Male genital system Systema genitalium masculinum Morphology

Organa genitalia masculina interna Testis (gr. orchis) Testis (gr. orchis) Epididymis Epididymis Funiculus spermaticus = spermatic cord Funiculus spermaticus = spermatic cord including ductus deferens (= vas deferens) including ductus deferens (= vas deferens) Glandula vesiculosa / seminalis (Vesiculae seminales) = seminal gland / vesicle Glandula vesiculosa / seminalis (Vesiculae seminales) = seminal gland / vesicle Prostata = prostate Prostata = prostate Glandula bulbourethralis = bulbo-urethral gland Glandula bulbourethralis = bulbo-urethral gland

Organa genitalia masculina externa Penis Penis Urethra masculina = male urethra Urethra masculina = male urethra Scrotum Scrotum

Testis (gr. orchis) Description Description extremitas (pole) sup. + inf, margo (border) ant. + post., facies (surface) med. + lat. extremitas (pole) sup. + inf, margo (border) ant. + post., facies (surface) med. + lat. Covers Covers tunica vaginalis et albuginea tunica vaginalis et albuginea Section Section septula, mediastinum, lobuli, rete septula, mediastinum, lobuli, rete Tubuli seminiferti contorti  recti Tubuli seminiferti contorti  recti Ligaments Ligaments gubernaculum testis gubernaculum testis

Testes - histology Tunica albuginea Tunica albuginea Lobuli testis Lobuli testis Tubuli seminiferi Tubuli seminiferi spermatogennic epithelium (structure ) spermatogennic epithelium (structure ) Spermatogennic cells – various stades - takes 64 days Spermatogennic cells – various stades - takes 64 days Sertoli´s cells (nutrition, testicular fluid, androgen-binding protein ABS, anti-müllerian hormone AMH=MIS, zonulae occludentes: hematotesticular barrier) Sertoli´s cells (nutrition, testicular fluid, androgen-binding protein ABS, anti-müllerian hormone AMH=MIS, zonulae occludentes: hematotesticular barrier) Intestitium Intestitium Leydig´s cells  testosteron Leydig´s cells  testosteron Collagen tissue, fenestrated capillaries, fibroblasta, histiocytes, macrophages Collagen tissue, fenestrated capillaries, fibroblasta, histiocytes, macrophages

Excretory genital ducts Tubuli recti Tubuli recti cuboideal Sertolli´s cells cuboideal Sertolli´s cells Rete testis Rete testis cuboideal Sertolli´s cells cuboideal Sertolli´s cells Ductuli efferentes Ductuli efferentes columnar epithelium with stereocilia and cilia columnar epithelium with stereocilia and cilia Ductus epididymidis Ductus epididymidis pseudostratified columnar epithelium with stereocilia pseudostratified columnar epithelium with stereocilia Inhibition of capacitation Inhibition of capacitation Ductus deferens Ductus deferens thick muscular wall thick muscular wall pseudostratified columnar epithelium pseudostratified columnar epithelium Ductus ejaculatorius Ductus ejaculatorius no muscle layer ! no muscle layer !

Epididymis Description Description caput, corpus, cauda caput, corpus, cauda Section Section lobuli, ductus lobuli, ductus Ligaments Ligaments lig. epididymidis sup. + inf. lig. epididymidis sup. + inf.

Testis + epidydimis arterial supply aorta abdominalis aorta abdominalis  a. testicularis branches enter lobuli from the periphery, not in the hilum ! auxilliary blood supply a. iliaca interna a. iliaca interna  a. umbilicalis  a. ductus deferentis a. iliaca externa a. iliaca externa  a. epigastrica inf.  a. cremasterica mutual anastomosis

Testis and epididymis other supply Veins: Veins: rete testis  plexus pampiniformis  vv. testiculares  v. cava inf. (dx.), v. renalis (sin.) rete testis  plexus pampiniformis  vv. testiculares  v. cava inf. (dx.), v. renalis (sin.) Lymph drainage: Lymph drainage: nodi lymphoidei lumbales nodi lymphoidei lumbales Nerves: Nerves: plexus testicularis plexus testicularis sympathetic by plexus coeliacus + intermesentericus, parasympathetic by n. vagus !!! sympathetic by plexus coeliacus + intermesentericus, parasympathetic by n. vagus !!!

