Podcast
Questions and Answers
The contraction of which muscle directly contributes to the sphincteric effect in the male urinary bladder?
The contraction of which muscle directly contributes to the sphincteric effect in the male urinary bladder?
- External urethral sphincter muscle
- Deep transverse perineal muscle
- Detrusor muscle (correct)
- Bulbospongiosus muscle
A patient undergoing a suprapubic catheterization experiences unexpected bleeding. Which of the following anatomical relationships is MOST likely implicated in this complication?
A patient undergoing a suprapubic catheterization experiences unexpected bleeding. Which of the following anatomical relationships is MOST likely implicated in this complication?
- Distention of the bladder (correct)
- Location of the internal iliac artery
- Position of the pubic symphysis
- Proximity of the median umbilical ligament
What is the MOST accurate description of the relationship between the urinary bladder and the peritoneum?
What is the MOST accurate description of the relationship between the urinary bladder and the peritoneum?
- The urinary bladder is subperitoneal, with only its superior surface covered by peritoneum. (correct)
- The urinary bladder is infraperitoneal, located below the peritoneum.
- The urinary bladder is retroperitoneal, situated behind the peritoneum.
- The urinary bladder is intraperitoneal, being fully enveloped by the peritoneum.
During a radical prostatectomy, injury to which structure would MOST likely result in urinary incontinence due to direct compromise of bladder support?
During a radical prostatectomy, injury to which structure would MOST likely result in urinary incontinence due to direct compromise of bladder support?
Which statement BEST describes the arterial supply to the base of the bladder?
Which statement BEST describes the arterial supply to the base of the bladder?
A surgeon is performing a pelvic lymph node dissection and needs to identify the primary lymphatic drainage pathway for the superior bladder. Which of the following node groups should they focus on?
A surgeon is performing a pelvic lymph node dissection and needs to identify the primary lymphatic drainage pathway for the superior bladder. Which of the following node groups should they focus on?
In a male patient undergoing cystoscopy, a bladder tumor is identified. The physician notes the tumor has spread through the bladder wall and invaded local structures. Through which route would tumor cells MOST likely spread initially?
In a male patient undergoing cystoscopy, a bladder tumor is identified. The physician notes the tumor has spread through the bladder wall and invaded local structures. Through which route would tumor cells MOST likely spread initially?
Which structure is located within the spongy urethra?
Which structure is located within the spongy urethra?
A male patient presents with recurrent urinary tract infections following catheterization. What anatomical characteristic of the female urethra makes women more susceptible to ascending infections?
A male patient presents with recurrent urinary tract infections following catheterization. What anatomical characteristic of the female urethra makes women more susceptible to ascending infections?
What action MUST be taken into consideration to prevent perforations of the prostate during male urinary catheterization?
What action MUST be taken into consideration to prevent perforations of the prostate during male urinary catheterization?
Which accessory gland(s) contribute(s) the MOST proteolytic enzymes into the semen, aiding in the breakdown of clotting factors in the ejaculate?
Which accessory gland(s) contribute(s) the MOST proteolytic enzymes into the semen, aiding in the breakdown of clotting factors in the ejaculate?
What anatomical structure does the prostate surround?
What anatomical structure does the prostate surround?
Which anatomical structure passes through the prostate?
Which anatomical structure passes through the prostate?
During a digital rectal exam (DRE), isolated enlargement of which prostatic lobe is MOST suggestive of benign prostatic hypertrophy (BPH)?
During a digital rectal exam (DRE), isolated enlargement of which prostatic lobe is MOST suggestive of benign prostatic hypertrophy (BPH)?
A patient is diagnosed with prostate cancer located in the peripheral zone. Where is this zone located relative to the prostate?
A patient is diagnosed with prostate cancer located in the peripheral zone. Where is this zone located relative to the prostate?
A clinician is performing a digital rectal examination (DRE). Which aspect of the prostate is directly palpable through the rectal wall in a normal examination?
A clinician is performing a digital rectal examination (DRE). Which aspect of the prostate is directly palpable through the rectal wall in a normal examination?
After a motor vehicle accident, a male patient presents with a fractured pelvis. Further imaging reveals a ruptured bladder and blood at the prostatic apex. Which structure is MOST likely compromised given these findings?
