Impotence due to External Iliac Steal Syndrome: Treatment with Percutaneous Transluminal Angioplasty and Stent Placement Serkan Gür, MD1, Levent Oguzkurt, MD2, Bilal Kaya, MD2, Güven Tekbas, MD2, Ugur Ozkan, MD2 1Sifa University, Department of Radiology, 35240 Basmane, Izmir, Turkey; 2Baskent University, Faculty of Medicine, Department of Radiology, 01250, Yüregir, Adana, Turkey We report a case of erectile dysfunction caused by external iliac artery occlusion, associated with pelvic steal syndrome; bilateral internal iliac arteries were patent. The patient stated that he had experienced erectile dysfunction at similar times along with claudication, but he did not mention it before angiography. He expressed that the erectile dysfunction did not last long and that he felt completely okay after the interventional procedure, in addition to his claudication. Successful treatment of the occlusion, by percutaneous transluminal angioplasty and stent implantation, helped resolve erectile dysfunction completely and treat the steal syndrome. Index terms: Erectile dysfunction; Pelvic steal syndrome; Percutaneous angioplasty INTRODUCTION and obstructive disease of the penile arteries are two main vascular causes of impotence. Obstructive arterial diseases Erectile dysfunction (ED) affects 10% of men between cause impotence by obstructing blood supply to the penis, the ages of 40 and 70 (1). ED includes multiple negative and impotence also occurs when the rare entities do not consequences; it was once believed to be a primarily obstruct the blood flow to the penis rather divert blood flow psychological problem. However, it has been estimated away from it.
  • Male Reproductive System 2

    Male Reproductive System 2

    Male Reproductive System 2 1. Excretory genital ducts 2. The ductus (vas) deferens and seminal vesicles 3. The prostate 4. The bulbourethral (Cowper’s) glands 5. The penis 6. The scrotum and spermatic cord SPLANCHNOLOGY Male reproductive system ° Male reproductive system, systema genitalia masculina: V a part of the human reproductive process ° Male reproductive organs, organa genitalia masculina: V internal genital organs: testicle, testis epididymis, epididymis ductus deferens, ductus (vas) deferens seminal vesicle, vesicula seminalis ejaculatory duct, ductus ejaculatorius prostate gland, prostata V external genital organs: penis, penis scrotum, scrotum bulbourethral glands, glandulae bulbourethrales Prof. Dr. Nikolai Lazarov 2 SPLANCHNOLOGY Ductus (vas) deferens ° Ductus (vas) deferens: V a straight thick-walled muscular tube V transports sperm cells from the epididymis V length 45-50 cm V diameter 2.5-3 mm ° Anatomical parts: V testicular part V funicular part V inguinal part – 4 cm V pelvic part ° Ampulla ductus deferentis: V length 3-4 cm; diameter 1 cm V ejaculatory duct, ductus ejaculatorius Prof. Dr. Nikolai Lazarov 3 SPLANCHNOLOGY Microscopic anatomy ° tunica mucosa – 5-6 longitudinal folds: V lamina epithelialis – bilayered columnar epithelium with stereocilia V lamina propria: dense connective tissue elastic fibers ° tunica muscularis – thick: V inner longitudinal layer – in the initial portion V circular layer V outer longitudinal layer ° tunica adventitia (serosa) Prof. Dr. Nikolai Lazarov 4 SPLANCHNOLOGY Seminal vesicle, vesicula seminalis ° Seminal vesicle, vesicula (glandula) seminalis: V a pair of simple tubular glands – two highly tortuous tubes V posterior to the urinary bladder V length 4-5 (15) cm V diameter 1 cm ° Macroscopic anatomy: V anterior and posterior part V excretory duct Prof.
  • Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions

    Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions

    Hindawi International Journal of Rheumatology Volume 2020, Article ID 2919625, 13 pages https://doi.org/10.1155/2020/2919625 Review Article Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions Worku Abie Liyew Biomedical Science Department, School of Medicine, Debre Markos University, Debre Markos, Ethiopia Correspondence should be addressed to Worku Abie Liyew; [email protected] Received 25 April 2020; Revised 26 June 2020; Accepted 13 July 2020; Published 29 August 2020 Academic Editor: Bruce M. Rothschild Copyright © 2020 Worku Abie Liyew. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lumbar disc degeneration is defined as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced flexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on
  • The Reproductive System

