Anatomy (Lecture)

TOPIC: Genitourinary Development and Male Reproductive System

SECTION A & B PROF: Dr. Trician Jan Taguba- Villarosa

OUTLINE - Migration of these cells into the dorsal

mesentery to differentiate into Leydig
I. Development of Genitourinary cells and Sertoli cells
II. Embryology
● Leydig cells
III. Male pelvic viscera
- produce testosterone
IV. Blood Supply
V. Lymphatic ● Sertoli cells
VI. Innervation - enclosed in seminiferous tubules
VII. Clinical focus of the male perineum Embryology of the External Genitalia
VIII. Clinical Application
● The female and male external genitalia develop
DEVELOPMENT OF THE GENITOURINARY SYSTEM from the genital tubercle (the phallic structures),
paired urogenital folds, and labioscrotal folds
● Genital organ and renal system development ● These tissues are undifferentiated, but after
are intimate with each other" about the twelfth week recognizable external
● Renal Development genital features associated with each sex begin
to form.
Nephrogenic cord (from the intermediate mesoderm)

- three sets of excretory ducts and tubules ● 6 weeks gestation

develop bilaterally - three external protruberances
- develop (cloacal folds r/l, and genital
Proneprhos and Pronephric ducts tubercle)

- most cranial part of the embryo (4th week - cloaca is divided into anal and
after conception) urogenital membranes

- most caudal end becomes the adrenal gland - urogenital fold and anal fold

● 7 weeks gestation
- urogenital membrane ruptures to
Mesonephric Tubules and Ducts expose the urogenital sinus to the
amniotic fluid
- fetal kidneys (tufts of capillaries, glomeruli and
excretory tubules) SEXUAL DIFFERENTIATION
- produce urine for 2 to 3 weeks
- gonads form from the central region ● Gender genetic
- ureteric bud (metanephric diverticulum) - gonadal and phenotypic
appears beginning 5 weeks gestation ● Genetic gender
(becomes the metanephric system) - xx or xy established at fertilization
● Gonadal gender
- determined by the primordial gonad
Metanephric System (male or female) in the presence or
absence of the y chromosome
- Permanent kidney (starts to function at 7 to 8
❏ Testis-determining factor (TDF)
weeks gestation)
protein encoded by the sex-
- Metanephros-derived form the metanephric
determining region (SRY) gene
mass and the ureteric bud
in the short arm of the y
- A critical process in the development of the
chromosome
kidney requires that the cranially growing
● Phenotypic gender
metanephric diverticulum meets and fuses with
- begins to develop at 8 weeks gestation
the metanephrogenic mass of mesoderm so
(indistinguishable sexes)
that formation of the kidney can take place"
- differentiation of internal and external
-
genitalia dependent on testicular
Genital Development
function (presence or absence of
● Male Gonadal Development precedes before AMH/MIS)
the females
- germinal epithelial cells proliferate
and invade the mesenchyme to form a
prominence, gonadal ridge

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 SECTION A&B TOPIC: Genitourinary Development and Male Reproductive System

EMBRYOLOGY ● It is thought to occur from a defective migration

of the genital tubercle primordia to the cloacal
Development of the Reproductive Organs
membrane early in development (fifth week).
● The reproductive systems of the female and
male develop from a consolidation of MALE PELVIC VISCERA
intermediate mesoderm on the dorsal wall of
the embryo (urogenital ridge)
● Embryo’s genotype is determined at fertilization
(XX for females and XY for males)
● sexual diferentiation of each gender does not
begin until after the sixth week of development
● the epithelium of the coelomic cavity and the
underlying mesoderm form a gonadal ridge,
which will become the definitive gonad
● mesonephric and paramesonephric ducts
● associated with the urogenital ridge
● Develops one of the duct systems
becoming a major component of the
Includes the following
reproductive system in each gender
*In genetic females, the mesonephric ducts ● Prostate gland and seminal vesicle
- This structures lie in a subperitoneal
degenerate and the paramesonephric ducts position and are in close association
with the urethra
- The testes descend into the scrotum
late in human prenatal development
and are connected to the seminal
vesicles > ductus (vas) deferens >
spermatic cord>scrotum >inguinal
canal,>retroperitoneally to join the duct
of the seminal vesicle(ejaculatory duct)