After a motor vehicle accident, a male patient presents with a fractured pelvis. Further imaging reveals a ruptured bladder and blood at the prostatic apex. Which structure is MOST likely compromised given these findings?
What is Batson's plexus MOST directly associated with?
What is Batson's plexus MOST directly associated with?
After a vasectomy, which cells would NO LONGER be transported from the tail of the epididymis to the ejaculatory duct?
After a vasectomy, which cells would NO LONGER be transported from the tail of the epididymis to the ejaculatory duct?
A patient is diagnosed with a varicocele and is found to have impaired spermatogenesis. Which structure is MOST directly involved in the formation and storage of sperm?
A patient is diagnosed with a varicocele and is found to have impaired spermatogenesis. Which structure is MOST directly involved in the formation and storage of sperm?
What is the course of the ductus deferens?
What is the course of the ductus deferens?
What role do the seminal vesicles play?
What role do the seminal vesicles play?
The testes descend from the posterior abdominal wall. What is the MOST accurate description of the testicular arterial supply?
The testes descend from the posterior abdominal wall. What is the MOST accurate description of the testicular arterial supply?
Which lymphatic pathway is DIRECTLY responsible for draining lymph from the inferior half of the urinary bladder?
Which lymphatic pathway is DIRECTLY responsible for draining lymph from the inferior half of the urinary bladder?
Within the male pelvis, which fascial structure separates the posterior surface of the prostate from the rectum?
Within the male pelvis, which fascial structure separates the posterior surface of the prostate from the rectum?
A patient experiences prostatic pain related to vascular congestion. Which anatomical feature contributes MOST directly to the potential for venous congestion in the prostate?
A patient experiences prostatic pain related to vascular congestion. Which anatomical feature contributes MOST directly to the potential for venous congestion in the prostate?
A physician is interpreting a magnetic resonance image (MRI) of a patient's prostate. Which zone should have the LOWEST signal intensity if the patient has prostate cancer?
A physician is interpreting a magnetic resonance image (MRI) of a patient's prostate. Which zone should have the LOWEST signal intensity if the patient has prostate cancer?
Which nerve directly innervates the detrusor muscle of the urinary bladder, facilitating bladder contraction?
Which nerve directly innervates the detrusor muscle of the urinary bladder, facilitating bladder contraction?
Which artery is a branch of the anterior division of the internal iliac artery?
Which artery is a branch of the anterior division of the internal iliac artery?
What is the MOST accurate statement regarding the composition of the pelvic viscera?
What is the MOST accurate statement regarding the composition of the pelvic viscera?
Following an injury to the pelvis, a male patient reports difficulty with erection and ejaculation despite normal libido. Damage to which nerve distribution is MOST likely responsible for these symptoms??
Following an injury to the pelvis, a male patient reports difficulty with erection and ejaculation despite normal libido. Damage to which nerve distribution is MOST likely responsible for these symptoms??
Which statement regarding the urethral structure is MOST accurate?
Which statement regarding the urethral structure is MOST accurate?
Under what circumstance would the urinary bladder be classified as an abdominal organ?
Under what circumstance would the urinary bladder be classified as an abdominal organ?
Which statement accurately contrasts basic features of prostatic carcinoma and benign prostatic hyperplasia?
Which statement accurately contrasts basic features of prostatic carcinoma and benign prostatic hyperplasia?
Which statement best describes the function of the urethral sphincters?
Which statement best describes the function of the urethral sphincters?
Which anatomical landmark continues from the apex of the bladder to the umbilicus?
Which anatomical landmark continues from the apex of the bladder to the umbilicus?
Which statement best describes the inferolateral surfaces of the bladder.
Which statement best describes the inferolateral surfaces of the bladder.
Which of the following structures is responsible for transporting sperm from the epididymis to the ejaculatory duct?
Which of the following structures is responsible for transporting sperm from the epididymis to the ejaculatory duct?
Where are sperm formed in the testes?
Where are sperm formed in the testes?
In a transurethral resection of the prostate (TURP), what is surgically addressed to improve urine flow in patients with benign prostatic hyperplasia (BPH)?
