Urology Physiology

Pudendal nerve

#1

Perineal nerve

#2

Dorsal nerve

#3

skeletal, sphincters, penis

Nerves of the Pelvis/Perineum: Sacral Plexus

-Pudendal nerve, perineal nerve, dorsal nerve

-Motor Function → __________ muscles in the perineum including the external urethral and anal _____________, levator ani and coccygeus muscles

-Sensory Function → most skin of the perineum, _____, and clitoris

splanchnic, erection, contraction, bladder

Nerves of the Pelvis/Perineum: Sacral Plexus

-Pelvic ___________ nerves

-Motor (visceral) Function → stimulate __________, bladder _________; inhibitory to internal urethral sphincter

-Sensory (visceral) Function → pain from cervix and possibly _________ and proximal urethra

sensory, skin

Nerves to Pelvis/Perineum: Coccygeal Plexus

S4-Co

-Anococcygeal nerves

-__________ (cutaneous) Function → perianal ____

relaxed, contracted

Phases of Bladder Function: Filling

-During filling, the detrusor muscle is __________. This allows the bladder to be filled with urine. The detrusor muscle is controlled by the sympathetic nervous system.

-At the same time, the internal (sympathetic) and external (somatic) sphincters are _____________. They stay this way to keep the urine in the bladder.

contracted, relaxed, inhibited

Phases of Bladder Function: Voiding

-During the voiding phase, the detrusor muscle is ____________ (parasympathetic).

-At the same time, the internal (parasympathetic) sphincter is ________, as is the external sphincter (_________ somatic)

autonomic, central, storage, voiding, reflex, supraspinal

Overview of Bladder Neural Control

-Bladder function is regulated by ___________ nervous system, somatic nervous system, and ________ nervous system

-Coordinates ________ and __________ phases

-Involves spinal cord ______ arcs and __________ centers

sensory, pelvic, stretch, spinal cord

Afferent Pathways

-________ pathways

-______ nerve afferents (S2-S4) detect bladder ________ and fullness

-Signals project to _______ ______ (S2-S4), periaqueductal gray (PAG), and pontine micturition center (PMC)

hypogastric, detrusor, internal, pelvic, contracts, relaxes

Autonomic Efferent Pathways

-Sympathetic nervous system

• ___________ nerve (T11-L2)

• Effects during voiding → relaxes _________, contracts _______ sphincter (storage)

-Parasympathetic nervous system

• ______ nerve (S2-S4)

• Effects during voiding → _________ detrusor, ________ internal sphincter (voiding)

pudendal, external, storage, voiding

Efferent Pathways

-Somatic pathways → voluntary, determine when you want to pee

-_________ nerve (S2-S4), controls ________ urethral sphincter (voluntary)

-Activated during _________, inhibited during _________

voiding, detrusor, relaxation, afferent, PMC, voluntary, micturition, urge

Central Nervous System Control

Pontine Micturition Center (PMC)

-Initiates __________ reflex

-Coordinates __________ contraction with sphincter __________

Periaqueductal Gray (PAG)

-Integrates bladder __________ signals

-Communicates with ___ and cortex

Cerebral Cortex

-_________ inhibition or initiation of ___________

-Damage → _____ incontinence

sympathetic, continence, parasympathetic, detrusor, involuntary, bladder

Reflexes of Bladder System

-Storage reflex → __________ and somatic activation to maintain ___________

-Voiding reflex → ______________ activation for _______ contraction, sphincter relaxation

-Guarding reflex → ___________ sphincter contraction during _________ filling to prevent leakage

300-400, stretch, cord, parasympathetic, contraction, relaxation, voluntarily

Micturition Reflex (Peeing Reflex)

-Initiated when bladder volume reaches ____-____ mL

-Involves: bladder _______ → spinal _____ → _____________ efferents → detrusor ___________

-Inhibition of sympathetic and somatic output → sphincter ___________

-Can be _________ overridden by higher centers (pons, cortex)

urge, coordination, spastic, flaccid

Clinical Correlations by Lesion Site

-Cortical → _____ incontinence

-Pontine → loss of ___________ (detrusor-sphincter dyssynergia)

-Spinal cord (above S2) → reflex (______) bladder

-Peripheral (S2-S4) → _______ bladder (overflow incontinence)

gonads, scrotum, vaginalis, weak

Inguinal Canal Development

-_______ descend from posterior abdominal wall → _______ in males

-Inguinal canal created by processus ________ → normally closes a few weeks before or few weeks after birth. ______ area in males, which is why inguinal hernias happen

deep inguinal ring, superficial inguinal ring

Inguinal Canal

-_______ _______ _______ (#1)

• The spermatic cord starts here and goes for 4cm before reaching #2

-__________ _________ ______ (#2)

-Anterior wall → aponeurosis of the external oblique muscle

-Posterior wall → transversalis fascia

-Floor → inguinal ligament

-Roof → fibers of the transversus abdominis and internal oblique muscles

epigastric, rectus abdominis, inguinal

Hesselbach’s Triangle (Inguinal Triangle)

