Urethra, Prostate and Genitalia

Written by:
Dr. Obasi Kosi (Ph.D)
Dept. of Anatomy
UNEC.
 OBJECTIVES
At the end of the lecture, students should be able
to:
• Describe the course of urethra
• Differentiate between male & female urethra
regarding length, structure, course & function.
• Describe the course of prostate
• Describe the male and female genitalia
 Introduction
• The urethra is a muscular
tube that serves as the
excretory canal for the
urinary bladder, responsible
for conveying urine from
the bladder to the exterior
of the body.
• It extends from the internal
urethral orifice of the
urinary bladder to the
external urethral orifice of
the external genitalia.
• About 8 inches (20cm) long Male Urethra
• Extends from the neck of bladder to
the external urinary meatus on the
tip of the glans penis
• Divided into four parts:
– Intramural
– Prostatic
– Membranous
– Penile/spongy

• Preprostatic urethra passes through the

neck of the bladder, just below
the internal urethral orifice.
• Measures 0.5-1.5 cm in length but
varies depending on whether the
bladder is filled with urine or empty.
• It is surrounded by the smooth muscle
of the internal urethral sphincter
• It prevents retrograde flow of semen
into the bladder during ejaculation.
 Prostatic urethra
• Length= 3 cm
• Widest & most dilatable
• Extends from neck of bladder inside
prostate gland
• Structures openings into prostatic
urethra:
 Ejaculatory ducts
 Ducts of prostate gland.

 Common site of obstruction to the

outflow of urine in patients with benign
hypertrophy of the prostate.

Membranous urethra Penile (spongy) urethra

• Length=1-1.5cm.  Length=16 cm
• Passes trough the urogenital diaphragm  Narrowest part of whole urethra
• Surrounded by external urethral
 Extends throughout the penis,
sphincter.
• This external urethral sphincter plays an dilates in the navicular fossa and
important role in voluntary control of opens externally through external
urinary flow. urethral orifice.
 Female urethra
 It is short and straight, (3-4cm in
length)
 starts from neck of urinary bladder and
ends at the external urethral orifice
(anteriorly to the vaginal opening).
 Urethra opens into the vestibule, the
area between the labia minora. The
urethral opening sits just in front of the
vaginal opening.

 Has only urinary function

FEMALE URETHRA MALE URETHRA
• Arterial supply • Applied Anatomy
• The arterial supply of the male urethra
includes the prostatic branches of
the inferior vesical and middle rectal arteries.
• Urethral catheterization
• It is one of the most commonly
• Venous supply performed procedures in health
• Dorsal veins of the penis and the care. It helps in the drainage of
pudendal veins, drain into the prostatic urine from the urinary bladder.
venous plexus.
• Cystitis is more common in
• Mainly from the Internal iliac lymph women due to the shorter length
nodes while others drain into of the female urethra compared to
the external iliac lymph nodes. that of males.
• Urinary tract infections
• The prostatic plexus and perineal
branches of the pudendal nerve.
 Prostate Anatomy
• The prostate gland is an
accessory gland of the male
reproductive system .
• The main function is to
produce fluid for semen, which
transports sperm.
• It is located in front of the
rectum and behind the bladder • Weighs approx. 20g in adults.
and is about the size of a
chestnut. • It comprises of glandular
• Measures approx. 4 cm and stromal elements, tightly
(transverse) × 3 cm (vertical) fused within a capsule
and 2 cm (anteroposterior).
 RELATIONS OF THE PROSTATE
• It is positioned
subperitoneally below the
pelvic diaphragm.
• Posteriorly- Pubis
Symphysis.
• Anteriorly- rectum
• Inferiorly- to the urinary
bladder surrounding its neck
 Boundaries of the Prostate
• The prostate includes a base
and an apex.
• The base of the prostate is near
the inferior surface of the
bladder and is directed upward.

• A large part of the base is

continuous with the bladder
wall.
• The apex is directed downward
and is in contact with the
urogenital diaphragm (pelvic
floor).

