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Anatomy of male reproductive

system

Dr. Santosa Budiharjo, MKes.,


PA
Sistem reproduksi pria

(organa genitalia masculina/virilia)


Sistem reproduksi pria
organa genitalia
externa: penis et
scrotum
Organa genitalia
interna: testis;
epididimis; ductus
deferens, ductus
ejaculatorius
Glandula :
gld. vesicalis;
prostata,
bulbouretralis
Organa reproduksi: produksi sel gamet
(spermatosoan et semen); organ genital :
untuk berkelamin/kopulasi
Scrotum: kantong kulit, terkandung
testis kanan et kiri di caudal ossis
pubis
Raphe scroti: garis di linea
mediana (berlanjut ke
raphe penis)
Rambut terminal pubis:
pubes
Kulit scrotum: pigmen
Tela subcutanea: serabut
otot polos: tunica dartos
Kontraksi otot polos
kerutan kulit, mengecil
Septum scroti- membagi
kanan et kiri
Fungsi scrotum: tempat testis,
memelihara suhu: spermatogenesis

Isi scrotum: kedua testis,


epididimis et ductus
deferens
Letak testis kanan lebih
tinggi dari yang kiri
Suhu luar dingin
berkerut, testis naik; suhu
luar panas : scrotum
melemah testis menjauh
badan
Vasektomi; memotong vas
deferens
Hernia scrotalis:

Masuknya organ visceral abdomen


(usus halus-intestinum tenue) ke
ruang scrotum melewati canalis
inguinalis pada laki-laki; saluran
yang dilewati testis saat
turun/keluar dari ronga abdomen
Penis:
penis
Alat kopulasi
(bersetubuh)
Dibedakan: glans
penis, corpus penis
dan radix penis
Kulit penis:
preputium pada glans
(frenulum); phimosis
lubang preputium
sempit
Circumsitio/dorsumsit
io:kotoran smegma
Pars affixa et pars libera
Struktur penis
2 corpus cavernosum et 1
corp0us spongiosum
Corpus cavernosum:
pangkal: crus pada ramus
inferior, kemedial bertemu
pihak lain, bentuk corpus,
bentuk batang, dinding
tunica albugenia, serabut
longitudinal et circular,
membentuk caverna
(ruang-ruang)
Corpus spongiosum: mulai
bulbus, bulatdi linea
mediana, pada fascia
diafragma urogenitalis
Penggantung penis

Lig. Suspensorium
penis ke
symphisis pubis ke
tunica albuginea
corpus cavernosum
Lig. Fundiforme
penis : dari dari
linea alba ke penis,
fascia penis
melingkupinya
Corpus et glans penis
corpus spongiosum
menempati sulcus kedua
corpora cavernosa (di
ventral)
Ujung corpus
spongiosummelebar ke
cranial et lateral,
menutupi kedua ujung
corpus cavernosum,
membentuk glans penis
(conus)dg corona glandis
et sulcus glans penis
Ditembus uretra
Penis dan refleks ereksi

Rangsang (berbagai bentuk)


rabaan erogen genital impuls
medulla spinalis - refleks efektor
caverna terisi darah, terbendung
oleh kontraksi otot polos
Corpora cavernosa membesar et
memanjang --- tegak, ereksi
Keras: tunica albuginea
Dipertahankan otot-otot
Arteriola helicinae
Ereksi
vasodilatasi
Cavernae membesar,
menarik tunica
albuginea tertarik,
menjepit venae yang
melewatinya
Tunica albuginea corpus
spongiosum tipis,
membesar sedikit
Ereksi: corpus
mengeras bagian
corpus cavernosum, dan
tetap lebihlembut: pada
corpus spongiosum et
glans
Tahap-tahap siklus bangkitan sexual

Tahap gairah (terangsang)


Tahap plateau (puncak)
Tahap ejaculasio et orgasmus
Tahap resolusi
Refleks ereksi et pusat kesadaran di otak

