Pelvis and Perineum (Urinary and Reproductive Systems) The Pelvic Cavity The organs of the pelvic region

are found within the cavity made up by the bony pelvis and its muscular walls. These organs include the internal organs of the reproductive system (mostly female), prostate gland (males), and organs of the urinary system. The kidneys (urinary system) are found adhered to the posterior abdominal wall, anterior to the last pairs of ribs. I. Bony Elements of the Pelvis The bony part of the pelvis is formed by: - two hip bones (os coxae)* - sacrum - coccyx *The os coxae (hipbones) are each comprised of three separate bones: the ilium, ischium and pubis. These two hipbones fuse anteriorly at the pubic symphysis to form the pelvic girdle, which is attached to the sacrum, providing support for the lower limbs. Human male and female pelves differ from each other in relation to the more robust build and larger musculature of males, and adaptations for childbearing in females. Often, forensic identification of human remains relies on sex-specific features of the male and female pelves. II. Pelvic Walls -Anterior Pelvic Wall: formed primarily by the bodies and rami of the pubic bones and pubic symphysis -Lateral Pelvic Wall: bony part formed by hipbones, the obturator internus muscle covers most of the bony lateral walls. Obturator nerves and vessels pass medial to these walls. The obturator internus muscle exits the pelvis via the lesser sciatic foramen, and attaches to the femur. -Posterior Pelvic Wall: formed by sacrum, adjacent portions of the ilia and sacroiliac joints. The piriformis muscles line this wall laterally. The piriformis muscles leave the pelvis via the greater sciatic foramen. Medial to the piriformis muscles are found the nerves of the sacral plexus and the internal iliac vessels and their branches. -Pelvic Floor: the floor of the pelvis is formed by the pelvic diaphragm. This span of muscles is made up of the levator ani muscle and the coccygeus muscle plus the fascia that covers the superior and inferior aspects of these muscles. The pelvic diaphragm stretches between the pubis anteriorly to the coccyx posteriorly, and also stretches between the lateral pelvic walls, giving the pelvic diaphragm the appearance of funnel. Levator ani muscle (has three separate parts, supports abdominopelvic viscera; resists intra-abdominal pressure; helps hold viscera in position; aids in raising pelvic floor and compressing abdominopelvic contents during forced respiration, coughing, vomiting and defecation) Puborectalis muscle (forms a u-shaped sling around the anorectal junction) Pubococcygeus muscle (constitutes main part of the levator ani muscle group) Iliococcygeus (most posterior part of the levator ani muscle group; thin and often poorly developed)

Muscles of the Pelvic Walls Muscle Proximal Attachment Obturator Pelvic surfaces of ilium internus and ischium, obturator membrane Piriformis Pelvic surface of sacrum, superior margin of sciatic notch and sacrotuberous ligament Levator ani Body of pubis, tendinous arch of obturator fascia, ischial spine Coccygeus Ischial spine

Distal Attachment Greater trochanter of femur Greater trochanter of femur

Innervation Nerve to obturator internus Ventral rami of S1 and S2

Perineal body, coccyx, anococcygeal ligament, walls of prostate or vagina, rectum and anal canal Inferior end of sacrum

Branches of S4 and pudendal nerve (S2-4)

Branches of S4 and S5

Urinary System The urinary system is responsible for the elimination of waste (electrolytes and nitrogenous wastes) products from the body in the form of urine. The kidneys are the focus of this system. I. Kidney development The urinary and reproductive systems are closely related and share structures during development. The adult kidney is the result of a series of embryonic kidneys. These embryonic kidneys derive from the urogenital ridge, which forms from intermediate mesoderm. This ridge is also responsible for the development of reproductive organs. Embryonic Kidneys 1. Pronephros First to develop and form pronephric ducts, which do not function but provide the template for the next set of kidneys to develop. 2. Mesonephros Utilizes the pronephric duct, which becomes the mesonephric duct (later involved in development of male reproductive organs). The pronephros degenerates. 3. Metanephros This becomes the adult kidney. As the mesonephros degenerates, the metanephros takes over the metanephric ducts. An ureteric bud will grow out of these ducts into the urogenital ridge so that nephrons will form. This ureteric bud eventually forms the renal pelvis, calyces, and collecting tubules of the kidneys. The proximal part of the ureteric bud becomes the ureter. The metanephric kidneys are actively producing urine at about the 3rd month of fetal development. This urine is excreted by the fetus and plays a role in maintaining the volume of amniotic fluid required by the fetus.