• There are anterior, posterior,

• Anterior surface lies behind the pubic
arch.
• The urethra pierces the prostate near
Surfaces of the Prostate
the middle of the base and exits on the
anterior surface above and in front of its
apical portion.
• Inferolateral surfaces are related to the
lateral pelvic wall.
• Posterior surface of prostate and
seminal vesicles is separated from the
rectum by a thin layer of connective
tissue called ‘Denonvilliers’ fascia’
• This fascia forms a surgical plane of
excision for rectal cancers.

• The ejaculatory duct traverses the base

on its posterior surface and terminates
adjacent to the seminal colliculus, also
known as verumontanum.
 Zones of the Prostate
• Peripheral
• Central
• Transitional
• Anterior
fibromuscular
stroma
• The peripheral zone is in
the outer most part of the prostate, and
the lower peripheral zone is fairly close
to the rectal wall. The peripheral zone is
the most common site for prostatic
adenocarcinoma.
• PZ constitutes 70 % of the glandular
prostate. This zone encloses the central • The central zone is in the
and transition zones and preprostatic center of the prostate and
urethra except anteriorly.
cancer does not originate
• It extends distally to enclose lower part there often.
of prostatic urethra below • A proteolytic enzyme of the
verumontanum.
seminal fluid, pepsinogen II,
is produced by the cells of
• The PZ contains the lateral lobes and the
remaining part of the posterior lobe the central zone.
• CZ occupies approximately
25 % of the glandular
prostate.
• The transitional zone is above the
central zone and is a common site for benign
prostatic hypertrophy, a non-malignant
condition of the prostate, but cancer may
originate there as well but not as often as in the
peripheral zone.
• TZ represents only 5 % of the gland. It
surrounds the distal part of preprostatic urethra
near the apex of central zone and ejaculatory
ducts.
• It incorporates part of anterior and median
lobes.

• Periurethral gland or anterior fibromuscular

stroma (AFMS): It comprises less than 1 % of
the glandular prostate.
• It fills the space between PZs anterior to
preprostatic urethra and incorporates the major
part of the anterior lobe.
• It is predominantly fibromuscular with little or
no glandular structures
Blood supply

• The prostate receives arterial blood by way of

three major vessels:
• Internal pudendal artery
• Inferior vesical artery
• Middle rectal arteries.
• Prostatic venous plexus
• Inferior vesical vein
• Internal iliac vein. Image Source: SEER Training Website
 Regulation of
Components of
Prostatic Function
Prostatic Fluid
• Prostate-Specific Antigen • Testosterone synthesized by the
• Prostate-specific antigen (PSA) is an testis and adrenals, diffuses into the
androgen-regulated serine protease. Its prostatic epithelium and is rapidly
physiological function is to liquefy the converted to Dihydrotestosterone
seminal coagulum formed just after (DHT) by the enzyme 5α-reductase.
ejaculation by cleaving the
semenogelins.
• Prolactin (PRL), a hypophyseal
peptide hormone, belongs to the
• Prostatic Acid Phosphatase growth hormone family. It has been
reported to be locally produced in the
• Citric Acid: Citrate level in the
prostate.
normal prostatic fluid is about 400–1500
times the level found in blood plasma. It • Oxytocin
maintains osmotic/electrolytic • Thyroid Hormones
equilibrium in the semen.
• BMPS
• Zinc, spermine • Growth factors
 Female Reproductive Anatomy
Ovaries are the primary female reproductive organs
– Make female gametes (ova)
– Secrete female sex hormones (estrogen and progesterone)

• Accessory ducts include uterine tubes, uterus, and vagina

• Internal genitalia – ovaries and the internal ducts (vagina, cervix,
uterus, Fallopian tubes)
• External genitalia – external sex organs (labia and clitoris)

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 Clinical correlates
• A digital rectal examination allows the clinician
to feel any nodular growth on the posterior surface of the
prostate. This is typically where prostatic
adenocarcinomas can be palpated as these tumours most
often arise in the peripheral zone.