Rangsangan:
Daerah erogen
(perabaan et
tekanan)
Visual : penglihatan
Pendengaran
Emosi
penciuman
Efek : penis ereksi, oto-
oto baan tegang,
tekanan darah den
denyut jantung naik
Sistem saraf yang terlibat pada proses
ereksi dan pengaturannya
Sistem saraf yang terlibat pada
proses ereksi dan pengaturannya
Poten, impotensi, disfungsi ereksi (DE)
Ereksi, lumen uretra, mictio,
ejaculatio
Saat ereksi
Lumen uretra tetap
dapat dilalui oleh
urine (saat mictio) dan
dilewati semen saat
ejaculatio

Lumen uretra pars


bulbus muara gld
bulbouretralis
(Cowperi) di diafragma
urogenitalis - sekret
antiseptik,
membersihkan sisa
urine
Testis, epididimis, ductus deferens,
ductus ejaculatorius, gld. Vesicalis et
prostata

Testis: di dalam scrotum, dua buah,


bulat memanjang memipih, extremitas
superior et inferior, facies lateralis et
medialis, margo anterior et posterior
Hilus pada margo posterior
Dinding : tunica albuginea ke septula
dalam testis membagi dalam lobuli
Septula dekat hilus sebagai
mediastinum testis
Pembungkus :Testis, epididimidis et
ductus deferens
Dari luar: kulit, tunica
funniculi spermatici, fascia
spermatica externa,fascia
cremasterica, m.
cremasterica, fascia
spermatica interna (tunica
vagina communis)
Korda spermatica
(funniculus spermaticus):
ductus deferens, a.
spermatica/testiscularis,
plexus pampiniformis
(vein), nervus.
Struktur testis
Isi: tubulus seminiferus
Isi: lobulus testis:
berbagai stadia gonocyt
ductus seminiferus
(spermatocytus) dan
contortus yang akhirnya
trophocytus (sel sertoli)
menyatu : tubulus
seminiferus rectus dan Proses spermatogenesis
di mediastinum sbg rete spermatogonium (1)
testis (mitosis,, 2n)
Diantara lobuli: jaringan 1 spermatocytus primer
interstitial : sel Leidig (meiosis 1, jumlah 2, 2n)
testosteron 2 spermatocytus
Selubung:tunica sekunder (meiosis 2,
vaginalis testis (lamina jumlah 4, n)
serosa ganda: parietalis spermatid (4, n)
(periorchium)et sperma
visceralis (epiorchium) (spermiogenesis)
Sperma
Komponen: caput, collum
et cauda
Spermiogenesis:
spermatid menjadi
sperma
bantuan sel sertoli
Cauda: flagellum
mitokondria aktif
bergerak
Caput (inti sel):
acrosoma; enzym
proteolitik
hyalorunidase
menembus zona pelucida
ovum
Morphologi sperma et semen
Berbagai Kelainan
bentuk
Sperma x, sperma y
Semen: sekret dari gld
vesicalis vesicula
seminalis (fruktosa, dll)
gld. Prostata (pH basis,
enzim proteolitik
kental kemudian
melisiskan-cair)
Semen: ejaculat (sperma
et sekret gld vesicalis et
prostat) saat ejaculatio
Epididimidis/epididimis
Di posteromedial testis,
dilekatkan lig. Epididimis
superior et inferior
Menampung sperma, dibedakan:
caput, corpus et cauda
Caput: isi ductuli efferentes,di
cranial testis
Corpus:ductus contortus
epididimis
Cauda: terminal dari corpus, di
inferior testis ke ductus deferens
(total ductus epididimis 5m)
Ductus deferens et ejaculatorius

Ductus deferens:
saluran sperma, 60cm,
antara epididimis ke
vesicula seminalis,
mula-mula melingkar
kemudian lurus
Perjalanan: inferior
testis medial scrotum ,
funniculus spermaticus,
canalis inguinalis masuk
rongga abdomen,
menyilangi ureter,
masuk vesicula
seminalis (ampula)
Struktur ductus deferens et ductus
ejaculatorius
Lapisan dari luar: tunica
adventitia, tunica
muscularis, et tunica
mucosa
Tunica muscularis relatif
tebal, tunica mucosa
berepitel columnare
stereocilia
Ductus deferens
bergabung dengan
ductus eferens
(excretorius) vesicula
seminalis menjadi
ductus ejaculatorius
Ductus ejaculatorius:
menyilang prostat,
muara pada uretra pars
prostatica
Glandula vesicalis (vesicula seminalis) et
glandula prostata

Di rongga pelvis, gld.


