Posted by lae2 on October 13, 2021 at 17:51:52:
A 57-year-old male with frequent urination and urgency is diagnosed with benign prostatic hypertrophy. Discuss the anatomy of the male prostate, including anatomical features, relationships, fascia, and ligamentous support. Account for the pathways followed by sperm before and during ejaculation. Define the named parts of the male urethra.
To assess the patency of the uterine tubes, you perform a hysterosalpingogram and observe radio-opaque contrast accumulation in the pararectal fossae. Describe the anatomy of the uterus and adnexa (ovarian tubes, ovaries, broad ligament), including relationships, vasculature, ligamentous support, and fascia. Trace the pathway from the vaginal opening to the pararectal fossae and rectouterine pouch.
True False Questions
The round ligament of the uterus is adhered to the anterior lamina of the broad ligament.
The remnant of the gubernaculum in males is the scrotal ligament, whereas the remnant of the gubernaculum in females forms both the round ligament of the uterus and ovarian ligament.
The transverse cervical ligament (cardinal, Mackenrodt's) is a condensation of visceral pelvic fascia and is followed by uterine vessels toward the cervix.
The seminal colliculus is the widening of the urethral crest on the posterior wall of the prostatic urethra and is a key landmark to identify during transurethral resection of the prostate (TURP).
The puboprostatic ligament can be accessed through the prevesical (retropubic) space without needing to enter the peritoneal cavity..
The ejaculatory ducts empty into the prostatic urethra at the seminal colliculus at the posterior wall.
The prostatic ducts empty into the prostatic urethra at the prostatic sinuses on the posterior wall.
The utricle is a small, midline depression of the seminal colliculus that is said to the homolog of the uterus.
The vas deferens crosses the superoanterior margin of the ureter at the ureterovesical junction.
The seminal vesicles are located lateral to the ampullae of the vas deferens.
The peripheral zone of the prostate is the site for 70% of cancers and is located within the posterior wall of the prostate, and thus, can be palpated during digital rectal examination.
In the male, the urethral crest extends from the uvula and then widens within the posterior wall of the prostatic urethra to form the seminal colliculus.
The membranous urethra is surrounded by the external urethral sphincter.
The navicular fossa is the widening of the spongy urethra at the glans of the penis and may be a challenge to navigate during catheterization.
The cervix of the uterus extends into the proximal vagina and, thus, forms fornices between the cervix and the vaginal wall.
The posterior fornix of the vagina is closely related to the rectouterine pouch (of Douglas) and the anterior wall of the rectum.
Culdocentesis is a procedure using the posterior vaginal fornix as means to sample fluids that may have accumulated in the rectouterine pouch.
The internal os of the cervical canal provides a communication between the vagina and the uterine cavity.
The uterus is normally anteverted 90 degrees and then anteflexed another 30 degrees and, thus, the cervical canal and uterine body do not have a linear relationship with the vagina.
The endometrium lines the uterine cavity.
The uterine tube provides communication between the uterine cavity and the peritoneal cavity.
Lymphatic drainage of the superior pole of the ovary is to upper lumbar nodes (follows ovarian vessels), whereas lymphatic drainage of the inferior pole of the ovary is to superficial inguinal nodes (follows ovarian and round ligaments).
Lymphatic drainage of the fundus of the uterus is to upper lumbar nodes (ovarian vessels anastomose along the margin of the fundus).
Lymphatic drainage of the cervix of the uterus is to internal iliac nodes (follows uterine vessels).
Lymphatic drainage of the proximal vagina is to internal iliac nodes (follows uterine, vaginal, and internal pudendal vessels).
Lymphatic drainage of the distal vagina is to superficial inguinal nodes (follows external pudendal vessels).
The suspensory ligament of the ovary is a visceral ligament, whereas the ovarian ligament is a fibrous ligament (remnant of gubernaculum).
The broad ligament consists of mesovarium plus mesosalpinx plus mesometrium and the extraperitoneal connective tissue within the broad ligament, known as parametrium.
Transversalis fascia of the abdominal cavity is continuous with parietal pelvic fascia of the pelvic cavity, whereas extraperitoneal connective tissue of the abdominal cavity is continuous with visceral pelvic fascia of the pelvic cavity.
Visceral pelvic fascia condenses to form perivisceral fascia around the retroperitoneal surfaces of the pelvic organs.
Visceral pelvic fascia condenses to form the pubosacral ligamentous complex.
The fascia of Denonvilliers is a thickening of the posterior periprostatic fascia and is derived from visceral pelvic fascia.
Retroperitoneal pelvic viscera are below the pelvic pain line and, thus, both nociception and homeostatic afferent pathways follow parasympathetic pathways (pelvic splanchnic nerves) and refer pain to S2-4 spinal cord levels.
There is an anatomical basis to predict that perturbed retroperitoneal pelvic viscera may refer pain to the posterior lower extremity, including the foot (S2 dermatome).
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