REAMPP of testes, and penis

Presenter – Dr Yonas F. (GSR - 1)

Moderator – Dr Desyibelew (Ass’t Profesor of

G,Surgery, Urosurgeon)
Outlines
• Embryology
• Anatomy
• Histology
• Physiology
• Common Pathology
• Pharmacology of testes and Penis

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 Embryology of Gonads
• Derived from Intermidate Mesoderm

• the gonad is developed three primordia:

• Primordial germ cells
• Genital ridge
• Coelomic epithelium overlying the
mesenchyme

• Sex of Embryo is Determined at time Fertilization.

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 Indifferente Stage < 8 weeks
• Males and females have the same primordia

• Gonads Begin as Urogenital Ridge (3-4 th

wks)

• Urogenital ridge Differentiation (5-6wks)

• A mesonephric duct & paramesonephric duct
form

• Migration of Primordal Germcell ( 7th wks)

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Cont...

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 Differentiated Stage of Development
• The genetic sex determines the sexual path
of differentiation.

• The sex regulatory (SRY) gene

• TDF - causes the gonad to become a testis.

• Testosterone - by Leydig cells

• causes external genital development
and
• the MD into the male genital duct
system.
• Setoli cells -MIF
• degeneration of thePMD

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 Descent of the Testes
• In lumbar region, Near to Developing kideny,
Retroperitoneal.
• Loosely attached with
• CSL and Gubernaculum.
• Start at 8-9 wks of Gestation
• Has two Stage
• Tran Abdominal Stage - Non Androgen
Dependent
• Inguino-Scrotal Stage of Development -
Androgen Dependent Descent
• Chronological Migration of testis

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 Factors for testicular descent
• Hormonal Factors • Mechanical Factors
• Androgens -HCG, Testosterone, DHT • Gubernaculum
• MIS (mullerian inhibiting substance), • Guild and Dilate Inguinal Cannal
• Calcitonine Gene related peptide (CGRP), • Increase Intra abdominal pressure
• by Genitofemoral Nerve under influence • Due to Development of Solid
of Androgens Organs and Intestine
• Direct the Migration Of Gubernaculum. • Elongation Process Vaginalis
• INSL-3 • Change in Temprature
• Direct Growth of Gubernaculum. • Need 3-4*C lower than Abdominal
Cavity T* for Spermatogenesis
• that is On Scrotum

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 Congenital Gonadal Anomalies
• The gonadal
• agenesis, hypogenesis, dysgenesis,

• Cryptorchidism

• ectopic testis
• Subsidary Tail of Gubernaculum
• Defects of Closure of the PV
• diverticular defects and cystic defects

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Cont....
• The paradidymis (organ of Giraldes)
• persistent remnants of MD.
• appendix of the epididymis (hydatid of
Morgagni).
• The cranial part of the MD.
• the appendix of the testis
• is the remnant of the cranial end of the
paramesonephric (müllerian) duct

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Surgical Anatomy of testicles
• paired Ovoid or Ellipsoid structures, located
within the scrotum.
• The normally testis is ;
• 4 to 5 cm long and 3 cm wide.
• Commonly, the left testicle lies lower than
the right.
• External Feature
• Two pole (Upper & Lower Pole).
• Two boarder (Anterior & Posterior)
• Two Surface (Medial & Lateral)

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 Cont...
• Layer of Testis
• Tunica Vaginalis
• Tunica Albuginea
• Tunica Vasculosa

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Epididymis

• It is Highly Coiled tubules Located on

Superior and Posterolateral Aspect of Testes.
• Has 3 Part
• Head - is firmly fixed to the upper pole of the testis
• Body &Tail
• less firmly fixed to the posterior border of the testis.

• Anatomical Variant of epididymis

• This posterior surface is not covered by the
tunica vaginalis, but it is the site of the blood
and nerve supply to both organs.

