Lecture 3: Pelvic Viscera, Nerves, and Arteries

What are the pelvic viscera?

1. rectum

2. urinary organs

3. reproductive system

Where is the urinary bladder in relation to the rectum?

the urinary bladder is anterior to the rectum

Ureter

• brings urine from the kidney and down to the posterior surface of the bladder for storage.

Male vs female bladder

• the male urethra runs through the prostate

Male internal genitalia

1. testis

2. epididymis

3. ductus deferens

4. seminal gland

5. ejaculatory ducts

6. prostate gland

7. bulbourethral gland

What creates sperm?

Testis + epididymis

What makes semen?

1. mixture of secretions produced by testes, seminal glands, prostate gland, bulbourethral gland

2. vehicle for sperm transport

   1. role in activating sperm

Ductus deferens

seminal gland

ejaculatory duct

prosstate

bulbourethral gland

bulbospongiosus

epididymis

external urethral orifice

Structure of the male urethra?

anterior view of male bladder

What is the seminal gland?

1. thick alkaline fluid with fructose (energy) for sperms and coagulating agents

What is the prostate gland?

1. think opaque fluid plays a role in activating sperms

What is the bulbourethrl gland?

1. lubrivates the spongy urethra and neutralized the acidity of residual urine in the urethra

What is the ejaculatory duct?

1. union of ducts of seminal glands and vas deferens

What is the prostatic urethra?

1. urinary and reproductive tracts merge

2. feature the urethral crest and seminal colliculus

3. prostatic sinuses lateral to urethra crest

4. prostatic ducts open into prostatic sinuses

5. ejaculatory ducts open onto seminal colliculus

What is the seminal colliculus?

1. prostatic utricle → no function just from embryological development

2. ejaculatory ducts orifice

Posterior view of male bladder

• ureter goes under the ductus deferens

What would be the consequences of a vasectomy?

you would still have semen but you would not have sperm because you still have all of the glands just no sperm going to the urethra

Where is the rectum in relation to the bladder?

External urethral orifice

anterior to the vaginal opening

Female urethra structure

External urethral sphincter

uternus location

1. Urinary bladder

2. Urterus

3. rectum

Fundus of uterus

Body of uterus

Cervix

What are the openings of the cervix?

1. internal Os

2. External Os

vagina

Cervial effacement and dilatation

Parts of the uterine (fallopian) tubes

What is the broad ligament?

connects uterus to pelvic wall

What is the round ligament

connects uterus to the labia majora

Ovarian ligament and round ligament are vestigial

remnants that make up the female gubernaculum

What is the ovarian liagement?

connects uterus to ovary

Ovarian ligament and round ligament are vestigial

remnants that make up the female gubernaculum

Suspensory ligaments of ovary

connects ovary to pelvic wall

What is the lumbosacral trunk?

1. L4-L5

2. descending into pelvis

   1. helps form the sacral plexus with anterior rami of S1-S4 spinal nerves

What nerves make up the sacral plexus?

1. Superior gluteal nerve (L4-S1)

2. Inferior gluteal nerve (L5-S2)

3. Posterior femoral cutaneous nerve (S1-S3)

4. Pudendal nerve (S2-S4)

5. Sciatic Nerve (L4-S3)

What foramen does the lumbosaccral plexus go through?

all go through the greater sciatic foramen

What is a landmark for the nerves

What nerve goes back through the lesser sciatic foramen?

pundendal nerve → Comes back through the lesser sciatic foramen. And innervates the perineum.

Side view of sacral plexus?

What does ventral ramus mean?

refers to. the anterior rami of that spinal nerve

Where does the ureter cross over?

at the point where the common iliac artery bifurcates

Where does the abdominal aorta bifurcate?

L4 → into the right and left common iliac artery

Where does the common iliac artery bifurcate

L5-S1 → into right and left internal and external iliac artery

Where does the femoral artery start?

after the inguinal ligament

Where is the lumboscrmal trunk compared to the internal iliac artery?

Lumbosacral trunk (L4-L5) is deep to internal iliac artery

Use Lumbosacral trunk (L4-L5) as a landmark to find S1-S3 spinal nerves

What does the internal iliac artery split into?

anterior and posterior trunk

Posterior division of internal iliac artery

1. Iliolumbar artery → goes up the lumbar vertebrae

2. Superior gluteal artery → exits the greater sciatic foramen above the piriformis, continuation of the posterior trunk

3. Lateral sacral artery

Anterior division of internal iliac artery

1. Umbilical artery → embryonic remnant that then continues as a ligament

   1. superior vesicle artery → goes to bladder

2. Obturator artery → travels with the obturator nerve to the obturator internus muscle

3. Uterine artery

   1. Vaginal artery

4. Inferior vesicle artery

5. Middle rectal artery → Could also come off the internal pudendal as well. In this image it is common off the internal iliac

6. Internal Pudendal artery

7. Inferior gluteal artery → continuation of the anterior trunk

What does the inferior gluteal artery and internal pudendal artery exit?

1. greater sciatic foramen below the piriformis

What does the obturator artery go through?

obturator canal

What is the suspensory ligament?

Male Blood supply: Posterior division of internal iliac artery

1. superior gluteal artery → The posterior trunk continues as superior gluteal artery

   1. iliolumbar artery

   2. Lateral sacral artery

Where does the superior gluteal artery exit?

exits the greater sciatic foreman above the piriformis

Male Blood supply: anterior division of internal iliac artery

1. internal iliac artery anterior dividsion

   1. Umbilical artery

      1. superior vesicle artery

   2. Obturator artery → through the obturator canal

   3. inferior vesicle artery → bladder

      1. Prostatic artery

   4. Medial rectal artery

   5. Internal Pudendal artery

What does the anterior trunk continue as?

The anterior trunk continues as internal

pudendal and inferior gluteal a.

Where do the inferior gluteal artery and internal pudendal artery exit?

1. exits the greater sciatic formamen below the piriformis

Artery of ductus deferens

Where does the internal pundendal go?

exits the greater sciatic foramen over the ischial spine posteriorly then through the lesser sciatic foramen anteriorly to the perineum