Developmental rudiments from mesonephric canals paradidymis (Giraldes´ organ) paradidymis (Giraldes´ organ) ductuli aberrantes (sup. + inf.) ductuli aberrantes (sup. + inf.) appendix epididymidis appendix epididymidis from Müllerian duct appendix testis appendix testis

Ductus deferens (Vas deferens) pars scrotalis pars scrotalis pars funicularis pars funicularis pars inguinalis pars inguinalis pars pelvica pars pelvica ampulla d.d ampulla d.dcrossings

Ductus deferens / Vas deferens Tunica mucosa – pseudostratified columnar epithelium with stereocilia Tunica mucosa – pseudostratified columnar epithelium with stereocilia Tunica muscularis – 3 layers of smooth muscle (L, C, L) Tunica muscularis – 3 layers of smooth muscle (L, C, L) Adventitia Adventitia tough as a goose-quill folds, very thick muscle layer Emission = sperms transport to colliculus seminalis prostatae

Ductus deferens / Vas deferens supply Arteries: Arteries: a. iliaca int.  a. umbilicalis  a. ductus deferentis a. iliaca int.  a. umbilicalis  a. ductus deferentis Veins: Veins: plexus pampiniformis, plexus venosus vesicalis plexus pampiniformis, plexus venosus vesicalis Lymph drainage: Lymph drainage: n.l. iliaci ext. + int. n.l. iliaci ext. + int. Nerves: Nerves: plexus deferentialis plexus deferentialis

Funiculus spermaticus (Spermatic cord) covers tunica dartos tunica dartos fascia spermatica externa fascia spermatica externa m. cremaster cum fascia cremasterica m. cremaster cum fascia cremasterica fascia spermatica interna fascia spermatica interna derivated from the anterior abdominal wall by descensus testis

Funiculus spermaticus content a. ductus deferentis (  a.iliaca int.) a. ductus deferentis (  a.iliaca int.) a. testicularis (  aorta abdominalis) a. testicularis (  aorta abdominalis) plexus pampiniformis (venous plexus)  v. cava inf. plexus pampiniformis (venous plexus)  v. cava inf. ductus deferens ductus deferens a. et v. cremasterica (  a. epigastrica inf.) a. et v. cremasterica (  a. epigastrica inf.) vestigium processus vaginalis peritonei vestigium processus vaginalis peritonei plexus deferentialis et testicularis (= nervous plexuses) plexus deferentialis et testicularis (= nervous plexuses) lymph vessels (along veins) lymph vessels (along veins)

Funiculus spermaticus - HE

Glandula vesiculosa /seminalis (incorrectly Vesiculae seminales) = seminal gland / vesicle Position: behind the urinary bladder, in connection with peritoneum! – excavatio rectovesicalis Position: behind the urinary bladder, in connection with peritoneum! – excavatio rectovesicalis Ductus excretorius  ductus ejaculatorius Ductus excretorius  ductus ejaculatorius cuboideal-to-pseudostratified epithelium, folded mucosa cuboideal-to-pseudostratified epithelium, folded mucosa Muscles: 2 smooth layer – circular (inner) and longitudinal (outer) Muscles: 2 smooth layer – circular (inner) and longitudinal (outer) Function: 70% of seminal fluid, pH 7,2 –7,6 /proteins + fructose + prostaglandins + citrate/ Function: 70% of seminal fluid, pH 7,2 –7,6 /proteins + fructose + prostaglandins + citrate/

Glandulae vesiculosae - HE

Prostata Prostate Section: lobuli (4), ductuli, parenchyma Section: lobuli (4), ductuli, parenchyma Pars prostatica urethrae Pars prostatica urethrae colliculus seminalis colliculus seminalis utriculus prostaticus utriculus prostaticus sinus prostaticus sinus prostaticus Position: Position: m. puboprostaticus m. puboprostaticus under urinary bladder under urinary bladder subperitoneal organ subperitoneal organ