• Benign prostatic hyperplasia, are more

prominent in the transition zone. Subsequently, this will result
in urinary retention which could result in bladder and kidney
infection if not adequately treated.

• Prostate Cancer.
• Prostatitis: a disorder of the prostate gland usually
associated with inflammation.
 The Ovaries
Blood supply –
 ovarian arteries and the
Paired organs on each side of the uterus held in
place by several ligaments ovarian branch of the uterine
– Ovarian – anchors the ovary medially to artery
the uterus  They are surrounded by a
– Suspensory – anchors the ovary laterally
to the pelvic wall fibrous tunica albuginea, which
– Mesovarium – suspends the ovary in is covered by a layer of
between epithelial cells called the
– Broad ligament – contains the germinal epithelium
suspensory ligament and the
mesovarium  Embedded in the ovary cortex
are ovarian follicles
 Each follicle consists of an
immature egg

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 THE UTERINE (FALLOPIAN) TUBES
It is 10 cm long.
It is enclosed in the broad
ligament of uterus.
2
It is divided into: 3
1
1) Intramural part: opening into 4
the uterine wall X
2) Isthmus: narrowest part
3) Ampulla: widest part
(site of fertilization)
4) Infundibulum: funnel-shaped
end, has finger-like processes
(fimbriae), related to ovary

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 FUNCTION OF:

OVARIES: PRIMARY SEX ORGANS IN FEMALE

1) Production of female germ cells
2) Secretion of female sex hormones
UTERINE TUBES:
1) Site of fertilization
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2) Transport of fertilized ovum into the uterus
 2’
UTERUS
A hollow, pear-shaped muscular 3’
organ 1’
Divided into:
1. Fundus: no cavity
2. Body: cavity is triangular
3. Cervix: cavity is fusiform,
divided into:
*Supravaginal part
*Vaginal part
Fundus

Body

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 UTERUS
FUNDUS: The part
of uterus above the
level of uterine tubes
BODY: The part of
uterus from the level
of uterine tube to the
level of the isthmus
of uterus
CERVIX: The part of
the uterus below the
level of the isthmus
of10/15/2024
the uterus 27
 THE CERVICAL CANAL

Multiparous

Nulliparous
INTERNAL OS: opening between cavity of body of uterus & cavity of cervix
(cervical canal)
EXTERNAL OS: opening between cervical canal & cavity of vagina
In a nulliparous woman: external os appears circular.
In a multiparous woman: external os appears as a transverse slit with an anterior
& a10/15/2024
posterior lip. 28
 RELATIONS OF UTERUS

 FUNDUS + BODY + SUPRAVAGINAL PART OF CERVIX:

1. Anterior: superior surface of urinary bladder
2. Posterior: sigmoid colon
3. Lateral: uterine artery
 VAGINAL PART OF CERVIX: surrounded by vaginal fornices
1. Anterior: anterior fornix of vagina
2. Posterior: posterior fornix of vagina
3. Lateral: lateral fornices of vagina

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 POSITIONS OF UTERUS

RETROVERTED UTERUS RETROFLEXED UTERUS

Fundus & body of uterus are bent backward on Long axis of body of uterus is bent
the vagina and lie in rectouterine pouch backward on long axis of cervix

30
 USUAL POSITION OF UTERUS

ANTEVERTED ANTEFLEXED UTERUS

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 Supports of the Uterus
• Mesometrium – portion of
the broad ligament that
supports the uterus laterally
• Lateral cervical ligaments –
extend from the cervix and
superior part of the vagina to
the lateral walls of the pelvis
• Uterosacral ligaments –
paired ligaments that secure
the uterus to the sacrum
• Round ligaments – bind the UTERINE PROLAPSE
anterior wall to the labia Downward dispalcement of uterus due to
majora damage of:
1. Ligaments of uterus
2. Levator ani muscles