Testis

● Are paired gonads about the size of a chestnut

Tunica vaginalis

o pouch of abdominopelvic
peritoneum during the descend
of the testis into the scrotum
o attaches to the anterior and
lateral aspect of the testes (has
visceral and parietal layers).
Hypospadias and Epispadias ● Testes are encased within a thick capsule, the
tunica albuginea.
● Congenital anomalies of the penis
● Testes are divided into lobules that contain
seminiferous tubules.
● The seminiferous tubules are lined with germinal
Hypospadias
epithelium that gives rise to spermatozoa
● Much more common ● Testes drain spermatozoa into the rete testes
● Characterized by failure of fusion of the (straight tubules) and efferent ductules of the
epididymis
urogenital folds, which normally seal the penile
(spongy) urethra within the penis.
● The defect occurs on the ventral aspect of the
penis (corpus spongiosum).
● May be associated with inguinal hernias and
undescended testes.
Epispadias

● Rare (1 in 120,000 male births)

● Characterized by a urethral orifice on the dorsal
aspect of the penis.

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 About 3 to 5 mL of semen and 100 million sperm/mL are

present in each ejaculation. The pH of the ejaculate is
between 7 and 8

Pelvic Peritoneum

In both sexes, the peritoneum on the lower internal

aspect of the anterior abdominal wall reflects of the
midline from the urinary bladder as the median
umbilical ligament (a remnant of the embryonic
urachus).

 Medial umbilical ligaments

o Pass superiorly about 2 cm laterally on
each side; they contain the inferior
epigastric vessels, which will course
superiorly in the posterior lamina of the
rectus sheath

● RECTOVESICAL POUCH
○ pouch formed by the peritoneum
(reflection of the peritoneum) between
the bladder and rectum
○ Lowest point in the male peritoneal
Epididymis cavity
○ IN FEMALE:
o a long coiled tube about 6 meters in ■ Vesicouterine pouch- reflection
length if uncoiled and where sperm of peritoneum formed between
mature and are stored the bladder and uterus
- Seminiferous tubules ■ Rectouterine pouch (of
o spermatogenesis occurs Douglas)- pouch in between
o the testis is divided into about 250 the uterus and rectum; lowest
lobules, each containing one to four point in the female peritoneal
seminiferous tubules cavity
● The complete cycle of spermatogenesis takes ● ENDOPELVIC FASCIA
about 74 days and 12 more days for the sperm ○ Fills the subperitoneal spaces
to mature and pass through the epididymis. ○ Contributes to stronger condensations
About 300 million sperm cells are produced that support the rectum and urinary
daily in the human testis Ductus deferens bladder in both sexes and the uterus of
o 40 to 45 cm long female
o joins the ducts of the seminal vesicles to ■ Major fascial condensations IN
form the ejaculatory ducts, which MALE:
empty into the prostatic urethra, the first 1. MEDIAL PUBOVESICAL
portion of the male urethra leaving the LIGAMENT-connects the
urinary bladder bladder to the pubis in both
Seminal vesicle gender
2. LATERAL LIGAMENT OF THE
o Contribute fluid to the ejaculate and BLADDER (PUBOVESICAL
account for about 70% of the ejaculate LIGAMENT)- provides lateral
volume support for the bladder and
o Produce a viscous and alkaline fluid conveys the superior vesical
that nourishes the spermatozoa and vessels supplying the
protects them from the acidic bladder in both gender
environment of the female vagina.  same ligament that supports the female
Prostate bladder also support the male bladder
● is a walnut-sized gland that surrounds the ● PROSTATIC FASCIA
proximal urethra ○ condensation that surrounds the
● Contributes fluid to the ejaculate and accounts anterolateral aspect of the prostate
for about 20% of the ejaculate volume. gland
● Produces a thin, milky, slightly alkaline fluid that ○ Envelop prostatic venous plexus and
helps to liquefy coagulated semen after it is extend posteriorly to envelop prostatic
deposited in the vagina arteries and nerve plexus →
● Contains citric acid, proteolytic enzymes, RECTOPROSTATIC FASCIA or
sugars, phosphate, and various ions DENONVILLIERS’ FASCIA

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 Internal iliac veins – Corresponding veins,

BLOOD SUPPLY usually multiple in number, course with each
of these arterial branches and drain
 Pelvis plexus of veins-Extensive venous
plexuses that are associated with the
bladder,rectum, vagina, uterus, and
prostate
 Inferior vena cava (IVC )-where the right
gonadal vein (ovarian or testicular)
 Left renal vein –where left gonadal vein
drains he superior

