The uterine artery is the most significant source of blood to the uterus and therefore requires

careful dissection. It is generally a branch of the internal iliac artery which supplies the uterus
and fallopian tubes. The uterine artery lies over the ureter.

To excise the uterus what ligaments would the surgeon have to cut?
(1) The round ligament of the uterus, which connects to the uterus anterior and inferior to
the fallopian tube between the layers of the broad ligament.

(2) The ligament of the ovary (proper ovarian ligament), which lies posterior and inferior to
the fallopian tube.

(3) The anterior leaf of the broad ligament and the lateral attachments of the broad
ligament.

(4) In addition the surgeon would detach the uterus by cutting below the external os of the
cervix and suturing the four corners of the vaginal wall.

ampulla of the vas deferens = dilated part of the vas deferens located posterior to the
bladder. ampulla is where the vas deferens joins with the duct of the seminal vesical to form the
ejaculatory duct to enter the prostate. Distally, ejaculatory duct passes through the prostate
gland to empty onto the seminal colliculus along the urethral crest in the prostatic urethra

ampulla of the fallopian tube = widest and longest part of the uterine tube. It is where
fertilization occurs.

Anal columns: longitudinal folds of mucosa on the inner wall of the anal canal. Anal columns
are connected inferiorly by anal valves; rectal vessels lie beneath the submucosa of the anal
columns

Anal valves: are folds of mucosa joining adjacent anal columns at their inferior below ends. Anal
valves can be difficult to locate in the older individual. The inferior border of the anal valve is the
pectinate line

Pectinate Line: an irregular line joining the undersides of the anal valves. Pectinate line is
where the mucosal lining of the digestive tract becomes continuous with the skin of the anal
aperture

Urinary Bladder: ureters enter the posterolateral surface of the bladder at the posterior two
angles of the vesical trigone. Urinary bladder is posterior to the pubic symphysis.

Fundus of the uterus: the rounded anterosuperior part of the uterus. Fundus of the uterus is
defined as that portion of the uterus located superior to an imaginary line joining the points of
entry of the fallopian tubes; the uterus is normally anteverted and anteflexed, so the fundus
normally points anterosuperiorly

Frenulum: a more posterior or deeper part of the labia minora passing posterior to the clitoris

Glans Penis: expanded distal end of the corpus spongiosum which caps the ends of the corpora
cavernosa. the fossa navicularis is an expanded portion of the penile urethra that occurs in the
glans penis

Hymen: thin, usually incomplete septum at the inferior vaginal orifice. The Hymen is the
remnant of the urogenital septum of the embryo

Isthmus of the fallopian tube is the narrowest part

Clitoris: erectile tissue corpus caversona

Labia Minora: paired folds of hairless skin located medial to the labia majora and
extending posteroinferiorly from the clitoris. The anterior end of each labium minora
divides: the anterior division of each labium forms the prepuce (hood) of the clitoris and
the posterior division of each labium forms the frenulum of the clitoris

Prepuce: fold of smooth skin extending over the clitoris. The anterior divisions of the labia
minora combine to form the prepuce of the clitoris

Labia Majora: fat-filled elevations of hair-covered skin lying on either side of the vestibule of
the vagina. Labia majora are joined across the midline by the anterior and posterior labial
commissures; they blend into each other anteriorly to form the mons pubis

posterior fornix of the vagina: space within the vaginal canal posterior to the cervix. An
incision made superiorly through posterior fornix will enter the rectouterine pouch of the
peritoneal cavity (Pouch of Douglass)

ovarian ligament: a band of connective tissue that connects the ovary to the lateral surface of
the uterus. Ovarian ligament lies within the mesovarium

Prostatic Utricle: is a remnant of the fused lower ends of the paramesonephric ducts - the
fused paramesonephric ducts form the uterine canal in the female