In a transurethral resection of the prostate (TURP), what is surgically addressed to improve urine flow in patients with benign prostatic hyperplasia (BPH)?
Flashcards
The Bladder
The Bladder
Anterior element of the pelvic viscera, located in pelvis when empty and abdominal when full. It is anterior to the rectovesical pouch and seminal vesicles in males, and the uterovesical pouch and the anterior vaginal wall in females.
Urinary Bladder Capacity
Urinary Bladder Capacity
The urinary bladder holds about 150-600 ml of urine. When empty, it is located in the pelvis; when full, it extends into the abdominal region.
Suprapubic Catheterization
Suprapubic Catheterization
A procedure where a small catheter is passed in the midline approximately 2 cm above the pubic symphysis to permit drainage.
Urinary Bladder Anatomy
Urinary Bladder Anatomy
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Arteries of Bladder
Arteries of Bladder
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Bladder Lymphatics
Bladder Lymphatics
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Bladder Cancer
Bladder Cancer
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Urethra Anatomy
Urethra Anatomy
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Vasectomy
Vasectomy
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Prostate
Prostate
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Benign Prostatic Hypertrophy
Benign Prostatic Hypertrophy
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Prostatic Cancer
Prostatic Cancer
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Prostatic Fascia
Prostatic Fascia
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Rectovesical Septum
Rectovesical Septum
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Batson Venous Plexus
Batson Venous Plexus
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Parasympathetic Nerves
Parasympathetic Nerves
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Sympathetic Nerves
Sympathetic Nerves
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Prostatic Arteries
Prostatic Arteries
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Study Notes
- The lecture covers the anatomy of the bladder, prostate, seminal vesicles, and ductus deferens
- The lecture also discusses related clinical significance, radiological imaging, and pathologies
Pelvic Content
- Pelvic viscera include parts of the gastrointestinal, urinary, and reproductive systems
- Gastrointestinal system includes the rectum and anal canal
- Urinary system consists of the terminal parts of the ureters, the bladder, and the proximal part of the urethra
- Female reproductive system includes the uterus, uterine tubes, ovaries, and proximal vagina
- Male reproductive system includes the vas deferens, seminal vesicles, prostate, and bulbourethral glands
Bladder Anatomy
- The bladder is the most anterior element of the pelvic viscera
- When empty, the bladder is located in the pelvis
- When full, it is located in the abdominal region
- The urinary bladder can hold 150-600 ml of urine
- The bladder is pelvic when empty and abdominal when distended
- Urinary bladder is anterior to the rectovesical pouch or the ureterovesical pouch
- The apex of the bladder is directed towards the pubic symphysis
- The median umbilical ligament continues from the apex to the umbilicus
- The base of the bladder faces posterior-inferiorly
- Two ureters enter at the top with oblique slit-like openings to prevent reflux
- Urethra drains inferiorly
- The interolateral surface is supported by the levator ani muscles
- Superior surface: domed and covered with peritoneum
- Inferolateral surface: supported by levator ani muscles
- Neck of bladder is most inferior part - fixed
- The bladder is supported by the perineal membrane, associated muscles, and pubic bones
- Females have pubovesical ligaments
- Males have puboprostatic ligaments.
Bladder Vessels
- Superior vesical arteries supply anterosuperior parts of the bladder
- Inferior vesical arteries (males) or vaginal arteries (females) supply base and neck of the bladder
- The obturator and inferior gluteal arteries also supply small branches
Catheterization
- A small catheter can be passed in the midline approximately 2 cm above the pubic symphysis to permit drainage during suprapubic catheterization
- Placing a bladder catheter is easier in females
- Ascending infections of the urinary bladder (cystitis) are more common in women
- Placing a catheter in men is made more difficult by the length and the angles in the urethra
- The angles in the urethra must be compensated for by aligning the penis, to prevent perforations
Bladder Lymphatics
- Lymphatics from the superior surface drain to the external iliac lymph nodes
- Lymphatics from the inferior half drain to the internal iliac lymph nodes
- Some lymphatics from the neck drain into the sacral or common iliac lymph nodes
Bladder Cancer
- The most common tumour of the urinary tract
- 1/3-multifocal
- 2/3 are superficial and amenable to local treatment
- May spread through the bladder wall and invade local structures
- Spreads through lymph nodes and local structures.