LYMPHATICS

 Much of the lymphatic drainage of the pelvis

parallels the venous drainage and drains into
lymph nodes along the internal iliac vessels
ARTERIES
o Aortic (lumbar) nodes of the
midabdomen-where the testes and
Arteries of the male reproductive sytem:
scrotal structures flows black directly
lymph from the more
 Bulbar Artery -supplies blood to root of penis
-lymph from the testes drains upward in
 Urethral Artery-supplies blood to corpus
the spermatic cord and follows the
spongiosum and penile urethra
testicular veins to these nodes
 Dorsal Artery-supplies blood to urethra &
o Superficial and deep inguinal lymph
glans penis
nodes-superficial structures of the
 Cavernosal Artery or Deep Artery-supplies
perineum drains into in the
blood to the penis
midabdomen

Arteries to the male pelvis:

INNERVATION
Innervation of the male reproductive sytem:
 Internal iliac arteries -arterial supply to the
pelvis arises from the paired, which not only
 Dorsal Penile Nerve-innervate the skin, glans
supply the pelvis but also send branches into
and corpora cavernosa
the perineum, the gluteal region, and the
 Lesser Cavernous Nerve –innervate the
medial thigh
corpus spongiosum and urethra
 Vesical branch-ductus deferens
 Greater cavernous nerve –innervate the
 Prostatic artery-from the inferior vesical artery
corpora cavernosa
 Testicular arteries-from the abdominal aorta
Innervation of the male pelvis:
VEINS
Veins in male reproductive system:
 the skin and skeletal muscle of the pelvis are
innervated by the somatic division of the
 Superficial Dorsal Vein-Drains from the
peripheral nervous system.
superficial vessels from the skin and
subcutaneous tissue
·pudendal nerve (S2-S4)
 Deep Dorsal Vein- Drains blood from the
·pelvic splanchnics (S2-S4; parasympathetic)
glans penis, corpus spongiosum and the
·lumbar and sacral splanchnics (L1-L2; sympathetic)
distal 2/3 of the c.
 Cavernosal and Crural Vein-Drain blood from
the proximal 1/3 of the corpora cavernosa
 Veno-occlusive mechanism- process by
which blood flow out of the corpora
cavernosa is largely (but not completely) shut
down, enabling the blood flowing in to
accumulate, creating penile expansion and
rigidity.

Veins in male pelvis:

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The sympathetic efferent fibers generally mediate the
following functions:
● Vasoconstrict and/or maintain vasomotor tone.
● Increase secretion from the skin’s sweat glands
and sebaceous glands.
● Contract the male internal urethral sphincter
and the internal anal sphincters in both
genders.
● Through smooth muscle contraction, move the
sperm along the male reproductive tract and
stimulate secretion from the seminal vesicles
and prostate.
● Stimulate secretion from the greater vestibular
(Bartholin’s) glands in females and the bulbo-
urethral (Cowper’s) glands in males, along with
minor lubricating glands associated with the
reproductive tract in both genders.
Visceral afferent fibers convey pelvic sensory
information (largely pain) via both the sympathetic
fibers (to the upper lumbar spinal cord [L1-L2] or lower
thoracic levels [T11-T12]) and parasympathetic fibers (to
the S2-S4 levels of the spinal cord).
Erection of the penis
(and clitoris in the female) and ejaculation involve the
following sequence of events:
1. Friction and sexual stimulation evoke the excita
tion of parasympathetic fibers, which leads to
relaxation of the cavernous vessels and
engorgement of the erectile tissue with blood
(penis and clitoris).
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2. Sympathetic fibers then initiate contraction of
the smooth muscle of the epididymal ducts,
ductus
deferens, seminal vesicles, and prostate, to move sperm
toward the prostatic urethra.
3. Sperm and the seminal and prostatic secretions
enter the prostatic urethra and combine with secre-
tions of the bulbourethral and penile urethral glands.
Prostatic secretions also are slightly alkaline and include
prostate-specific antigen, prostatic acid phosphatase,
fibrinolysin (helps to liquefy the semen), and
citric acid.
4. The internal urethral sphincter contracts to
Prevent retrograde ejaculation into the urinary bladder.
Through rhythmic contractions of the bulbos-pongiosus
muscle and somatic stimulation from the pudendal
nerve, the semen moves along the spongy urethra with
help from parasympathetic stimulation of urethral
smooth muscle and is ejaculated (orgasm).
The deep (perineal) pouch in males includes the
following:
● Membranous urethra
- a continuation of the prostatic urethra.
● Deep transverse perineal muscles
- extend from the ischial tuberosities and
rami to the perineal body; stabilize the
perineal body.
● Bulbourethral (Cowper’s) glands
- their ducts pass from the deep pouch
to enter the proximal part of the spongy
urethra; provide a mucus-like secretion
that lubricates the spongy urethra.
● External urethral sphincter
- skeletal muscle that encircles the
membranous urethra, and extends
superiorly over the anterior aspect of
the prostate gland.
 SECTION A&B TOPIC: Genitourinary Development and Male Reproductive System
-
The neurovascular components include the following:
● Pudendal nerve
- passes out of the greater sciatic
foramen with the internal pudendal
vessels, around the sacrospinous
ligament, and into the lesser sciatic
foramen to enter the pudendal
(Alcock’s) canal; provides the somatic
innervation (S2-S4) of the skin and
skeletal muscles of the perineum and its
branches; includes the inferior rectal
(anal), perineal, scrotal, and dorsal
nerves of the penis.
● Internal pudendal artery: arises from the
internal iliac artery, passes out of the greater
sciatic foramen with the pudendal nerve,
around the sacrospinous ligament, and into the
lesser sciatic foramen to enter the pudendal
(Alcock’s) canal distributes to the perineum as
the inferior rectal, perineal, scrotal, and dorsal
arteries of the penis as well as the artery of the
bulb.
Urethral Trauma in the Male
Direct trauma to the corpora cavernosa
- Rare
- Rupture of tunica albuginea
o Usually involves the deep fascia of
the penis (Buck’s fascia)
o blood can extravasate quickly
o penile swelling
Urethral rupture
- is more common and involves one of three
mechanisms:
o External trauma or a penetrating injury
o Internal injury (caused by a catheter,
instrument, or foreign body)
o Spontaneous rupture (caused by
increased intraurethral pressure or
periurethral inflammation)
Urine Extravasation in the Male
● Rupture of the male urethra can lead to urine
extravasation into various pelvic or perineal
spaces that are argely limited by the perineal,
pelvic, and lower abdominal wall fascial planes.
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Erectile Dysfunction
 is an inability to achieve and maintain penile
erection sufficient for sexual intercourse
 dysfunction can also occur from damage to the
nerves innervating the perineum
 occurrence increases with age
 Normal erectile function:
- sexual stimulus causes the release of
nitric oxide from the corpora cavernosa
- relaxing the smooth muscle tone of the
vessels
- increasing blood flow into the erectile
tissues
- erectile tissue becomes engorged with
blood, it compresses the veins in the
tunica albuginea
- the blood remains in the cavernous
bodies
 The available drugs for treatment aid in relaxing
the smooth muscle of the blood vessels of the
erectile tissues
 Afferent impulses conveying stimulation/arousal
sensations are conveyed by the pudendal
nerve (S2-S4, somatic fibers
 autonomic efferent innervation of the
cavernous vasculature is via the pelvic
splanchnics (S2-S4, parasympathetic fibers).
CLINICAL APPLICATION:
● Common complaints or concerns for
consultation among Males
○ STI’s (penile discharge, dysuria, penile
lesions, etc)
○ Sexual orientation (issues on sex
change, gender reassignment) and
sexual response (failure to orgasm,
erection problems, ejaculation
problems)
○ Scrotal lesions, pain and swelling (STI’s,
orchitis(measles) and other infection)
 SECTION A&B TOPIC: Genitourinary Development and Male Reproductive System