-Location of direct inguinal hernias

-Lateral border → inferior __________ vessels

-Medial border → lateral edge of _______ ________

-Inferior border → ________ ligament (lacunar portion)

hernia, inguinal, lacunar, femoral, pectineal

Femoral Ring (Medial Compartment)

-Femoral ______, weak area where the abdomen contents meet the thigh

-Anterior border → _______ ligament

-Medial border → ________ ligament

-Lateral border → _________ vein

-Posterior border → _________ ligament and pectineus muscle

descend, scrotum, gametes, hormones, connects, abdominal, sac, peritoneum, tests

Testes

-Originally develop high on the posterior abdominal wall then _______, usually before birth into the ______

-Function → production of ________ (sperm), production of sex __________ (androgens and testosterone)

-Spermatic cord → tube-like structure that _________ testes to ________ wall

-Tunica vaginalis → closed ___ of __________ surrounding most of _____

Spermatic cord

#1

Tunica vaginalis

#2

Seminiferous tubules, spermatozoa

#1

-Within testes and produce ___________

Tunica albuginea

#2

-Thick connective tissue capsule surrounding testes

Efferent ductules

#3

-Originate from rete testis and connect and form head of epididymis

seminiferous, androgens, testosterone

Leydig Cells

-Found between ____________ tubules

-Produce _________ (mostly ___________)

testis, maturation, ejaculation, head, body, tail, ductus

Epididymis

-Comma shaped, courses along the posterolateral side of ______

-Spermatozoa acquire ability to move and fertilize an egg (___________ of sperm)

-Stores spermatozoa until _____________

-____ (#1)→ formed by coiled mass of efferent ductules, sits on posterior superior pole of testis

-____ (#2) → along the posterolateral margin of testis

-____ (#3) → located at the inferior pole of testis, continuous with _____ deferens

spermatozoa, epididymis, ejaculatory, seminal, duct

Ductus Deferens

-Long, muscular duct

-Transports _____________ from _________ to __________ duct

-Located within spermatic cord, joins ________ vesicle duct to form ejaculatory ____

Ductus deferens

#1

Seminal vesicle

#2

Ejaculatory duct

#3

Seminal vesicle

#1

bladder, ejaculatory, volume, glucose, energy, sperm

Seminal Vesicle

-Accessory gland that is an outgrowth from ductus deferens

-Coiled tube with numerous pockets, located between ________ and rectum (towards base of bladder)

-Joins ductus deferens to form ___________ duct

-Secretions contribute to ________ of ejaculate (semen)

• Nutritive ______-rich fluid (fructose)

• Source of ______ for _____

urethra, secretions, semen, alkaline, sperm, acidic, vagina

Prostate

-Accessory structure surrounding the _______. Inferior to bladder, posterior to pubic symphysis, anterior to the rectum

-Inverted, rounded, cone like structure that has a large base, narrow apex, and is the size of a walnut. Cradled between levator ani muscles

-____________ contribute to formation of _____ → thin, milky substance with _______ pH

• Helps ______ survive the _______ environment of the female ______

mucous, urethra, lubriction, pre-ejaculate

Cowper’s Glands

-Small, pea-shaped _______ glands. Located in the deep perineal pouch (one on each side)

-Lateral to the membranous _______. Ducts open into the bulb of the penile urethra

-Contribute to _________ of the urethra and ___-________

Prostate gland

#1

Cowper’s gland

#2

corpora cavernosa, corpus spongiosum, prepuce

Penis

-_________ ________ (#1)

• A pair, anchored to the pubic arch

• Runs along dorsal penis

-________ ___________ (#2)

• Single, anchored to perineal membrane

• Runs along ventral penis

• Surrounds urethra

• Forms glans penis

-________ → fold of loose skin covering the glans (Foreskin)

vascular, parasympathetic, arteries, erection, pudendal

Erection

-________ event

-____________ fibers in pelvic splanchnic nerves → relaxation of penile _______ → blood fills penile tissue → __________

-Arteries supplying the penis are branches of internal _________ artery (cavernosal, dorsal, deep, bulbourethral)

posterior, anterior, bladder, ureter, seminal, prostate, perineum, erectile

Arteries of the Pelvis/Perineum

-Internal iliac artery is the main supply

-________ trunk → supply of lower posterior abdomen wall, posterior pelvic wall, and gluteal region

-________ trunk → supply pelvic viscera, perineum, gluteal region, adductor region of thigh

• Superior vesical artery → supplies superior _______ and distal ______

• Inferior vesical artery → supplies bladder, ureter, ______ vesicle, and _______

• Internal pudendal artery → main supply to the _________ as well as ______ tissue

Superior vesical artery

#1

Inferior vesical artery

#2

Internal pudendal artery

#3

Internal iliac artery

#4

pudendal, scrotum, testicular, testes

Arteries of Scrotum/Testes

-External _________ arteries → skin of penis and _________

-_________ and cremasteric arteries → scrotum/____

Testicular artery

#1

Cremasteric artery

#2

Testicular artery

#3