1. Gross Anatomy of male internal genitalia
Dr Namani Sathya.

2. Functions of male reproductive system
Testis produces sperms
Various parts of genital tracts carry the sperms to the exterior
They provide for maturation and nutrition of sperms all along the tract
Accessory glands of male genitalia besides providing nutrition add quantity to semen

3. Parts of male internal genitalia
Testis
Epididymis
Vas deferens
Seminal vesicle
Ejaculatory duct
Prostate
Cowpers gland

4. Components of male internal genitalia
Testes
Duct system
Accessory glands

5. Testis

6. Shape & Size Male gonad It is ovoid in shape
3.5cm long, 2.5cm broad and 1.8cm thick
Weight 10 to 15 gm

7. External Features
2 poles upper and lower (upper attached to spermatic cord)
2 borders (anterior convex and smooth posterior straight partially covered by tunica vaginalis)
Epididymis separated by testis by sinus of the epididymis.
2 surfaces medial and lateral

8. Coverings of Testis
Tunica vaginalis – lower persistent portion of processus vaginalis ( parital and visceral layer cavity in between them)
Tunica albuginea – dense white fibrous coat, its posterior border is thickened to form incomplete vertical septum is called mediastinum testis.( numerous septa extend from mediastinum to inner surface of tunica albuginea this divides the testis into 200 to 300 lobules)
Tunica vasculosa it’s the innermost vascular coat

9. Internal Structure of Testis
1.Septa
2.Semeniferous tubule
3.Lobule
4.Straight tubule
5.Efferent ductules
6.Rete testis

10. Internal structure of testis
Testis is covered by tunica albugenia
It is thickened in the posterior part to form mediastinum testis
Mediastinum is traversed by network called rete testis
It sends septa to tunia albugenia
Dividing testis into 300 lobules

11. Internal structure of testis
Each lobule has 2-4 seminiferous tubules
They are lined by multilayered epithelium
Responsible for production of spermatozoa
Seminiferous tubules join to form 20 to 30 straight tubules
Straight tubules anatomose to form rete testis
12 to 30 Efferent ductules arise from rete testis

12. Efferent ductules
Efferent ductules emerge from upper end of mediastinum testis
They are in number
Efferent ductules open into single duct of epididymis

13. Epididymis The epididymis is 6 meters long Epididymis is highly coiled
It is comma shaped
It consists of head ,body and tail
Vas deferens emerges from the tail of epididymis
Reservoir of spermatozoa

14. Epididymis Artery- testicular artery Venous similar to testis
Nerves – sympathetic nerves through testicular plexus T11 to L 1

15. Blood supply of testis Testicular artery Artery of ductus deferens
Venous drainage is by pampiniform plexus ( anterior part around testicular artery middle part around ductus deferens and its artery posterior part isolated)
The plexus is responsible for maintenance of subnormal temperature
This is require for normal spermatogenesis to occur

16. Lymphatic and Nerves
Lymphatic drain into pre and paraarotic groups of lymph node.
Nerves – arises from T 10 through renal and aortic plexus

17. Descent of testis
Testis is formed in the lumbar region ( mesonephros) T10 to 12
3rd month IUL iliac fossa
Testis is near deep inguinal ring at 4th to 6 th month
7th month tranverse inguinal canal
At superficial inguinal ring at 8th month
At 9th month or about birth it descends into scrotum

18. Clincal - testis Undescended testis (cryptorchidism).
(anorchism) absence of both testis. The absence of one testis is termed monorchism
the testis, emerging at the subcutaneous inguinal ring, slips down between the scrotum and thigh and comes to rest in the perineum. This is known as perineal ectopia testis
Hydrocele - vaginal hydrocele,
congenital hydrocele, the fluid is in the sac of the tunica vaginalis, but this cavity communicates with the general peritoneal cavity
infantile hydrocele,
encysted hydrocele of the cord.

19. Vas deferens It is thick walled muscular duct
Also called as ductus deferens
It is thick walled muscular duct
It begins at the inferior pole of testis then posterior border of testis
It passes in the posterior part spermatic cord transverse the canal to reach the deep ring of inguinal ring.
In greater pelvis hooks around inferior epigastric artery
In lesser pelvis runs downwards and backwards on the lateral wall of pelvis
Reaches base of bladder

20. Vas deferens
It joins the duct of the seminal vesicle to form the ejaculatory duct
Each tube is about 45cm long
Arterial supply-artery to vas deferens usually arises from superior vesical artery.
Veins- joins vesical venous plexus then into internal iliac vein
They propel the sperm forward
In vasectomy it is cut as a permanent method of sterilization

