UROGENITAL ANATOMY: STRUCTURE LIST Labs 1, 2, and 3 NOTE: * Indicates a structure can be identified on a cadaver in addition to a model. Red Highlighting = Lab 1 Structures Hip bones (os coxae pelvic bones) • Ilium • Ischium • Pubis Osseous Landmarks on hip bones • Pubic symphysis • Sacral promontory • Sacrum • Ischial spine • Coccyx • Ischial tuberosity • Iliac crest • Ischiopubic ramus • Anterior superior iliac spine • Pubic arch • Anterior inferior iliac spine • Pubic tubercle • Arcuate line • Acetabulum • Pectineal line • Obturator foramen • Sacral ala • Pubic symphysis Ligamentous Structures on Pelvis • Obturator membrane • Anterior & posterior sacroiliac • Sacrotuberous ligament* ligaments • Sacrospinous ligament* Pelvic foramina/spaces • Greater sciatic foramen* • Lesser sciatic foramen* • Obturator canal • Pelvic brim (pelvic inlet or superior pelvic aperture) • Pelvic outlet (inferior pelvic aperture) • Greater pelvis (false pelvis) • Lesser pelvis (true pelvis, pelvic cavity) Differentiate a male pelvis from a female pelvis Obstetrical pelvic measurements • Interspinous • Obstetrical conjugate • Transverse • Diagonal conjugate • True (anatomical) conjugate Pelvis muscles • Obturator internus • Piriformis muscle • Pelvic diaphragm (floor) • Levator ani muscles o Puborectalis o Pubococcygeus o Iliococcygeus ▪ Coccygeus muscle ▪ Tendinous arch 1 Perineum Male & Female • Urogenital triangle o Urogenital hiatus • Anal triangle o Rectal hiatus (anal aperture) • Perineal membrane • Deep perineal pouch (space) o “Fibromuscular” region (former urogenital diaphragm) o Anterior recesses of ischioanal fossa • Superficial perineal pouch (space) Posterior Abdominal Wall Muscle • Diaphragm* • Psoas major* • Quadratus lumborum* • Iliacus* Removed Kidney • Renal artery* • Renal hilum* • Renal vein* • Renal sinus* • Renal capsule* • Minor calyx* • Renal cortex* • Major calyx* • Renal medulla* • Renal pelvis* • Renal columns* • Ureter* • Renal papilla* Kidney in Situ • Right and left renal veins* • Renal fascia • Right and left renal arteries* • Perinephric space • Renal pelvis* • Perinephric fat* • Ureter (path into pelvis)* Bladder • Opening of ureter • Internal urethral orifice* • Trigone • Apex* • Base (Fundus)* • Body* • Urachus (median umbilical fold) * • Detrusor muscle * o Contraction (emptying): parasympathetic via pelvic splanchnic nerves (S2-S4) o Relaxation (filling): sympathetic (T11-L2) • Internal urethral sphincter (Male) o Contraction: (filling): sympathetic (T11-L2) o Relaxation (emptying): parasympathetic via pelvic splanchnic nerves (S2-S4) Peritoneal Cavity Spaces • Rectouterine pouch* (female only) • Vesicouterine pouch* (female only) • Pararectal fossae* • Paravesical fossa* • Rectovesical 2 Lumbar Plexus Nerves: • Iliohypogastric*: o Sensory to posterolateral gluteal region and pubic region o Motor to transversus abdominis and internal abdominal oblique muscles • Ilioinguinal* o Motor to transversus abdominis and internal abdominal oblique muscles o Sensory • Men: sensory to the upper medial thigh, the root of the penis, the anterior scrotum • Women: sensory to the upper medial thigh, the mons pubis, and labia majora. • Genitofemoral nerve o Femoral branch*: sensory to skin in the upper anterior thigh o Genital branch* • Men: innervates the cremaster muscle and terminates in the skin of the upper anterior scrotum • Women: accompanies the round ligament of the uterus and terminates/innervates skin of the mons pubis and labia majora • Obturator nerve* o Motor innervation to muscles of the medial compartment of the thigh and sensory innervation to a small area of the medial thigh. • Lateral femoral cutaneous nerve of the thigh*: sensory innervation to the skin across the anterior and lateral region of the thigh • Lumbosacral trunk: L4 and L5 contribution to lumbosacral plexus • Pudendal nerve*: o Inferior rectal nerve*: skin in the perianal area, mucosa of the lower half of the anal canal, and the external anal sphincter o Dorsal nerve of the penis (males) or clitoris (females). • Perineal nerve*: innervates the muscles of the superficial perineal pouch (bulbospongiosus, ischiocavernosus, superficial transverse perineal, and external urethral sphincter) and the skin of the posterior scrotum in males and the labia majora in females. CT Abdomen/Pelvis • Kidney • Aorta • Psoas major m. • Common iliac arteries • Iliacus m. • Inferior vena cava • Quadratus lumborum m. • Common iliac veins • Ureter • Renal arteries • Bladder • Renal veins • Iliac Arteries • Common iliac artery* • External iliac artery* • Internal iliac artery* • Superior gluteal a.