II. Anatomy of the Kidneys The paired kidneys lie in the posterior abdominal cavity at the level between the 11th thoracic and the 3rd lumbar vertebrae, receiving some protection from the last pairs of ribs. The right kidney lies lower than the left due to the position of the liver. Each kidney sends off a ureter, which is a long tubular structure that empties into the bladder. Each kidney is enclosed in a layer of dense connective tissue called the renal capsule. Around this capsule is a layer of perirenal fat that makes up the fatty, protective adipose capsule. Superficial to this are renal fascia and even more fat. In this way, the kidneys are well protected from blows to the posterior body wall. Kidneys Structures: Renal pelvis (large opening of the kidney into the ureter) Major and minor calyces (calyx) Renal columns Renal pyramids Renal cortex The renal pyramids have uriniferous tubules within them, which are responsible for production and concentration of urine before it leaves the kidney to travel in the ureter to its destination on the bladder. Uriniferous tubules= nephron (urine production) + collecting tubule (urine concentration) The ureters are slender tubes that convey urine to the bladder. They are retroperitoneal, as are the kidneys. Each ureter enters the bladder posterolaterally, running in the bladder wall before opening into the cavity. III. Urinary Bladder This is a muscular (smooth muscle) sac that is capable of collapsing and expanding, depending on the volume of urine stored within it. It lies outside the peritoneum at the floor of the pelvis, just behind the pubic symphysis. In males it is positioned in front of the rectum, and on top of the prostate. In females, it lies in front of the uterus and vagina. Urinary bladder structures: - Urachus (anterior fibrous bandremnant of the allantoisattached internally to umbilicus) - Trigone (inferior triangular region with ureter openings and urethra openings at each corner)

IV. Urethra A thin walled tube that drains urine from the bladder. This tube has a mucosal lining. The smooth bladder muscle thickens to form the internal urethral sphincter (involuntary), while the external urethral sphincter (voluntary control) falls within the urogenital diaphragm and is actually skeletal muscle. In females, the urethra is very short (3-4 cm). In males however, it courses for approximately 20 cm. In males, the urethra that passes through the prostate is called the prostatic urethra. As the urethra passes

through the U-G Diaphragm it is called the membranous urethra. The urethra then continues through the penis and is called the spongy or penile urethra.

Male and Female Reproductive Organs Anatomically, the male and female reproductive systems consist of both internal organs and external structures that are involved in the production of gametes, delivery or reception of gametes, and the support of the growing embryo/fetus. I. Development of the Reproductive System Like the urinary system, the reproductive system develops from intermediate mesoderm. Part of the urogenital ridge that develops from this mesoderm will form the gonadal ridge. This is the structure that the male testis and the female ovaries develop from. Between 7 and 8 weeks developmentally, the gonadal ridge will differentiate into testes or ovaries. The mesonephric ducts (of the developing kidneys) and the paramesonephric ducts will develop into the other associated reproductive organs. If testes develop, the paramesonephric ducts degenerate and the mesonephric ducts become the epididymus, ductus deferens, and ejaculatory ducts. If ovaries develop, the mesonephric ducts degenerate and the paramesonephric ducts become the uterine (fallopian) tubes, uterus, and the superior vagina. The external genitalia of both sexes develop from the genital tubercle. In both sexes, the gonads must descend from the lumbar region (where they develop) into the lower pelvic cavity. In males the testes actually descend through the anterior body wall (inguinal canal) and lie in the external sac-like scrotum. Normal sperm development requires lower temperatures than inside the body cavity. This traversing of the body wall accounts for the higher incidence of hernias in males. II. The Male Reproductive System Primary Organs and Duct Systems: 1. Scrotum: external sac-like pouch that holds the paired testes. dartos muscle: smooth muscle in superficial fascia of scrotum responsible for wrinkling of the scrotal skin cremaster muscle: bands of skeletal muscle that extend from the internal oblique muscle that elevated the testes. 2. Testes (Testicles): produce male gametes (sperm cells): tunica vaginalis: serous sac around each testicle; derived from the peritoneal cavity; has a parietal and visceral layer. tunica albuginea: deeper, fibrous capsule around each testicle, forms invagination into the testicle that creates wedge-shaped compartments, dividing sections of seminiferous tubules (produce sperm)

