Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section I: ANATOMY AND PHYSIOLOGY OF THE GENITOURINARY ORGANS
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3-7. MALE REPRODUCTIVE ORGANS
a. The male reproductive organs (see figure 3-5) include the two testes, epididymides, seminal ducts (vas deferens), seminal vesicles, Cowper's glands, and ejaculatory ducts, as well as the single reproductive organs of the prostate, penis, and urethra. The scrotum is located behind the base of the penis and in front of the anus. This loose sac contains and supports the testes, the epididymides, and some of the spermatic cord. The two sides of the scrotum are separated from each other by a median raphe. Within the scrotum there are two cavities or sacs that are lined with smooth and glistening tissue, known as the tunica vaginalis. Normally, a small amount of clear fluid is contained in the tunica vaginalis. The condition known as hydrocele denotes an abnormal accumulation of this fluid.
b. The testes manufacture the spermatozoa and also contain a specialized cell (Leydig) that produces the male hormone. Each testis consists of many tubules, in which the sperm are formed, surrounded by a dense capsule of connective tissue. The tubules coalesce and continue into the adjacent epididymis where the sperm mature and are stored.
c. The epididymis is a long narrow organ that lies along the posterior border of each testis. It connects the testis with the seminal duct. The vas deferens (ductus deferens, or seminal duct) is a distal continuation of the epididymis. Each is the excretory duct of the testis and conveys the sperm from the epididymis to the seminal vesicle.
d. The vas deferens lies within the spermatic cord in the inguinal region. The spermatic cord also contains the veins, arteries, lymphatics, nerves, and surrounding connective tissue (cremaster muscle) that give support to the testes.
e. The seminal vesicles are structures that unite with the vas deferens on either side. The terminal portion of each vas deferens is called the ejaculatory duct, which passes between the lobes of the prostate gland and opens into the prostatic urethra.
f. The prostate gland is an accessory sex organ. It lies just below the bladder in front of the rectum and surrounds the prostatic portion of the urethra. The entire prostate gland, which consists of five lobes, is surrounded by a fibrous capsule, through which the ejaculatory ducts enter to pass through the gland. Behind the prostatic capsule, there is a fibrous sheath that separates the prostate gland and the seminal vesicles from the rectum. The lobes of the gland secrete a highly alkaline fluid that dilutes the testicular secretion as it comes from the ejaculatory ducts. The prostate gland receives its blood supply from the internal pudendal, inferior vesical, and hemorrhoidal arteries.
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g. Two small bodies called Cowper's glands are situated on either side of the membranous portion of the urethra inferior to the prostate. Each gland via its duct empties mucous secretions into the urethra.
h. The penis is a pendulous organ suspended by the fascial attachments of the pubis arch and supported by the suspensory ligaments. The penis contains three distinct vascular sponge-like bodies: the two upper bodies are called the right and left corpus cavernosum and the lower body, the corpus spongiosum urethras. The tissue contains a network of vascular channels that fill with blood on erection. At the distal end of the penis, the skin is doubly folded to form the so-called prepuce, or foreskin, which serves as a covering for the glans penis. The glans penis contains the urethral orifice.