● HANDLING MALE PATIENTS ○ Recurrence of the bulging inguinal

○ like handling female patients mass
○ Chief complaint, history of illness, ○ Chronic inguinal pain
complete personal and family history, ○ Damage to the vas deferens or
thorough physical exam testicular vessels (orchitis or infertility)
○ Physical exam in male is almost the ● Patient instructions for the testicular self
same with female patient examination
○ find the epididymis. This is a soft, two
black structure at the back of the
● Evaluation of STI testicle that collects and carry sperm,
○ has the patient experience discharge, not an abnormal lump
noted lesions or dysuria, etc. ■ If you find any lump, don’t wait.
○ health promotion and counselling See your doctor. The lump may
just be an infection, but if it is
● How to prevent HIV and STI
○ Practice monogamy
○ Safe sex
○ Regular check up (prostate, Scrotum,
penis, etc.)
● Examination of the male genitalia
○ physical examination of the organ
system must be done before
proceeding to the genitalia
○ Properly signed consent for
examination
○ White gown or coat as the physicians
attire
○ Properly gloved
○ It is important to have a companion
with you (if female physician)
○ Patients proper attire: Patient must
wear a gown and comfortably position
on the examination table or standing
up
● Inguinal Hernia
cancer, it will spread unless
○ an internal tissue (i.e. Intestine)
stop stop by treatment
protrudes into a weakened portion of
● Sexually Transmitted Infections
the abdominal wall particularly at
○ genital warts (condylomata
inguinal area
acuminata)
○ Risk factors (male, elderly, family history,
○ Genital herpes Simplex
chronic cough, chronic constipation
○ Primary syphilis
got my previous personal history of
○ Chancroid
hernias)
● Vasectomy
● Direct inguinal hernia (20%)
○ Birth control with a failure rate below
○ intestine enters the inguinal canal
that of the peel, condom, IUD, Tubal
directly through a weakened area on
ligatioN
the posterior wall of the canal
○ Perform as an office procedure with
(Hasselbach’s triangle)
local anesthetic
○ Most common among older male due
○ one approach uses a small incision on
to laxity of the abdominal wall or a
each side of the scrotum to isolate the
significant increase in abdominal
vast difference, another uses a small
pressure
puncture (no incision) in the scrotal skin
● Examination of hernias
to isolate both right and left vas
○ informed consent
○ vas deferens is identified, A small
○ proper patients attire
segment is isolated between two small
○ Patient is asked to stand for the
metal clips or sutures
examination
○ The isolated segment is resected, the
○ Inspection of the inguinal and femoral
clip ends of the vas are cauterize, and
areas (patient is asked to strain down,
the incision is close
cough or do Valsalva maneuver)
○ palpate the external inguinal ring
through the scrotal skin (then ask the
patient to do strain down)
● Usual concerns
○ pain, bruising, hematoma, urinary
retention or infection

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 SECTION A&B TOPIC: Genitourinary Development and Male Reproductive System
● Testicular Cancer
○ heterogenous neoplasm
○ 95% arising from germ cells and almost
all malignant
○ Surgical resection usually is performed
using an inguinal approach (radical
inguinal orchiectomy) to avoid spread
of the cancer to the adjacent scrotal
tissues
○ Most common cancer in men 15 to 35
years old
● Hydrocele and Varicocele
○ hydrocele most common cause of
scrotal enlargement due to excessive
accumulation of serous fluid within the
Tunica vaginalis (potential space)
■ Causes: infection in the testes
or if he did I miss, trauma, or
tumor or idiopathic
○ Varicocele abnormal dilation and
tortuosity of the pampiniform Venous
plexus
■ Almost all varicocele are on
the left side (90%) —> left
testicular vein drains into the
left renal vein, which has a
slightly higher pressure, rather
than into the larger inferior
vena cava, as the right
testicular vein does
■ evident at physical
examination when a patient
stands, but is usually resolves
when the patient is recumbent
● Transurethral Resection of the Prostate
○ benign prostatic hypertrophy occurs in
20% of men by age 40, increasing with
age to 90% of males older than 80
○ nodular hyperplasia not a hypertrophy -
results from proliferation of epithelial
and stromal tissues, often in the
periurethral area
○ growth can lead to urinary urgency,
decrease extreme force, frequency
and nocturia
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○ Symptoms may necessitate
transurethral resection of the prostate,
in which the obstructing periurethral
part of the gland is remove using a
resectoscope
● Prostatic Carcinoma
○ most common visceral cancer in males
and the second leading cause of that
in men older than 50, after lung cancer.
○ Primary lesion in which the prostatic
capsule and then spread along the
ejaculatory ducks into the space
between the seminal vesicles and
bladder
○ The pelvic lymphatics and rich venous
drainage of the prostate (prostatic
venous plexus) facilitate metastatic
spread to distant site
○ Blood test for PSA levels and the rectal
exam can detect cancer but only
biopsy can confirm
Sexually Transmitted Diseases
Human papillomavirus (HPV) and Chlamydia
trachomatis infections-The two most common STDs in the
United States
Human papillomavirus (HPV)
● HPV infections (>90% benign) are characterized
in both genders by warty lesions caused most
often by serotypes 6 and 11.
● The virus is typically spread by skin-to-skin
contact; the incubation period is 3 weeks to 8
months.
● HPV is highly associated with cervical cancer in
women.
Chlamydia trachomatis infections
● Chlamydial infection is the most common
bacterial STD, with antibodies present in up to
 SECTION A&B TOPIC: Genitourinary Development and Male Reproductive System

40% of all sexually active women (which

suggests prior infection).
● Infected structures include the urethra, cervix,
greater vestibular glands, and uterine tubes in
females and the urethra, epididymis, and
prostate in males.

Reference

Doc Villarosa’s ppt

Netter’s Clinical anatomy 4th edition

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