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Question. Blood supply of the rectum?. Superior rectal artery (inferior mesenteric) Middle rectal artery (anterior division of internal iliac) Inferior rectal artery (internal pudendal ). Nerves of the Pelvis. Pudendal S2‑S4

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  1. Question • Blood supply of the rectum? • Superior rectal artery (inferior mesenteric) • Middle rectal artery (anterior division of internal iliac) • Inferior rectal artery (internal pudendal)

  2. Nerves of the Pelvis • Pudendal • S2‑S4 • Sensory to genitalia; muscular branches to perineal muscles, external urethral sphincter, external anal sphincter • Pelvic splanchnic • S2‑S4 • Pelvic viscera via inferior hypogastric and pelvic plexuses • Nerve to levator ani and coccygeus • S3‑S4 • Levator ani and coccygeus muscles

  3. Revision on Inguinal Canal

  4. Spermatic Cord • Contains structures to and from testes • Begins at deep inguinal ring, lateral to inferior epigastrics • Fascial coverings: • Internal spermatic fascia (transversalisfascia) • Cremasteric fascia (internal oblique) – contains cremaster muscle • External spermatic fascia (external oblique) • Contents: • Ductus (vas) deferens • Testicular artery, cremasteric artery, deferential artery, pampiniform plexus • Sympathetics, genital branch of genitofemoral nerve • Vestige of processus vaginalis • Lymphatics

  5. Anatomy of the Scrotum • Cutaneous sac • Dartos fascia (continuous with Scarpa and Colles fascia) • Dartos muscle • Septum, scrotal raphe • Innervation: Genital branch of genitofemoral nerve (anterolateral surface) • Posterior scrotal nerves (internal pudendal, S2-S4)

  6. Anatomy of Testes • Tunica vaginalis = closed peritoneal sac = closed-off remnant of processus vaginalis in embryo • Testis covered by visceral layer, except for attachment to epididymis and spermatic cord • Parietal layer is adjacent to internal spermatic fascia • Small amount of fluid allows free movement • Tunica albuginea = tough fibrous outer surface • Mediastinum of testis = origin of fibrous septa • Right testicular vein  IVC, left vein  renal artery

  7. Epididymis • Duct of epididymis = Convoluted tube of smooth muscle of posterior aspect of testes – moves spermatozoa distally with peristalsis and stereocilia • Head superior expanded part (lobules of 12-14 ductuli efferentes) • Appendices of epididymis = remnant of mesonephric (Wolffian) duct • Body • Tail

  8. Ductus Deferens • Continuation of duct of epididymis (from tail) – ascends posterior to testis and medial to epididymis • Penetrates abdominal wall via spermatic cord / inguinal canal, crossing external iliac vessels • Crosses ureter, terminates as the ampulla of ductus deferens to join duct of seminal gland to form ejaculatory duct • Artery to ductus deferens arises from superior vesical

  9. Seminal Vesicles and Ejaculatory Duct • Seminal vesicle (gland) about 5cm-long glandular diverticulum between fundus of bladder and rectum • Does not store sperm • Duct of seminal vesicles joins ampulla of ductus deferens • Ejaculatory duct: 2.5cm long, slender tubes that pass through prostate • Alongside prostatic utricle • Open on the verumontanum (seminal colliculus) • Supplied by artery to ductus deferens • Ductus deferens, seminal glands, ejaculatory ducts and prostate innervated by sympathetic nervous system (intermediolateral cell column T12-L2 via transverse lumbar splanchnic nerves, hypogastric and pelvic nerve plexuses)

  10. Prostate • Fibrous capsule + visceral layer of pelvic fascia = prostatic sheath • Connects with puboprostatic ligaments anteriorly • Rectovesical septum posterior • Base (neck of bladder) • Apex (urethral sphincter, perineal muscles) • Anterior surface (rhabdosphincter/ external urethral sphincter); Space of Retzius / retropubic space • Posterior surface (ampulla of rectum) • Inferolateral surface (levator ani) • Largest accessory gland of male system – 3 x 4 x 2cm (length/width/depth)

  11. Divisions of prostate • Lobes • Isthmus (anterior lobe) • Right and left lateral lobes • Inferoposterior lobule (palpable in DRE) • Inferolateral lobule (lateral to urethra) • Median lobe – undergoes hypertrophy • Superomedial lobule (surrounds ejaculatory duct • Anteromedial lobule (proximal prostatic urethra) • Zones • Transition zone (5% of glandular tissue, around proximal urethra – site of benign nodular hyperplasia) • Central zone (around ejaculatory ducts, 20% of tissue) • Peripheral zone (70% of tissue, most cases of prostatic carcinoma)

  12. Prostatic ducts (20-30) open into prostatic sinuses either side of verumontanum (seminal colliculus) • Prostatic utricle = remnant of uterovaginal canal • Corpora amylacea = inspissated prostatic secretions that increase with age and become calcified • Prostatic arteries = branches of inferior vesicle (some from internal pudendal and middle rectal) • Prostatic venous plexus drains into internal iliac

  13. Male Urethra • Four parts: intramural, prostatic, membranous, spongy • Membranous • Apex of prostate to bulb of penis via external urethral sphincter • Bulbourethral glands of Cowper lie posterolateral to membranous urethra, inside external urethral sphincter • Spongy urethra in corpus spongiosum, 5mm in diameter • Intrabulbar fossa in bulb of penis • Navicular fossa in glans • Urethral glans secrete mucus • Somatic innervation visa dorsal nerve of penis (pudendal) • Dorsal artery of penis supplies membranous and spongy parts

  14. Penis • Erect in anatomical position, so dorsum faces anteriorly when flaccid • Three cylindrical cavernous bodies • Paired corpora cavernosa dorsally (singular = corpus cavernosum). Forma crura of the penis proximally, separated by septum penis • Corpus spongiosum • Each covered in fibrous capsule, tunica albuginea • Root of penis = attached part. Located in superficial perineal pouch • Crura = masses of erectile tissue. Each crus attached to ischial ramus • Bulb = enlarged posterior part. Penetrated by urethra • Ischiocavernosus and bulbospongiosus muscles • Suspensory ligament of penis (sling from symphysis) • Fundiform ligament of penis (from linea alba, anterior to symphysis) • Buck’s fascia = deep fascia of the penis (continuation of perineal fascia)

  15. Body is free part suspended from pubic symphysis. No muscular tissue • Glans = distal expansion of corpus spongiosum • Corona of glans = proximal margin • Coronal sulcus = oblique groove overhung by corona • Covered by prepuce (foreskin) • Frenulum of prepuce = median fold • External urethral meatus near tip of glans • Arterial supply: From internal pudendal • Dorsal arteries of penis run in dorsal groove between corpora cavernosa • Deep arteries run in centre of corpora cavernosa • Form helicine arteries of penis in erectile tissue • Venous drainage: Dorsal vein of penis drains to prostatic venous plexus • Innervation: PSNS S2-S4 via pelvic splanchnic and pudendal

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