Vesicalis di dorsal vesica
urinaria, gld. Prostata di
inferior vesica urinaria
Vesicula seminalis:
kelenjar vesicalis,
dengan satu tubulus
melingkar-lingkar
panjang 12cm (ductus
exretorus/eferens)
lapisan: tunica adventia,
tunica mucosa et tunica
mucosa:epitel
sekretorus simplex
Gld. prostata
Kelenjar tuboalveolar, 30
50 buah (parenchym);
lobus kanan et kiri (dg
istmus prostat) dan lobus
medius
Diselubungi capsula
prostat, bentuk kacang
kastranye, dibedakan:
basis (melekat vesica
urinaria), apex (berisi
uretra-ke depan dan
atas), 3 permukaan:
anterior, posterior et
inferolateral
Ductus excretorius (15
30) ke uretra pars
prostatica
Substantia muscularis
interglandula
Prostat: pemeriksaan prostat (rectal
toucher), hipertropi prostat
Vesicula seminalis &
gland.bulbourethralis

Vesicula seminalis terletak di dorsal vesica


urinaria, menghasilkan cairan semen
mengandung fruktosa; ductus excretorius
bersama dengan ductus deferens
membentuk ductus ejaculatorius bermuara
di urethra pars prostatica
Glandula bulbourethralis terletak di caudal
membrana urogenitale, ductus excretorius
bermuara di urethra urethra pars
penil/spongiosa di bulbus penis
Ejaculatio- pengeluaran
ejaculat/semen
Refleks pengeluaran
ejaculat/semen: proses yang tidak
dapat ditahan
Dimulai perangsangan, ereksi,
plateu dan ejaculatio
pemancaran semen keluar ostium
uretra externum
Semen: terkumpul di ampula
ductus deferens (efek
penyedotan-vacum)
Secret dari gld. Vesicalis dan
prostat saat ejaculatio tercurah di
pars prostatica
Kontraksi otot polos ductus
Kontraksi otot badan, otot sphincter
vesicae, berkeringat, berdebar debar
Sensasi nikmat: orgasmus
Nerves in penile erection
Three sets of peripheral nerves are
involved in penile erection:
two are autonomic
Parasympathetic nerves
sympathetic nerves
one is somatic
Nerves in penile erection
Parasympathetic nerves : S2
S4
Sympathetic nerves : T10L2
Somatic fibers travel in the
pudendal nerves and their cell
bodies are situated in the S2S4
segments
Mechanism of erection
Cavernosal smooth muscle tone is the
most important determinant of penile
blood flow.
This, in turn, is critically dependent on the
level of intracellular calcium ([Ca]2+),
modulated by a number of mechanisms.
The most important vasodilator transmitter
is nitric oxide (NO), released from both
nitrergic nerve endings and vascular
endothelium
Mechanism of erection
NO stimulates production of cyclic
guanosine monophosphate (cGMP)
from guanosine triphosphate (GTP) by
the enzyme guanylate cyclase (GC)
A second vasodilator mechanism
involves the production of cyclic
adenosine monophosphate (cAMP)
from adenosine triphosphate (ATP) by
adenylate cyclase (AC)
Mechanism of erection
Both vasoactive intestinal
polypeptide (VIP) and prostaglandin
E1 (PGE1) activate AC.
Both cGMP and cAMP lower
intracellular calcium, thereby
triggering smooth muscle relaxation.
Mechanism of erection
NO also activates sodium
(Na+)/potassium (K+)-channel
ATPase, resulting in hyperpolarization
of the smooth muscle cell membrane
which, in turn, prevents the opening
of voltage-dependent calcium
channels, thereby reducing
intracellular calcium
Hemodynamic of flaccidity
Tonic contraction of the walls of the
helicine arteries and trabeculae
allows only relatively small amounts
of blood into the lacunar spaces.
Whatever blood is entering is
drained through the walls of the
tunica albuginea by subtunical
vessels
Hemodynamic of erection
dilatation of the helicine arteries and
relaxation of the trabeculae allow the
lacunar spaces to fill.
Their engorgement compresses the
obliquely oriented subtunical veins against
the tunica albuginea.
This veno-occlusive mechanism prevents
venous leakage and facilitates the
development of a full and rigid erection
Hemodynamic of erection
The key event in the induction of
erection is vasodilatation of the
helicine arteries, which is induced by
nitric oxide and other neurotransmitters
The veno-occlusive mechanism is a
secondary event brought about by
compression of the subtunical veins
against the sturdy tunica albuginea
Schematic representation of
the hemodynamics of flaccidity
and erection
During erection, the penile vascular
volume increases rapidly
Full erection is achieved when
intracorporeal pressure approximates
systolic blood pressure
types of erections