Round Ligament of the Uterus: a connective tissue band that attaches to the inner aspect of
the Labia Majora. It comes from the abdomen to reach the lateral surface of the uterus below the
fallopian tube; it is a remnant of the gubernaculum; it is continuous with the ovarian ligament; it
holds the fundus of the uterus forward in antewarded positi

In the scrotum the fatty and membranous layers of the superficial fascia (as seen in the lower
abdominal wall: Campers & Scarpa’s) are fused to form the Dartos muscle

Scrotal Raphe: the midline, bilateral embryonic formation of the scrotum. Dividing line between
two testes

Seminal Colliculus: is a mound in the posterior wall of the prostatic urethra; on its summit is
found the opening of the prostatic utricle

seminal vesicle: blind sac located on the posterior surface of the bladder supero-lateral to the
ampulla of the vas deferens

Spermatic Cord: comprises the: vas deferens, testicular artery, pampiniform venous plexus,
and genital branch of the genitofemoral nerve; coverings of the cord are the: internal spermatic
fascia (from the transversalis fascia), cremasteric muscle and fascia (from the internal abdominal
oblique), external spermatic fascia (from the external abdominal oblique aponeurosis)

Suspensory Ligament of the Ovary: peritoneal fold overlying the ovarian vessels as they
cross the pelvic brim to reach the ovary. It is continuous with the broad ligament at the ovary

Ureteric Orifices: openings of the ureters in the bladder wall

prostatic part of the male urethra: passing through the prostate gland- the prostatic urethra
begins at the internal urethral orifice at the antero-inferior angle of the vesical trigone; posterior
wall of the urethra has an elevated ridge called the urethral crest with a prominence called the
seminal colliculus. Seminal Colliculus has a blind diverticulum called the prostatic utricle with
orifices of ejaculatory ducts located below it.

Uterus: normally lies anteverted posterosuperior to the bladder

Vesical Trigone: smooth triangular region located on the inner surface of the posterior wall of
the urinary bladder. Vesical trigone is bounded by the openings of the ureters in the bladder.

vestibule of the vagina: region inferior to the hymen and between the labia minora

Dorsal view is when penis is angled down

Rectouterine Pouch: in females, a peritoneal fold reflecting from the rectum to the posterior
fornix of the vagina wall. Also known as the Pouch of Douglass

Vesicouterine Pouch: in females, seperates the bladder from the uterus

Rectovesical Pouch: in males, fold between bladder and rectum. Has rectouterine bursa.
Similar to rectouterine pouch in females

Perineum has 2 divisions: urogenital triangle anteriorly and anal triangle posteriorly

Ectopic Pregnancy: implantation of embryo elsewhere than in the uterus. Often occurring in
the fallopian tube. Presents with abdominal pain, fainting, and/or vaginal bleeding.

Enterocele: a hernial protrusion of bowel through a defect in the rectouterine or vesicouterine

pouch on posterior vaginal wall

Cystocele: a condition where the bladder herniates into the vaginal canal and usually results in
stress incontinence. In anterior vaginal wall

tunica vaginalis testis: a peritoneal sac located anterolateral to the testis. tunica vaginalis
testis has two layers: visceral and parietal; the visceral layer lies on the anterolateral surface of
the testis and epididymis; the parietal layer lines the inner surface of the scrotal sac

Broad ligament has three named parts: mesovarium, mesosalpinx, mesometrium

Mesosalpinx: (most superiorly located)connects and attaches fallopian tube to uterus and
mesometrium

Mesovarium: connects ovary to uterus and mesometrium. Also inferior continuation of

mesosalpinx between fallopian tube and ovaries

Mesometrium: attaches the body of the uterus to the pelvic wall

The lining of the anus officially changes from "skin" to mucosal at the pectinate line,
though there is a transitional zone, or "white line", between the two areas. The
pectinate line runs along the inferior borders of the anal valves, which are mucosal folds
connecting the anal columns to one another.