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 Histology of Testis
• Microanatomy of Testis
• Covering Layers
• Semniferious tubules
• Contain Spermatogonea
• Sertoli cell.
• Lyding cells.
• They are held together by
loss CT with interpspersing
group of cell called Lyding
cells.
• Reti testis/Tubular testis
• In Apex of S.tubules,
Tubules became Less
convoluted(Stright),
Converge in to 20-30 large
ducts called Reti
testis/Tubular testis
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 Vascular Supply
• Testicular arteries
• The main arterial Supply
• Cremasteric artery
• from the inferior epigastric artery.
• Artery of the vas deferens
• from the inferior vesical artery).
• anastomoses to the main testicular
artery.
• Ant. & Pos Scrotal Arteries also.

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 Venous Drainage
• a deep and a superficial venous network
System.
• The deep venous network
• Anterior: Pampiniform plexus and testicular
vein
• Middle: Deferential and funicular veins
• inferior epigastric veins
• Posterior: Cremasteric veins
• the pelvic plexus

• The superficial venous network

• The scrotal veins

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 Cont...
• The pampiniform venous plexus is
• a network of veins from testis
• formed in the spermatic cord by 10 to 12 veins

• Superficial Inguinal ring - 04 veins

• internal inguinal ring - 02 veins.

• Rt testicular vein - the IVC
• Lt testicular vein - left renal vein.

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Lymphatics
• the lymphatic drainage is to the
lumbar and Pre/para-aortic nodes.
• At level of L2&L3.

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Cont...
• Innervation
• Autonomic Nerves
• sympathetic - Renal & Aortic
Sympathatic Plexus
• Affarant Sensory Nerves
• Genitofemoral nerve (L1, L2)
• Supply Cremasteric Muscle
• The ilioinguinal nerve (L1)
• supplies the skin of the penile root,

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 Physiology of Testis
• Endocrine and reproductive
function.
• site of testosterone and Sperm
cell Synthesis.
• Spermatogenesis
• Testes
• Seminiferous tubule
• Sertoli Cells,
Spermatogenic cells .

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Cont...
• Testosterone Synthesis
•Through process HPT Axis
• regulation, maintenance,
well-being, and transport
of the spermatozoa,
• Development of the
reproductive glands and
• secondary sex
characteristics.

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Cont...
• Common Pathology of Testis
• Infectious
• Epididymorchitis
• Trauma
• Hydrocele
• Testicular torsion
• Varicocele
• Testicular Ca

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Development of Male Ex. Genitalia
• Undifferent Stage of Development
• Primordal External Genitalia
contains
• Genital Tubercle
• Labioscrotal Swelling
• Urethral folds

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 Differentiated stage Stage of Dev’t
• At approximately 9 weeks’ gestation
• he gene products of the SRY genetic
cascade
• direct testicular development.,
• Testestrone & DHT from Lyding
cell of Testis.
• masculinize
• the genital tubercle,
• urogenital sinus (UGS),
• Urethral folds and
• Labioscrotal Swellings

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Differentiated stage Stage of Dev’t

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Congenital Anomalies
• Aphallia, Micropenis,Megalopenis
• Bifida penis/Double penis
• Penile curveture

• Hypospadiasis
• Epispadiasis

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Anatomy of Penis
• The root, or penile bulb,
• in the superficial perineal pouch.
• formed by bulb and Pair of crura
• it provides fixation and stability.
• The body
• is formed by the three spongy erectile
anatomic entities:
• The glans
• is the distal end of the corpus
spongiosum.

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Cont...
• Body of Penis
• Pair of corpora cavernosa
• corpus spongiosum, or penile
bulb.

• Glans of penis

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Penile Coverings

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 Microanatomy

• T.Albuginea
• Collagens and Elastic fibers
• two layers (Emissary vein in B/n).
• C.Cavernosum
• Formed by interconnected Sinusoids
separated by SM Trabiculae
• Larger in center and smaller in Periphery
• Helical Artery and terminal Cavernose
nerve (Branches of deep penile artery).
• C.Spongiosum
• Sinusoids are Larger
• Thinner outer layer of T,Albuginea
• Glans
• No tunical Covering
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Vascular Supply
• Arteries
• For Skin of Penis
• Superficial penile artery.
• From Superficial external
pudendal artery.