Three types of erections :


genital-stimulated (contact or
reflexogenic)
central-stimulated (noncontact
or psychogenic)
central-originated (nocturnal)
Genital-stimulated erection
induced by tactile stimulation
of the genital area
can be preserved in upper
spinal cord lesions, although
erections are usually short in
duration and poorly controlled
by the individual
Central-stimulated erection
more complex
resulting from :
memory
fantasy
visual
auditory stimuli
central-originated
(nocturnal)
can occur spontaneously without
stimulation or during sleep
most sleep erections occur during rapid
eye movement (REM) sleep
During REM sleep, the cholinergic neurons
in the lateral pontine tegmentum are
activated while the adrenergic neurons in
the locus ceruleus and the serotonergic
neurons in the midbrain raphe are silent.
central-originated
(nocturnal)
This differential activation may be
responsible for the nocturnal erections
during REM sleep. Of note, the number
and duration of erections for men with
hypogonadism or receiving
antiandrogen therapy is markedly
reduced
Phases of the Erection
Process
Flaccid phase
Latent (filling) phase
Tumescent phase
Full erection phase
Skeletal or rigid erection phase
Detumescent phase
Phases of the Erection
Process
Flaccid phase (1)
Minimal arterial and venous flow
blood gas values equal those of venous blood
Latent (filling) phase (2)
Increased flow in the internal pudendal artery
during both systolic and diastolic phases
Decreased pressure in the internal pudendal
artery
unchanged intracavernous pressure
Some elongation of the penis
Phases of the Erection
Process
Tumescent phase (3)
Rising intracavernous pressure until full
erection is achieved
Penis shows more expansion and elongation
with pulsation
The arterial flow rate decreases as the pressure
rises
When intracavernous pressure rises above
diastolic pressure, flow occurs only in the
systolic phases
Phases of the Erection
Process
Full erection phase (4)
Intracavernous pressure can rise to as much as 80
90% of the systolic pressure
Pressure in the internal pudendal artery increases
but remains slightly below systemic pressure
Arterial flow is much less than in the initial filling
phase but is still higher than in the flaccid phase
Although the venous channels are mostly
compressed, the venous flow rate is slightly higher
than during the flaccid phase
Blood gas values approach those of arterial blood
Phases of the Erection
Process
Skeletal or rigid erection phase (5)
As a result of contraction of the
ischiocavernous muscle
the intracavernous pressure rises well above
the systolic pressure, resulting in rigid erection
During this phase, almost no blood flows
through the cavernous artery; however, the
short duration prevents the development of
ischemia or tissue damage
Phases of the Erection
Process
Detumescent phase (6)
After ejaculation or cessation of erotic stimuli,
sympathetic tonic discharge resumes, resulting
in contraction of the smooth muscles around
the sinusoids and arterioles
This effectively diminishes the arterial flow to
flaccid levels, expels a large portion of blood
from the sinusoidal spaces, and reopens the
venous channels
The penis returns to its flaccid length and girth
Anatomy & Hemodynamics
of Penile Erection
The tunica of the corpora cavernosa is a bilayered structure with multiple
sublayers. The inner circular bundles support and contain the cavernous
tissue. From this inner layer, intracavernosal pillars that act as struts radiate to
augment the septum; both structures provide essential support to the erectile
tissue. The outer-layer bundles are oriented longitudinally and extend from the
glans penis to the proximal crura. These fibers insert into the inferior pubic
ramus but are absent between the 5- and 7-oclock positions. In contrast, the
corpus spongiosum lacks an outer layer or intracorporeal struts, ensuring a
lower pressure structure during erection. The tunica is composed of elastic
fibers forming a network on which the collagen fibers rest. Emissary veins run
between the inner and outer layers for a short distance, often piercing the outer
bundles obliquely. Branches of the dorsal artery take a more direct