Superior to the pectinate line we have blood coming from the superior rectal artery, blood
draining to the portal system via the inferior mesenteric branch called the superior rectal veins,
and visceral (no localized pain) innervation via the inferior hypogastric plexus (autonomous).
Inferior to the pectinate line we have blood coming from the inferior rectal arteries, draining
into the IVC. Innervation here (inferior to the pectinate line) comes from the inferior rectal nerves
from the pudendal nerve(somatic innervation).

The pectinate line is the place where the lining of the anal canal changes from skin to mucosa. It
is also a landmark that divides the lymphatic drainage, vascular supply, and innervation of the
anal canal. Lymph coming from structures above the pectinate line drains to the inferior
mesenteric lymph nodes or the internal iliac nodes. Lymph from structures below the pectinate
line travels to the superficial inguinal lymph nodes.
The tapered neck or cervix of the uterus is traversed by the cervical canal. Above, it is
continuous with the cavity of the body of the uterus at the internal os. Below, at a depression on
the vaginal portion of the cervix, the external os opens into the cavity of the vagina.

Also on the posterior aspect of the bladder lie the seminal vesicles. On each side, the ductus
deferens and seminal vesicle join to form the ejaculatory duct, which dumps into the prostatic
portion of the urethra. From there, the urethra travels through the penis to its external opening.

The prostate gland sits under the bladder, with the ampulla of the rectum posterior to it. (The
rectovesical septum is between the two.) The base of the gland, which is the TOP, is continuous
with the bladder wall. The ejaculatory ducts enter the prostate posterosuperiorly and run to the
prostatic urethra. Near the mouth of the prostatic utricle, the two ejaculatory ducts empty into
the prostatic urethra.

Inferior to the bladder we find the pelvic diaphragm (in females) or the prostate gland
(in males).

The anterior flexure at the anorectal junction is held by the sling of the puborectalis portion of
the levator ani muscle, which passes posteriorly around the anorectal junction.

The ureter passes over the pelvic brim just medial to the ovarian vessels, usually at the
bifurcation of the common iliac artery. The ureter then descends and passes anteriorly within the
pelvis. It is crossed superiorly by the uterine artery ("bridge over water") before it turns medially
to enter the posterior wall of the bladder.

The cardinal ligaments and the endopelvic fascia around the uterine vessels helps to fix the
cervix in place, as do the rectouterine ligaments. Even the broad ligament lends a slight amount
of support to the uterus. (Anterversion of the uterus seems to be key, since retroversion is
associated with prolapse of the uterus into the vagina.

The cervix is the inferior end of the uterus that projects into the vagina. This means that the
vagina comes up and wraps around the cervix, creating the vaginal fornix. There are multiple
fornices at the top of the vagina: anterior, posterior, and lateral. The cervical canal is the
passageway through the cervix to the vagina.
Which of the following would be most likely to be damaged by a stab wound into the (ischioanal)
fossa 2 cm lateral to the anal canal? Pudendal nerve

After agreeing to have no more children, a man and his wife decided he should have a
vasectomy. What structure would then be surgically ligated? Vas Deferens

Benign hyperplasia (excessive growth of cells) of which part of the male reproductive system
would be most likely to interfere with the passage of urine? Periurethral Zone of the Prostate

Bulb of corpus spongeosum (male) = vestibular bulb (female)

The shaft of the penis is an analog of the shaft of the clitoris, while the labia majora is derived
from the same embryonic structures as the scrotum.

The rectovesicular pouch is a reflection of the peritoneum between the rectum and the bladder.
It can only be found in males because females have the uterus sitting between the rectum and
the bladder. This means that females have two pouches created by reflections of peritoneum
draped over the pelvic viscera: the rectouterine and vesicouterine pouches.

The ovary is entirely covered by a layer of peritoneum called the mesovarium. The mesovarium,
along with the mesometrium and the mesosalpinx, creates the broad ligament. Because the
ovary is completly encased in peritoneum, it would be outlined on a CT with intraperitoneal
contrast material.