    The Reproductive System

    27 The Reproductive System PowerPoint® Lecture Presentations prepared by Steven Bassett Southeast Community College Lincoln, Nebraska © 2012 Pearson Education, Inc. Introduction • The reproductive system is designed to perpetuate the species • The male produces gametes called sperm cells • The female produces gametes called ova • The joining of a sperm cell and an ovum is fertilization • Fertilization results in the formation of a zygote © 2012 Pearson Education, Inc. Anatomy of the Male Reproductive System • Overview of the Male Reproductive System • Testis • Epididymis • Ductus deferens • Ejaculatory duct • Spongy urethra (penile urethra) • Seminal gland • Prostate gland • Bulbo-urethral gland © 2012 Pearson Education, Inc. Figure 27.1 The Male Reproductive System, Part I Pubic symphysis Ureter Urinary bladder Prostatic urethra Seminal gland Membranous urethra Rectum Corpus cavernosum Prostate gland Corpus spongiosum Spongy urethra Ejaculatory duct Ductus deferens Penis Bulbo-urethral gland Epididymis Anus Testis External urethral orifice Scrotum Sigmoid colon (cut) Rectum Internal urethral orifice Rectus abdominis Prostatic urethra Urinary bladder Prostate gland Pubic symphysis Bristle within ejaculatory duct Membranous urethra Penis Spongy urethra Spongy urethra within corpus spongiosum Bulbospongiosus muscle Corpus cavernosum Ductus deferens Epididymis Scrotum Testis © 2012 Pearson Education, Inc. Anatomy of the Male Reproductive System • The Testes • Testes hang inside a pouch called the scrotum, which is on the outside of the body
  • Male Reproductive System

    Male Reproductive System

    MALE REPRODUCTIVE SYSTEM DR RAJARSHI ASH M.B.B.S.(CAL); D.O.(EYE) ; M.D.-PGT(2ND YEAR) DEPARTMENT OF PHYSIOLOGY CALCUTTA NATIONAL MEDICAL COLLEGE PARTS OF MALE REPRODUCTIVE SYSTEM A. Gonads – Two ovoid testes present in scrotal sac, out side the abdominal cavity B. Accessory sex organs - epididymis, vas deferens, seminal vesicles, ejaculatory ducts, prostate gland and bulbo-urethral glands C. External genitalia – penis and scrotum ANATOMY OF MALE INTERNAL GENITALIA AND ACCESSORY SEX ORGANS SEMINIFEROUS TUBULE Two principal cell types in seminiferous tubule Sertoli cell Germ cell INTERACTION BETWEEN SERTOLI CELLS AND SPERM BLOOD- TESTIS BARRIER • Blood – testis barrier protects germ cells in seminiferous tubules from harmful elements in blood. • The blood- testis barrier prevents entry of antigenic substances from the developing germ cells into circulation. • High local concentration of androgen, inositol, glutamic acid, aspartic acid can be maintained in the lumen of seminiferous tubule without difficulty. • Blood- testis barrier maintains higher osmolality of luminal content of seminiferous tubules. FUNCTIONS OF SERTOLI CELLS 1.Germ cell development 2.Phagocytosis 3.Nourishment and growth of spermatids 4.Formation of tubular fluid 5.Support spermiation 6.FSH and testosterone sensitivity 7.Endocrine functions of sertoli cells i)Inhibin ii)Activin iii)Follistatin iv)MIS v)Estrogen 8.Sertoli cell secretes ‘Androgen binding protein’(ABP) and H-Y antigen. 9.Sertoli cell contributes formation of blood testis barrier. LEYDIG CELL • Leydig cells are present near the capillaries in the interstitial space between seminiferous tubules. • They are rich in mitochondria & endoplasmic reticulum. • Leydig cells secrete testosterone,DHEA & Androstenedione. • The activity of leydig cell is different in different phases of life.
  • The Incidence and Anatomy of Accessory Pudendal Arteries As