Outer description: basis, apex, facies /3/, isthmus Lobi prostatae: dexter et sinister /4 lobuli each / (Lobus medius) Pars prostatica urethrae + ductus ejaculatorius

Prostata (Prostate) section urethral glands zone + ductuli prostatici urethral glands zone + ductuli prostatici Inner (transitory) zone Inner (transitory) zone tuboalveolar glands tuboalveolar glands outer (peripheral) zone outer (peripheral) zone less glands + fibromuscular stroma (= substantia muscularis) less glands + fibromuscular stroma (= substantia muscularis) capsula prostatica capsula prostatica (plexus venosus prostaticus) (plexus venosus prostaticus)

Prostata + glandulae vesiculosae supply arteries: branches of a. iliaca int. arteries: branches of a. iliaca int. a. ductus deferentis a. ductus deferentis a. vesicalis inferior a. vesicalis inferior a. rectalis media a. rectalis media veins: plexus venosus prostaticus + vesicalis  v. iliaca int. veins: plexus venosus prostaticus + vesicalis  v. iliaca int. lymph drainage: lymph drainage: n. l. iliaci int. + ext. n. l. iliaci int. + ext. n.l. sacrales (prostate only!) n.l. sacrales (prostate only!) nerves: plexus hypograstricus inf.  plexus prostaticus nerves: plexus hypograstricus inf.  plexus prostaticus

Prostata - HE

Prostata - WvG

Prostate – function and diseases tuboalveolar glands tuboalveolar glands Seminal fluid: 30%, pH 6,4 /zinc, citrate, prostaglandins, spermin and spermidin, proteases, acid phosphatase, Ig, PSA/ Seminal fluid: 30%, pH 6,4 /zinc, citrate, prostaglandins, spermin and spermidin, proteases, acid phosphatase, Ig, PSA/ benign hyperplasia (50% men over 50 years), benign hyperplasia (50% men over 50 years), symptoms – hyperplasia of glands in the inner zone! symptoms – hyperplasia of glands in the inner zone! outer zone changes into the thin and tough so- called surgical capsule outer zone changes into the thin and tough so- called surgical capsule malign tumourr – 85% arise in outer zone malign tumourr – 85% arise in outer zone  blood level of prostatic phase of acid phosphatase  blood level of prostatic phase of acid phosphatase

Glandulae bulbourethrales Cowperi paired paired composed mucinous tuboalveolar glands composed mucinous tuboalveolar glands pea-sized pea-sized from under the m. transversus perinei profundus from under the m. transversus perinei profundus short ductus gl. bulbourethralis short ductus gl. bulbourethralis opens into ampulla urethrae (widened beggining of pars spongiosa) opens into ampulla urethrae (widened beggining of pars spongiosa) gland product: clear sticky, enables sperm sliding in urethra gland product: clear sticky, enables sperm sliding in urethra

Male urethra ostium urethrae internum (accipiens, evacuans) ostium urethrae internum (accipiens, evacuans) pars intramuralis pars intramuralis pars prostatica (pars proximalis x distalis, colliculus seminalis, utriculus prostaticus, m. sphincter urethrae internus) pars prostatica (pars proximalis x distalis, colliculus seminalis, utriculus prostaticus, m. sphincter urethrae internus) pars intemedia (= membranacea) pars intemedia (= membranacea) pars spongiosa (ampulla, fossa navicularis + valvula, lacunae et glandulae urethrales, ductus paraurethrales) pars spongiosa (ampulla, fossa navicularis + valvula, lacunae et glandulae urethrales, ductus paraurethrales) ostium urethrae externum ostium urethrae externum constrictions (4) and enlargements (3) constrictions (4) and enlargements (3) clinically: front and hind urethra clinically: front and hind urethra