The prostate is located on the postero-inferior to the bladder. Since the rectum is behind the
bladder and prostate, you can image the prostate by placing an ultrasound transducer in the
rectum and pressing it against the anterior wall. Then, the ultrasound transducer will be against
the prostate gland.

The ovarian ligament is located in the broad ligament but is not part of the broad ligament. It is
a round cord that attaches the ovary to the uterus just below the point where the uterine tube
enters the uterus. The round ligament of the uterus reaches the lateral surface of the uterus
below the uterine tube. It is continuous with the ovarian ligament and it holds the fundus of the
uterus forward.

The duct of the seminal vesicle carries seminal fluid, a basic fluid containing fructose. The
contents of the seminal fluid buffers the acid in the vagina and provides nutrients for sperm. The
duct of the seminal vesicle joins with the ampulla of the vas deferens (which is carying sperm) to
form the ejaculatory duct. This is the first place where seminal fluid mixes with sperm. Sperm is
first formed in the seminferous tubules. They then travel from the head to the tail of the
epididymis, through the ductus deferens, into the ejaculatory duct where they mix with seminal
fluid, into the prostatic urethra, through the rest of the urethra, and then out the penis.

 Which of the following does not conduct spermatozoa? Seminal vesicle duct

The cervix of the uterus is anterior to the rectum. Since the cervix is the inferior part of the
uterus that is protruding into the vagina, it should feel like a firm structure upon palpation.

The ejaculatory duct travels through the prostate and opens into the prostatic urethra.

The most inferior extent of the peritoneal cavity in the female is the: rectouterine pouch
Remember: The rectouterine and vesicouterine pouches are the two pouches created by draping
the peritoneum over the pelvic organs. These pouches are the two lowest extents of the
peritoneal cavity, so to answer this question, you just need to decide which one goes lower.
Since the uterus is folded over the bladder, the rectouterine pouch can extend to a slightly lower
level than the vesicouterine pouch.

There are two true statements here. First, the prostate gland encircles the urethra. It circles
around the first part of the urethra, the prostatic urethra. This is why urinary retention is one
symptom of prostatic hypertrophy--if the prostate is enlarged, it may close around the urethra,
occluding this passage and preventing urine from exiting the bladder. The prostate gland is also
extraperitoneal. Remember: the rectovesicular pouch, a fold of peritoneum that hangs between
the bladder and rectum, is the lowest extent of the peritoneal cavity in males . But, the prostate
is found on the infero-posterior side of the bladder, below the point where the peritoneal
membrane created this fold. So, it is an extraperitoneal organ.
Remember, the pectinate line (the line in the anus where mucosa changes to skin) is the dividing
line for lymphatic drainage. Structures above the pectinate line drain into the inferior mesenteric
and internal iliac nodes. Structures below the pectinate line drain into the superficial inguinal
nodes. Since the tumor is in the cutaneous (skin) region of the anal canal, it is going to be
drained by the superficial inguinal nodes. This means that these nodes would be the first site of
metastases. The pectinate line is the line of transition between the mucosal lining of the anal
canal and the skin lining of the anal canal. So, this is the point where the mucosal zone ends and
the skin begins. The white line is a transitional zone between the pectinate line and "regular"
skin where there are some more subtle changes in the epithelial lining of the anal canal. But the
pectinate line is the line that demarcates the major transition from mucosal lining to skin.

Anal columns are longitudinal folds of mucosa over rectal vessels. They are found on the
inner wall of the anal canal. Anal valves are folds of mucosa that join the anal columns at their
inferior ends and create spaces between the wall and the valves known as anal
sinuses.

The Transverse Rectal Folds:

These valves are reflections of the rectal mucosa, which contain some fibers of the circular
muscle coat of the rectal wall. They are crescentic plications, which have a definite
structure. They lie obliquely and transverse to the length of the rectum and project into
the length of the rectal lumen. The valves are quite variable in number, location and
degree of development. Usually there are three: an inferior, middle and superior but
occasionally there are more. The inferior valve is usually located from 2.5 to 3.5 cm above
the anal margin Occasionally, the valves are absent.