    The Incidence and Anatomy of Accessory Pudendal Arteries As

    The Incidence and Anatomy of Accessory Pudendal Arteries as Depicted on Multidetector-Row CT Angiography: Clinical Implications of Preoperative Evaluation for Laparoscopic and Robot-Assisted Radical Prostatectomy Beom Jin Park, MD1 Objective: To help preserve accessory pudendal arteries (APAs) and to Deuk Jae Sung, MD1 ensure optimal postoperative sexual function after a laparoscopic or robot-assist- Min Ju Kim, MD1 ed radical prostatectomy, we have evaluated the incidence of APAs as detected Sung Bum Cho, MD1 on multidetector-row CT (MDCT) angiography and have provided a detailed 1 Yun Hwan Kim, MD anatomical description. Kyoo Byung Chung, MD1 Materials and Methods: The distribution of APAs was evaluated in 121 con- Seok Ho Kang, MD2 secutive male patients between February 2006 and July 2007 who underwent 64- Jun Cheon, MD2 channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascu- lar complex. We also subclassified APAs into lateral and apical APAs. Two radiol- ogists retrospectively evaluated the origin, course and number of APAs; the final Index terms: Accessory pudendal arteries APA subclassification based on MDCT angiography source data was determined Computed tomography (CT) by consensus. Angiography Results: We identified 44 APAs in 36 of 121 patients (30%). Two distinct vari- Laparoscopy Prostatectomy eties of APAs were identified. Thirty-three APAs (75%) coursed near the antero- lateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs DOI:10.3348/kjr.2009.10.6.587 (25%) coursed along the lateral aspect of the prostate, termed lateral APAs.
  • The Male Body

    The Male Body

    Fact Sheet The Male Body What is the male What is the epididymis? reproductive system? The epididymis is a thin highly coiled tube (duct) A man’s fertility and sexual characteristics depend that lies at the back of each testis and connects on the normal functioning of the male reproductive the seminiferous tubules in the testis to another system. A number of individual organs act single tube called the vas deferens. together to make up the male reproductive 1 system; some are visible, such as the penis and the 6 scrotum, whereas some are hidden within the body. The brain also has an important role in controlling 7 12 reproductive function. 2 8 1 11 What are the testes? 3 6 The testes (testis: singular) are a pair of egg 9 7 12 shaped glands that sit in the scrotum next to the 2 8 base of the penis on the outside of the body. In 4 10 11 adult men, each testis is normally between 15 and 3 35 mL in volume. The testes are needed for the 5 male reproductive system to function normally. 9 The testes have two related but separate roles: 4 10 • to make sperm 5 1 Bladder • to make testosterone. 2 Vas deferens The testes develop inside the abdomen in the 3 Urethra male fetus and then move down (descend) into the scrotum before or just after birth. The descent 4 Penis of the testes is important for fertility as a cooler 5 Scrotum temperature is needed to make sperm and for 16 BladderSeminal vesicle normal testicular function.
  • Vascularization of the Penis of a Man

    Vascularization of the Penis of a Man

    Roczniki Akademii Medycznej w Białymstoku · Vol. 49, 2004 · Annales Academiae MedicaeVascularization Bialostocensis of the penis of a man 285 Vascularization of the penis of a man Okolokulak E, Volchkevich D The Human Anatomy Department, Grodno State Medical University, Grodno, Belarus Abstract Conclusions: The penis receives blood from external and internal pudendal arteries, which are very variable. The Purpose: The study of the features of the blood supply of venous blood of the penis flows off in three types of veins. a penis of the man. Material and methods: Macromicropreparation, angio- graphy, corrosion method, morphometry, statistical method. Key words: penis, veins of penis, arteries of penis, erectile Results: The penis has three venous collector-execut- dysfunction. ing outflow of blood. First of them is submitted surface dorsal vein, which is shaped from small-sized venous ves- sels of skin, subcutaneous fat and surface fascia of penis. Introduction The beginning deep dorsal vein, which will derivate second venous collector, gives veniplex of head of the penis. The The development of the medical technology has deepened spongy veins outstanding as third venous collector, reach the knowledge of organic violations of gears of erection. It was the bulb of penis, where they receive small-sized bulbar vein. straightened out, that more than 50% from them cause vascular The arterial blood supply of penis happens at the expense of disorders [1-4]. It has given a particular push to more detailed external and internal pudendal arteries. The external puden- learning extra- and intraorgans vessels of the penis. At the same dal artery starts from an internal wall of femoral artery on time, the problems of vascularization and relationships of blood 2.5-2.7 cm below inguinal ligament.
  • Clinical Pelvic Anatomy

    Clinical Pelvic Anatomy

    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
  • 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.