perpendicular route and are surrounded by a periarterial fibrous sheath.
The paired internal pudendal artery is the major carrier of the blood supply to the
penis, dividing into 3 branches: the bulbourethral artery, dorsal artery, and the
cavernous artery (deep artery). The cavernous artery supplies the corpora
cavernosa; the dorsal artery, the skin, subcutaneous tissue, and the glans penis;
and the bulbourethral artery, the corpus spongiosum. In some cases, accessory
pudendal arteries from external iliac or obturator arteries may supply a major
portion of the penis, with collaterals among the 3 branches often observed. The
venous drainage of the glans is mainly through the deep dorsal vein. The corpus
spongiosum is drained via the circumflex, urethral, and bulbar veins, but the
drainage of the corpora cavernosa is more complex: the mid- and distal shaft
are drained by the deep dorsal vein to the preprostatic plexus while the proximal
portion is drained by the cavernous and crural veins to the preprostatic plexus
and internal pudendal vein. The drainage of all 3 corpora originates in the
subtunical venules, which unite to form emissary veins. The glans penis
possesses numerous large and small veins that communicate freely with the
dorsal veins. The penile skin and subcutaneous tissue are drained by superficial
dorsal veins, which then empty into the saphenous veins.
Activation of the autonomic nerves produces a full erection secondary to filling
and trapping of blood in the cavernous bodies. After full erection is achieved,
contraction of the ischiocavernosus muscle (from activation of the somatic
nerves) compresses the proximal corpora and raises the intracorporal pressure
well above the systolic blood pressure, resulting in rigid erection. This rigid
phase occurs naturally during masturbation or sexual intercourse but can also
occur from slight bending of the penis, without muscular action. The erection
process can be divided into 6 phases. The hemodynamics of the penile glans is
somewhat different. Arterial flow increases in a manner similar to that in the
shaft. Because it lacks the tunica albuginea, however, the glans functions as an
arteriovenous fistula during the full erection phase. Nevertheless, during rigid
erection, most of the venous channels are temporarily compressed, and further
engorgement of the glans can be observed
Mechanism of Penile Erection
The penile erectile tissue, specifically cavernous, arteriolar, and arterial wall
smooth musculature, is key to the erectile process. In the flaccid state, these
smooth muscles are tonically contracted due to intrinsic smooth-muscle tone
and possibly tonic adrenergic discharge, allowing only a small amount of
arterial flow for nutritional purposes. The blood partial pressure of oxygen
(PO2) is about 35 mmHg. When smooth muscles relax due to the release of
neurotransmitters, resistance to incoming flow drops to a minimum. Arterial
and arteriolar vasodilatation occurs, and sinusoids expand to receive a large
increase of flow. Trapping of blood causes the penis to lengthen and widen
rapidly until the capacity of the tunica albuginea is reached. Expansion of the
sinusoidal walls against one another and the tunica albuginea results in
compression of the subtunical venous plexus. As well, uneven stretching of
the layers of the tunica albuginea compresses the emissary veins and
effectively reduces the venous flow to a minimum .Intracavernous pressure
(ICP) and PO2 increase to about 100 and 90 mm Hg, respectively, raising the
penis from a dependent position to the erect state; further pressure increases
due to contraction of the ischiocavernosus muscles (to several hundred
millimeters of mercury) result in the rigid erection phase.
Mechanism of ejaculation: ejaculation is a reflex response involving
both sympathetic and pudendal nerve activity. Sympathetic nerve
discharge results in contraction of the bladder neck, seminal vesicles and
prostate gland. Seminal fluid and prostatic secretions are emptied via the
verumontanum into the prostatic urethra. Reflex relaxation of the
membranous urethra and rhythmic contraction of the bulbocavernosus
muscles result in the pulsatile emission of semen from the urethral meatus