1. Peen and related structures Haddy Cosh and Amy Wood

2. Testicles Derive from intermediate mesoderm Development: High on posterior abdominal wall, drop down via gubernaculum Coverings: Skin Dartos External Spermatic Fascia Cremasteric Fascia (Cremasta muscle, genitofemoral nerve, s2 reflex) Internal spermatic fascia Tunica vaginalis Testicles Some Damn Englishman Called It The Testes

3. Spermatic Cord The rule of 3’s: Coverings: 1.Internal spermatic fascia 2.Cremasteric fascia 3.External spermatic fascia Veins: 1.Pampiniform plexus (visible – varicocoele) 2.Ductus deferens 3.Lymphatics Arteries 1.Testicular (Torsion) 2.Ducts deferens artery 3.Cremasteric artery Nerves 1.Genital 2.Autonomic 3.Illioinguinal

4. Ductus Deferens Runs from? Tail of Epidydimis to ejaculatory duct Capable of peristalsis, controlled by which nervous system? Sympathetic Arterial supply: Branches of vesical and testicular arteries

5. Prostate Location? Surrounds urethra, between bladder and levator ani muscles Produces? Prostatic fluid (20% seminal fluid) = Citric acid, prostaglandins, proteolytic enzymes Zones? Central, Transitional, Peripheral (most glandular so carcinoma site) Lobes? Anterior, posterior, median, 2 X lateral Arterial supply: Middle rectal and inferior vesical arteries Venous supply: Runs to prostatic venous plexus  vertebral veins Valveless plexus, route of cancer spread

6. Seminal Vesicles Accessory gland which produces? Alkaline fluid rich in fructose, Prostaglandin E and semen clotting factors Arterial supply? Inferior vesicle and middle rectal Venous supply? Vesical and prostatic venous plexi What do you need to warn men about vasectomies? May be fertile for a couple of weeks as sperm can sill be in the vesicles

7. Penis Structure? 2 X Corpus cavernosum (most erectile tissue) 1 X Corpus spongiosum Arterial supply Internal iliac  Internal pudendal  Deep and dorsal penile arteries (Through Alcock’s canal LOL) Venous supply Superficial and deep dorsal veins  venous plexus  vertebral plexus Problems: Priapism Persistant, painful, non-stimulated erection for +4 hours Prepuce: Phimosis / Paraphimosis

8. Erection and Ejaculation ERECTION: (Point = Parasympathetic = Cavernous Nerve = S234) Straightening of coiled helicine arteries, relaxation of smooth muscle  blood flow to corpus cavernosum Bulbospongiosus and Ischiocavernosus muscles compress venous plexi (blood remains in penis) Flaccid penis: Arterio-venous anastomoses allow blood to bypass corpus cavernosum

9. EMISSION (Shoot = Sympathetic = Secretion = L1,2) Internal urethral sphincter closes Peristalsis of vas and seminal vesicles Smooth muscle of prostate relaxes  Ejaculate squeezed into penile bulb

10. EJACULATION (Score = Somatic = Pudendal = S2-4) Contraction squeezes base of penis  ejaculation Although brought about by somatic system, there is no control

11. Lymph drainage routes Testicles  Para Aortic nodes (~L2) Prostate  Internal Iliac nodes Seminal Vesicles  Internal / External Iliac & sacral nodes Ductus deferens  Internal Iliac Glans of penis  Deep inuinal Corpus cavernosum  Internal iliac

12. Per rectal examinations What can you feel (7)? Walls of anal canal Walls of inferior rectum Bones: Sacrum, Coccyx Sacral Lymph nodes Prostate Inferior bladder - possible Seminal vesicles – possibly If you don’t put your finger in it, you stick your foot in it!

13. Catheterisation Indications (4) Inability to void bladder (urinary retention) Spinal injury Incapacitated Surgery Difficulties (4) Navicular fossa (mucosal fold superiorly) Angle at penile bulb and membranous urethra Prostate (crest / enlarged lobes) Sphincters – nervous patient

14. Catheterisation contd.. Procedure: See http://almostadoctor.co.uk/content/osces/skills-and- procedures/catheterization