21. Seminal vesicle
They are 2 tubular glands posteroinferior to bladder (between bladder and rectum)
5 cm in length
Each gland forms as an outpocketing from the wall of ampulla of vas deferens
The duct of the seminal vesicle opens into vas deferens to form the ejaculatory duct
It secretes significant portion of semen and concerned with nutrition of spermatozoa.
Alkaline (fructose and vesiculase Coa Ezy)

22. Ejaculatory duct They are 2 cm in length
It is formed by the union of vas deferens and duct of the seminal vesicle
They enter and pass through the prostate and empty into urethra

23. Prostate

24. Prostate gland It is a male gland It secretes slightly alkaline fluid
Constitutes 30% of volume of semen
It surrounds urethra just below the urinary bladder
Can be felt in the rectal examination
The part of urethra in the prostate is called the prostatic part
Ejaculatory ducts open into this part

25. Size and shape It is an inverted cone
Its measures 3.5 cm across the base and length is 3 cm
It has
upper base
lower apex
four surfaces
Anterior
Posterior
Two inferolateral surfaces

26. Capsules It has outer false capsule made of pelvic visceral fascia
It has inner true capsule formed by fibromuscular tissue
There is prostatic venous plexus in between the capsules
The capsule should not be disturbed in surgery as it will lead to heavy bleeding
The plexus communicates with internal vertebral venous plexus
Cancer can spread to brain without blood passing through the heart

27. Lobes Lobe in front of urethra is the anterior lobe
In the posterior part the lobe above the ejaculatory duct is the median lobe
The lobe below the ejaculatory duct is the posterior lobe

28. Lobes Lobes on either sides of anterior lobe are the lateral lobes
This is done by an imaginary line at the level of ejaculatory ducts
So there are five lobes:
Two lateral lobes
Anterior lobe
Median lobe
Posterior lobe

29. Showing lobes of prostate

30. Relations Base related to -neck of bladder
Apex related to -urogenital diaphragm
Lateral surfaces related to- levator ani muscle

31. Relations
Anteriorly related to -pubic bone separated by retropubic pad of fat
Posteriorly related to
rectum separated by rectovesical septum
Pierced by ejaculatory ducts

32. Structures within prostate
Prostatic urethra transverse btw ant 1/3rd and post 2/3rd
There is a longitudinal ridge called urethral crest
In its lower end there is swelling called the seminal colliculus
On it there are opening on either side for ejaculatory ducts
An blind opening in the centre called prostatic utricle
It is similar to uterus in females
On either side of the urethral crest there is a fossa called prostatic sinus and prostatic ducts open here

33. Prostatic urethra Seminal colliculus Ejaculatory ducts
Prostatic utricle

34. Blood supply Prostate is supplied There are two types of branches
Internal pudendal arteries
Inferior vesicle arteries
Middle rectal arteries
There are two types of branches
Capsular
Urethral
Urethral branches mainly supply median lobe
Urethral branches
Capsular branches

35. Venous drainage Prostatic venous plexus is between the capsules
Drains into internal vertebral venous plexus (walveless communication)
Cancer can spread to vertebral column and skull

36. Lymphatic drainage-
Internal iliac
Sacral
External iliac

37. Nerve supply
Parasympathetic from S 2-4
Sympathetic from T11 –L2

38. Zones of prostate It consists of 3 distinct zones
Central zone
Transitional zone
Peripheral zone.
Benign prostate hypertrophy occurs in – Central zone
Prostate cancer occurs in -peripheral zone

39. Zones Central zone consists of median lobe
Peripheral lobe consists of posterior lobe

40. Age changes in prostate
At birth-
Contains fibromuscular tissue with rudimentary duct system
This will continue for 9 years
At puberty
Testosterone levels increase
Duct system increases
Fibromuscular tissue condenses
Prostate becomes doubles the size
During 3rd decade
Follicles increase in size
With infoldings of epithelium
During years
Size remains constant
But infolding are lost and becomes regular
After 45 years
Either undergo hypertrophy
Or atrophy because of hormonal imbalance

41. Applied anatomy
Rise in acid phophatase in blood occurs in cancer of prostate
because it is not excreted
In benign prostatic enlargement
Median lobe is mainly involved
Frequency of micturation
Enlarged median lobe distorts the internal urethral sphincter
Leading to trickling of urine drops and causing frequency
Precipitancy of micturation
Trickling drops elicits micturation reflex
leading to wetting of cloths before reaching bathroom
Urine stagnation
Median lobe enlargement can close the urethral sphincter while straining to pass urine
Leading to stagnation
Hesitancy of micturation
Median and lateral lobe enlargement
Can close the urethra completely
Unable to start micturation