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1. Male Reproductive System

2. Male Genital Organs Divides in 2 parts Outside pelvic cavity- Male External Genital Organ Within pelvic cavity – Male Internal Genital Organs

3. Male External Genital Organs Penis Scrotum Testis Epididymis Scrotum containing

4. Male Internal Genital Organs Single Prostate Gland Parts of Ductus Defrense on each side Seminal Vesicles on each side Ejaculatory Ducts on each side

5. Perineum Perineum is the region at the lower end of the trunk in the interval between the two thighs. The external genitalia are located in the perineum. The perineum forms the lower division of the pelvis that lies below the pelvic diaphragm.

6. Boundaries of Perineum

7. Male Perineum Male External Genital Organs Male Urogenital Region The anterior division of the perineum is the urogenital region. It contains the superficial and deep perineal spaces or pouches.

8. Male Urogenital Region

9. Cutaneous Innervation Dorsal Nerve of Penis Ilioinguinal nerve and genital branch of genitofemoral nerve Perineal branch of posterior cutaneous nerve of thigh Posterior scrotal nerve Perineal branch of pudendal nerve

10. Cutaneous innervation of the male perineum

11. Superficial Fascia Superficial fatty layer Deep membranous layer or Colles ’ fascia

12. Deep Fascia Made up of one layer that lines the thin deep perineal space inferiorly. This fascia of the urogenital diaphragm is thick. It is also called the perineal membrane.

13. Boundaries Posteriorly – Interischial line Anteriorly and Laterally – Symphysis pubis and Ischiopubic rami. Urogenital region extend superficially to encompass the scrotum and root of penis.

14. Boundaries of Perineum

15. Urogenital region is divided into two parts by strong perineal membrane. Above it: Deep perineal space Below it: Superficial Perineal Space

16. Superficial Perineal Space This is the superficial space of the urogenital region situated superficial to the perineal membrane. Boundaries Superficial – Colle‘s fascia Deep – Perineal membrane On each side – Ischiopubic rami Posteriorly – Closed by the fusion of perineal membrane with Colle‘s fascia Anteriorly – Open and continous with the spaces of the scrotum ,penis and the anterior abdominal wall

17. Coronal section through the urogenital region of the male perineum

18. Contents Root of Penis ,made up of two crura and one bulb traversed by the urethra Muscles on each side Ischiocavernosus covering the corpora cavernosa of penis Bulbospongiosus covering corpus spongiosum ; both are united by median raphe Superficial transversus perineal

19. Coronal section through the urogenital region of the male perineum

20. Nerves Three sets of branches from perineal nerve posterior scrotal nerve, branch to bulb and muscular branches Long perineal nerve from posterior cutaneous nerve of thigh Vessels Two branches of perineal artery Four branches from the artery of penis Glands and Ducts Only the ducts of bulbourethral gland

21. Transverse section of penis through the body of the penis

22. Deep Perineal Space This is the thin space of the urogenital region situated deep to the perineal membrane. Boundaries Superficial – Perineal membrane Deep – Open above On each side – Ischiopubic rami Anteriorly – Gap between perineal membrane and inferior pubic ligament Contents Tubes Part of urethra Muscles Sphincter urethrae Deep transverse perinei .

23. Nerves on each side Dorsal nerve of penis Muscular branches from perineal nerve Vessels Artery of penis Stems of origin of four branches namely, artery to the bulb of penis, urethral artery, deep and dorsal arteries of penis Glands - Bulbourethral glands

24. Perineal membrane is almost triangular membrane:

• Laterally attached to periosteum of ischiopubic rami.

• Apex attached to arcuate ligament of pubis, where the membrane is attached to this arcuate ligament of pubis, it is particularly thick and is called transverse perineal ligament.

• Posterior border is fused to deep parts of perineal body and is continuous with the fascia over deep transversus perinei . Perineal Membrane

25. Perineal membrane is pierced by: Urethra 2-3 cm behind the inferior border of pubic symphysis. Artery to the bulb of penis. Ducts of bulbourethral gland. Muscular branches to muscles. Deep artery to the penis, urethral artery. Dorsal artery and dorsal nerve of penis. Posterior scrotal vessels and nerves, anterior to transverse perinei .

26. Clinical Anatomy

27. • The membranous part of the male urethra is the narrowest and least dilatable part of the urethra. In inexperienced hands, it is likely to be ruptured during instrumentation. The urethra can also rupture in accidental injuries.

28. • Rupture of the urethra leads to extravasation of urine, which may be superficial or deep. In superficial extravasation, the urine spreads downwards deep to the membranous layer of the superficial fascia. It first fills the superficial perineal space; and then the scrotum, the penis and the lower part of the anterior abdominal wall. It is prevented from going to the ischioanal fossa or the thigh by the firm attachment of the membranous layer of superficial fascia to their boundaries.

29. Extravasation of urine due to rupture of penile urethra

30. In deep extravasation, the urine spreads upwards into the extraperitoneal space of the pelvis around bladder and prostate into the anterior abdominal wall.