Penis Description: radix, crura, corpus, dorsum, facies urethralis, glans /corona, collum/, preputium /frenulum/, raphe Description: radix, crura, corpus, dorsum, facies urethralis, glans /corona, collum/, preputium /frenulum/, raphe Structure: corpora cavernosa et corpus spongiosum /bulbus/, tunica albuginea, septum (incomplete) Structure: corpora cavernosa et corpus spongiosum /bulbus/, tunica albuginea, septum (incomplete) Section: trabeculae, cavernae, glandulae preputiales Tysoni Section: trabeculae, cavernae, glandulae preputiales Tysoni Covers: fascia penis superficialis + profunda Covers: fascia penis superficialis + profunda Fixation: ligamentum fundiforme et suspensorium, crura penis Fixation: ligamentum fundiforme et suspensorium, crura penis

Penis - supply arteries: arteries: branches of a. pudenda interna (a. dorsalis et profunda penis, a. urethralis, a. bulbi penis)  aa. helicinae (+ Ebner´s pillows)  vv. cavernosae branches of a. pudenda interna (a. dorsalis et profunda penis, a. urethralis, a. bulbi penis)  aa. helicinae (+ Ebner´s pillows)  vv. cavernosae veins: veins: v. dors. penis spf.  vv. pudendae ext.  v. femoralis v. dors. penis spf.  vv. pudendae ext.  v. femoralis v. dors. p. prof. + v. bulbi penis + v. urethralis  v. pudenda int.  v. iliaca int. v. dors. p. prof. + v. bulbi penis + v. urethralis  v. pudenda int.  v. iliaca int. lymph drainage: lymph drainage: n.l. inguinales superficiales (skin), profundi (glans) et iliaci interni (cavernous and spongious bodies, urethra) n.l. inguinales superficiales (skin), profundi (glans) et iliaci interni (cavernous and spongious bodies, urethra) nerves: nerves: n. pudendus (sympathetic - plexus hypogastricus inf., parasympathetic- nn. splanchnici pelvici S2-4) n. pudendus (sympathetic - plexus hypogastricus inf., parasympathetic- nn. splanchnici pelvici S2-4) glans penis is the best innervated skin area in the body! glans penis is the best innervated skin area in the body!

Penis - HE

Scrotum Description: raphe, septum /complete!/ Description: raphe, septum /complete!/ Wall structure: anterior abdominal wall derivates + tunica dartos Wall structure: anterior abdominal wall derivates + tunica dartos Arteries: a. femoralis  aa. pudendae ext., a. iliaca int.  a. pudenda int., a. cremasterica pro obaly Arteries: a. femoralis  aa. pudendae ext., a. iliaca int.  a. pudenda int., a. cremasterica pro obaly Veins: vv. scrotales ant.  v. femoralis Veins: vv. scrotales ant.  v. femoralis vv. scrotales post.  v. pudenda int. vv. scrotales post.  v. pudenda int.

Scrotum - supply lymph drainage: n.l. inguinales superficiales lymph drainage: n.l. inguinales superficiales No testis puncture because of possible tumour cells spreading nerves: nerves: anterior 1/3 (n. ilioinguinalis + r. genitalis n. genitofemoralis) anterior 1/3 (n. ilioinguinalis + r. genitalis n. genitofemoralis) posterior 2/3 – (n. pudendus + n. cutaneus femoris post.) posterior 2/3 – (n. pudendus + n. cutaneus femoris post.)

Abdominal wall x Scrotal wall skin skin Camper´s layer Camper´s layer fascia abd. subcutanea /Scarpae/ fascia abd. subcutanea /Scarpae/ fascia abd. superficialis fascia abd. superficialis mm. abdominis mm. abdominis fascia transversalis fascia transversalis peritoneum peritoneum skin skin tunica dartos tunica dartos fascia spermatica ext. fascia spermatica ext. m. cremater + f. cremasterica m. cremater + f. cremasterica fascia spermatica int. fascia spermatica int. tunica vaginalis testis tunica vaginalis testis lamina parietalis = periorchium lamina visceralis = epiorchium