*: muscle and skin of the gluteal region and muscles and bones of the pelvic wall • Umbilical a.*: patent and fibrous portions • Superior vesical a. *: supplies the superior bladder and the distal ureter. • Obturator a. *: supplies the medial compartment of the thigh 3 • Uterine a.*: supplies the uterus • Inferior vesical a.* (male): supplies the bladder, ureter, seminal vesical, and prostate • Vaginal a.* (female): vagina and parts of the bladder • Middle rectal a.: supplies the rectum • Inferior gluteal a.*: contributes blood supply to the gluteal region • Internal pudendal a.*: primary blood supply of the perineum, which includes the erectile tissue of the penis and clitoris FEMALE REPRODUCTIVE STRUCTURES Structures of superficial perineal pouch (space) • Muscles: innervated by (deep) perineal branch of pudendal nerve o Bulbospongiosus o Ischiocavernosus o superficial transverse perineal muscle o Perineal body • Clitoris o Crura of clitoris (surrounded by ischiocavernosus m.) o Root (bisected pelvis model) o Body (bisected pelvis model) o Glans* o Prepuce* o Frenulum* • Bulb of vestibule (surrounded by bulbospongiosus) • Greater vestibular gland Vulva • Mons pubis* • Labia majora* • Labia minora* • Vestibule* o Vaginal orifice o Urethral orifice and urethra* Reproductive Tract/Organs • Vagina* o Posterior, Anterior, and lateral fornices • Uterus* o Body* o Fundus* o Isthmus o Cervix* o Cervical canal • Internal os • External os o Normal uterine position • Anterverted • Anteflexed 4 • Uterine (Fallopian) tube o Infundibulum* o Fimbriae* o Ampulla* o Isthmus* o Uterine portion Ligaments • Round ligament of uterus* • Ligament of ovary* • Broad ligament o Mesosalpinx* o Mosovarium* o Mesometrium* • Suspensory ligament of ovary (infundibulopelvic ligament) * o Ovarian artery* o Ovarian vein (termination point of right versus left)* MALE REPRODUCTIVE STRUCTURES Penis regions • Root • Glans* • Body* • Corona (of glans) * Penis erectile tissue • Corpora cavernosa* • Corpus spongiosum* Penis connective tissue layers • Superficial (dartos) fascia • Tunica Albuginea surrounding corpus • Deep (Buck's) fascia* cavernosum* Penis vessels and nerves • Deep dorsal vein* • Dorsal arteries * • Dorsal nerve (branch of pudendal nerve) * • Deep arteries (of penis) • Root of penis o Bulb of penis (surrounded by bulbospongiosus m.) o Bulbospongiosus muscle: innervated by (deep) perineal branch pudendal nerve o Crura of penis (surrounded by ischiocavernosus m. o Ischiocavernosus muscle: innervated by (deep) perineal branch pudendal nerve. Male Urethra • Intramural (preprostatic) urethra • Membranous urethra • Prostatic urethra* • Spongy urethra* • External urethral sphincter • External urethral orifice* o Innervation: pudendal nerve S2- S4 5 Glands • Prostate gland* o Ejaculatory duct o Prostatic urethra* • Seminal gland* • Bulbourethral (Cowper's) gland Testicular Blood Supply/Ductus Deferens • Testicular artery in abdomen/pelvis • Testicular vein (termination point of right versus left) * • Ductus (vas) deferens * ▪ Ampulla* Inguinal canal* • Deep inguinal ring* • Superficial inguinal ring* Spermatic cord • Cremaster muscle: innervated by genital branch genitofemoral (genital branch courses through deep ring, inguinal canal, and superficial ring. o Cremaster reflex • Afferent: ilioinguinal/femoral of genitofemoral • Efferent: genital of genitofemoral • Layers of abdominal wall from which spermatic cord layers are derived o External oblique aponeurosis* = external spermatic fascia o Internal abdominal oblique muscle and fascia* = cremaster muscle and fascia o Transversalis fascia = internal spermatic fascia • Testicular artery* • Pampiniform venous plexus* Scrotum • Testis* • Tunica vaginalis* o Visceral layer* o Parietal layer* • Epididymis* o Tail* o Body* o Head* 6 .