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 Vagina
• The vagina is a muscular canal that leads
from the uterus to the external orifice of
the genital canal
• It measures about 3 in. (8 cm) long.
• It serves as the excretory duct for the
menstrual flow & forms part of the birth
canal.
• The vaginal orifice in a virgin possesses a
thin mucosal fold, called the hymen,
which is perforated at its center. It lies
posterior to the urethral orifice.
• Arteries:
• Vaginal artery, a branch of the internal
iliac artery
• Vaginal branch of the uterine artery
• Veins: drain into the internal iliac veins.
• Provides a passageway for birth, menstrual
flow, and is the organ of copulation
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33
 RELATIONS OF VAGINA

ANTERIOR: Urinary bladder (in pelvis) & urethra (in perineum)

POSTERIOR: Rectum (in pelvis) & anal canal (in perineum)
LATERAL: ureters (in pelvis)

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 Vagina
Vaginal Wall consists of three
coats:
– fibroelastic adventitia
– smooth muscle muscularis
– stratified squamous
mucosa
• Mucosa near the vaginal orifice
forms an incomplete partition
called the hymen
• Vaginal fornix – upper end of
the vagina surrounding the
cervix

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 External Genitalia: Vulva (Pudendum)
Lies external to the vagina and
includes the labia, clitoris,
and vestibular structures.
• Labia majora – elongated,
hair-covered, fatty skin
folds homologous to the
male scrotum.
• Labia minora – hair-free
skin folds lying within the
labia majora; homologous
to the ventral penis

36
 External Genitalia: Vulva (Pudendum)
Greater vestibular glands:
– Pea-size glands flanking
the vagina
– Homologous to the
bulbourethral glands
– Keep the vestibule moist
and lubricated

Clitoris - embryologically homologous to the penis

 Erectile tissue hooded by the prepuce
 The exposed portion is called the glans
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 APPLIED ANATOMY
• Pudendal Nerve Block- Pudendal nerve block is
used in providing analgesia for the second stage of
labour .
• To provide anesthesia of the perineum in order to
create or repair an episiotomy (An episiotomy is a
surgically planned incision on the perineum and
the posterior vaginal wall during second stage of
labor to prevent perineal tear).
• Method: can be done by transvaginally or through
perineal approach
 Male Reproductive System

Figure 16.2

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide

 Male Reproductive System

• · Accessory organs
· Testes · Seminal vesicle
· Duct system · Prostate gland
· Epididymis · Bulbourethral gland
· Ductus deferens · External genitalia
· Urethra
· Penis
· Scrotum

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide

 Male Reproductive System

Figure 16.2

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide

MALE GENITALIA

Figure 27.3a
 The Penis
• A copulatory organ designed to deliver sperm into the female
reproductive tract
• Prepuce (foreskin) – cuff of skin covering the distal end of the penis
(removed during a circumcision).
Internal penis – the urethra and cylindrical bodies of erectile tissue
Erectile tissue – spongy network of connective tissue and smooth muscle
riddled with vascular spaces
– Corpus spongiosum – surrounds the urethra and expands to form
the glans and bulb of the penis
– Corpora cavernosa – paired dorsal erectile bodies
– Erection – during sexual excitement, the erectile tissues fill with
blood causing the penis to enlarge and become rigid
The Penis

Figure 27.4
 Epididymis
• Non-motile sperm enter, pass through its tubes and become
motile
• Upon ejaculation the epididymis contracts, expelling sperm
into the ductus deferens

Ductus Deferens and Ejaculatory Duct

 Propels sperm from the epididymis to the urethra
 Vasectomy – cutting and ligating the ductus deferens, which
is a nearly 100% effective form of birth control
Ductus Deferens and Ejaculatory Duct
• Propels sperm from the epididymis to the urethra
• Vasectomy – cutting and ligating the ductus deferens, which
is a nearly 100% effective form of birth control
Accessory Glands: Bulbourethral Glands (Cowper’s Glands)

• Pea-sized glands inferior to the prostate

• Produce thick, clear mucus prior to ejaculation that
neutralizes traces of acidic urine in the urethra and
lubricates the penis
FLY
HIGH