• For Ventral aspect of Skin of penis

• by Posterior Scrotal Artery.
• Branch from Superficial Deep
internal pudendal Artery.

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 Supply to Deep Structure of penis
• From internal pudendal arteries,

• the bulbourethral artery

• the deep artery (central
or cavernous), and
• the dorsal artery.

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 Venous Drainage
• Superficial System - penile skin
• The superficial dorsal vein
• via Ex, Pudendal Vein - to Great
saphenous
• Intermediate system
• Deep dorsal & circumflex veins
• Deep drainage System
• Crural and Cavernosal Vein
• (Consolidation of Emissary vein)

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 Cont...

• Lymphatics
• The lymphatic drainage of the penis
is peculiar.
• The skin and prepuce
• to superficial inguinal lymph nodes.
• glans and penile urethra
• to the deep inguinal and external
iliac lymph nodes.

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 Innervation
• Sensory
• The dorsal nerves of Penis
• innervate the skin and glans
of the penis.
• The ilioinguinal nerve
• innervates the skin of the
root of the penis.
• Motor
• The perineal nerves
• innervate bulbo cavernosus
and ischiocavernosus

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 Autonomic
• The sympathetic nerves(L1 &
L2,)
• hypogastric and pelvic nerves to
join cavernous nerve
• also travel to penis via pudendal
nerve
• vasoconstriction & detumescence
• The parasympathetic nerves
• Inferior Hypogastric Plexus (S2 -
S4) (the nervi erigentes).
• post ganglionic parasympathetic
fibers emerge as a part of the
cavernous nerve
• vasodilation and erection.

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 Physiology of Penis
• Organ of Copulation
• Erection - Parasympathatic Process
• Triggered by Site, thought or Toch
• Activate Parasympathetic NS, S2-S4 -
Cavernosus Nerve
• Endothelium Dorsal artery of Penis Convert
Arginine to NO & citrine
• NO Activate Guanine Cyclase, Convert GCT-
cGMP ,
• cGMP activate k+ channel on SM membrane,
K+ Leak out of Cells,
• Relaxation of Smooth muscle of Artery, Leads to
Vaso dilation.
• Significant Arterial Engorgement –
Compress the emissary veins, preventing
venous outflow.
• This so-called ‘veno-occlusive mechanism’
converts tumescence into an erection.
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 Cont....
• Ejaculation
• it is Reflex action Controlledd by Sympathatic NS (T12-L2)
• Triggered by Persistent Parasympathetic Outflow & Sexual
Act reach to critical Level of Excitement.
• Cerebral Cortex Recognize trigger and Start inhibit the
Parasympathetic Out flow by Activating sympathetic rxn.
• Send Multiple axons in D/t Area to inhibit Parasympathetic
flow
• Release NE, Activate SM
• Has 02 Phases
• 1st Phase - Vas deference, Seminal Vesicle, Ejaculatory duct start
Contract and Squeeze Semen to Reach to Prostatic Urethra.
• Also act on SM of Bladder neck – Prevent Retrograde ejaculation
• 2nd Phase - Muscle at base of Penis Start contract and Eject Semen
out of Penile urethra.
• Following ejaculation,all process is reversed; smooth muscle
contraction in response to sympathetic stimulation leads to
penile detumescence
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Common Pathology
• Phimosis, Paraphimosis
• Infectious
• Balanitis, balanoposthitis
• Trauma
• Penile Fracture
• Inflammatory
• Peyronie’s Disease
• Priapism
• Neoplasia
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Pharmacology
• Drug for Erectile dysfunction
• PDE-5 inhibitors
• Sildenafil, Vardenafil, Avanafil and
Tadalafil

• Drugs known to cause sexual dysfunction

• Antihypertensive
• Thiazide diuretics, β blockers,
• Antipsychotics, Antidepressants,
Anxiolytics
• aldostrone receptor antagonists
• Tobacco
• Alcohol large amount
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References

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 Thank you
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