- Depending on severity: Local resection with preservation of the bladder, chemotherapy, or radical surgical removal of the bladder and prostate in men
Urethra
-
Males: long and bends twice.
-
Pre-prostatic part, with internal urethral sphincter
-
Prostatic, with the prostatic sinus and seminal colliculus
-
Membranous with the external urethral sphincter
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Spongy part with corpus spongiosum and openings of the bulbourethral glands and two parts: bulbar and penile
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Females: short.
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Runs through the pelvic floor and perineum to open into the vestibule
-
Contains para-urethral mucous glands
Male Reproductive System
- Major components are:
- Testis
- Epididymis
- Ductus deferens
- Ejaculatory ducts
- Urethra and penis
- Accessory glands include:
- A single prostate
- A pair of seminal vesicles
- A pair of bulbourethral glands
Testes and Epididymis
- The testes originally develop high on the posterior abdominal wall and then descend
- Testes produce sperm and testosterone with sperm formed in the seminiferous tubules
- The Epididymis is on the posterolateral sides of the testis and stores newly formed sperms
- The ductus deferens (vas deferens) is a muscular duct that transports spermatozoa from the tail of the epididymis to the ejaculatory duct
- The vas deferens is part of the spermatic cord and joined with the duct of the seminal vesicle
- Seminal vesicles are accessory glands of the reproductive system with blind-ended tubular outgrowth
- They join the vas deferens to form the ejaculatory duct and secretions increase the volume of semen
Vasectomy
- A method of birth control performed under local anaesthesia
- Involves removing a section of the vas deferens and ligating/cauterizing the cut ends
Prostate Gland
- Secretes proteolytic enzymes into the semen and surrounds the urethra in the pelvic cavity
- The prostate is posterior to the pubic symphysis and anterior to the rectum
- The base is inferior to the urinary bladder and the apex is along the superior fascia of the deep perineal pouch
- Inferolateral surfaces are the levator ani
- Has Capsule, prostatic urethra, seminal colliculus and Bulbourethral glands
- Anterior, median, posterior and lateral lobes classify the gland.
Prostate Zones
- Transitional zone: surrounds the proximal and middle urethra
- Benign prostatic hypertrophy occurs in the transition zone
- Central zone: posterior to the prostatic urethra forming the base of prostate, and contains the ejaculatory ducts
- Peripheral zone: surrounds distal portion, and is where 70% prostatic tumors occur
- Deficient anteriorly- replaced by the fibromuscular stroma
Rectal Exam
- The prostate can be examined by digital rectal examination
- Malignant prostate feels hard and irregular
- Other structures include:
- Males: seminal vesicle, recto-vesical pouch
- Females: posterior wall of the vagina, cervix, rectouterine pouch
Benign Prostatic Hypertrophy
- Common in older men, affecting >50% at the age of 60, and >75% by 80
- Features result from compression of the prostatic urethra and obstruction of urine outflow
- Involves muscular hypertrophy of the bladder and retrograde back pressure, causing hydroureter and hydronephrosis
- Requires Transurethral Resection of the Prostate (TURP)
Prostatic Cancer
- Common after age 65 but now becoming more regular with 2 decades before
- Adenocarcinoma is the most common in American males
- Only 1/41 diagnosed patients die
- Occurs usually in peripheral regions and is usually asymptomatic in early stages
Male Pelvic Fascia
- Prostatic fascia: condensation of fascia around the anterior and lateral region of the prostate, contains venous plexus
- Rectovesical septum: separates the posterior surface of the prostate and base of the bladder from the rectum
Prostate Blood Supply
- Superior and inferior vesicle arteries supply the prostate
- Prostatic blood supply drains to the internal iliac arteries
- There is also connection with vertebral spinous and Batson veins that can cause cancer to spread
- *Autonomics to the urinary bladder The Autonomics to the bladder: parasympathetic (S2-4) via Plevic Splanchnic (motor to detrusor muscle) and the Contraction to the urethral spinster. The sympathetic (T12-L2), Inervate blood vessels and are for contraction to the uretheral spinchter. visceral afferents (pain) follow sympathetics in superior part and parasympathetics in inferior part.
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