testicular arteries supply blood to the testes 3. Epididymus: stores sperm for ejaculation walls have smooth muscle for ejaculation of sperm into the ductus deferens. 4. Ductus deferens (vas deferens): propels the sperm toward the ejaculatory duct spermatic cord: mostly comprised of the ductus deferens, testicular artery and veins; runs through the inguinal canal Accessory Glands: 5. Seminal Vesicles: produces most of the semen (60-70%) 6. Prostate Gland: secretes fluid into semen that enhances sperm motility and liquefies semen 7. Bulbourethral Glands: inferior to prostate gland; secretes mucus into spongy urethra prior to ejaculation (lubrication of urethra and neutralization of urine) External Organs: 8. Penis: delivers sperm into the female reproductive tract Shaft made up of three cylindrical bodies of erectile tissue Corpus spongiosum: contains spongy urethra (ventral penile surface) o Bulb of the penis: root of the penis secured to the urogenital diaphragm; it is the proximal end of the corpus spongiosum o Glans penis: enlarged end of the corpus spongiosum (head of the penis). Corpus cavernosum (2): fused together above corpus spongiosum (dorsal) o Crus (pl. crura): proximal end or roots of the corpora cavernosa; each is anchored to the ischiopubic rami Innervation: branches of the pudendal nerve from the sacral plexus Blood supply: branches of the internal pudendal arteries from the internal iliac arteries Erection is under parasympathetic control (pelvic splanchnic nerves), as blood fills erectile bodies within the erectile tissues of the corpus spongiosum and corpora cavernosa. Ejaculation is under sympathetic control. III. Female Reproductive System Primary Organs and Duct Systems: 1. Ovaries: produce female gametes (oocytes). Held in place by mesenteries Broad ligament of the uterus (peritoneal covering of uterus) Mesovarium (suspends ovary as part of broad ligament) Suspensory ligament of the uterus (part of broad ligament) Ovarian ligament (within broad ligament) Fibrous capsule covers ovary: tunica albuginea (thinner than testes) Oocytes form within follicles before release during ovulation Blood supply from ovarian arteries

2. Uterine Tubes (Fallopian Tubes): Oviducts that receive oocyte and are the primary site of fertilization Infundibulum: funnel shaped opening near ovary; surrounded by fimbriae (receives oocyte) Ampulla: where fertilization usually occurs (lateral 1/3)

Isthmus: medial 1/3 closest to uterus Mesentery of uterine tube: mesosalpinx (part of broad ligament of uterus) 3. Uterus: hollow, thick-walled organ that nourishes fertilized egg/embryo/fetus throughout pregnancy; highly distensible organ Body: major part of the uterus Fundus: rounded region superior to the entrance of the uterine tubes Isthmus: region between body and cervix Cervix: narrowed neck of the uterus, projects into the vagina; has cervical canal for entry into uterus The round ligament of the uterus binds the uterus to the anterior body wall, while lateral cervical ligaments bind it to the lateral pelvic walls. Uterine Wall: perimetrium: outer serous visceral layer; myometrium: middle, smooth-muscled layer; & endometrium: inner mucosal lining Blood supply: uterine arteries off internal iliac arteries 4. Vagina: (birth canal) smooth muscle walls, inner mucosal lining distensible (expandable) walls with transverse folds that expand and flatten during childbirth External Organs: generally in females referred to as the vulva: Mons pubis: fatty pad overlying pubic symphysis Labia majora: homologue of male scrotum Labia minora: enclosed within the folds of the labia majora Vestibule: enclosed within the folds of the labia minora; opening of vagina (and urethra) Prepuce of clitoris: hood-like fold of skin over the clitoris Clitoris: homologue of the male penis; also contains erectile corpora cavernosa (crura)