In the strict sense they are not valves, and the degree to which they are able to function is
still debatable. Their purpose seems to be to serve as steps or spiral supports to modify
the flow of the feces as they descend into the lower rectum. Slow it down and catch

In a CT scan of the pelvis, the uterus is located: posterior to the bladder and anterior to the
rectum

In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior
fornix of the vagina. At its lowest extent, the rectouterine fold is draped over the
posterior fornix of the vagina. This means that surgeons can make an incision in the
posterior fornix of the vagina and enter the rectouterine pouch to harvest eggs from the ovaries
or remove an ectopic pregnancy.

There are four major differences between the male and female pelvis:
1. First, the subpubic angle and pubic arch are greater in the female pelvis than in
the male pelvis.
The male pelvis has a smaller subpubic angle than the female pelvis.
Females often have a subpubic angle of 90 degrees or greater (obtuse)
while males have a acute subpubic angle.
 2. A second difference between the female and male pelvis is that the pelvic inlet
for females is rounded, while for males it is heart shaped.
3. Third, the pelvic outlet for females is larger than in males.
4. Finally, the female pelvis has iliac wings that are more flared than in males.

The vesicouterine pouch --it helps to separate the uterus from the bladder. The rectovesicular
pouch is only found in males--it seperates the posterior wall of bladder from rectum. It is the
female equivalent of the Pouch of Douglass.

The external os of the cervix is the part of the cervix between the vagina and the cervical canal
inferiorly; the internal os of the cervix is the part of the cervix between the uterus and the
cervical canal superiorly.

The ureters pass through the base of the mesometrium as they travel to
reach the bladder.
You are observing a doctor perform an abdominal hysterectomy. He notes that it is vital to
protect the ureter which is found in the base of the: mesometrium

The labia majora and scrotum are homologous structures. The labia minora is the female
counterpart of the medial scrotal raphe.

Female Labium majora = male scrotum

Female Labia minora = male medial scrotal raphe between 2 testes
shaft of the corpus cavernosum in the female is the shaft of the clitoris = male shaft
of the penis.

The prepuce is a fold of smooth skin that extends over the glans clitoris. It is formed by the
joining of the anterior divisions of the labia minora. The frenulum of the clitoris is a small fold
found posterior to the clitoris. It is formed by the joining of deeper, posterior, divisions of the
labia minora. The labia minora are smaller folds of skin lying medial to the labia majora. They
extend posteriorly and inferiorly from the clitoris.

A structure which takes the form of a hood anterosuperior to the clitoris: Prepuce

The part of the broad ligament giving attachment and support to the uterine tube is the:
mesosalpinx

The lesser true pelvis is the area beneath the pelvic brim (pelvic inlet), where the pelvic viscera
are located. The greater false pelvis is the area above the pelvic brim, bounded by the iliac
blades. Now, you just need to think about the structures listed and determine which ones are in
which location. The femoral nerve is the structure that is not in the true pelvis. After coming off
the lumbar plexus with contributions from L2, 3, and 4, the femoral nerve runs along the border
between the psoas major muscle and the iliacus to travel into the lower limb. It never descends
below the pelvic brim, so it is not in the true pelvis. Hypogastric nerves connect the superior and
inferior hypogastric plexuses. Since the inferior hypogastric plexus is lying between the pelvic
viscera and the pelvis wall, in the lesser true pelvis, the hypogastric nerves should also be in the
true pelvis as they supply the area above anterior to the pectinate line in anal columns
autonomously. The internal pudendal artery is a branch of the anterior division of the internal
iliac artery. It lies in the true pelvis and supplies blood to the perineum. The obturator artery is a
branch of the anterior internal iliac artery or, if it is the aberrant obturator, the inferior epigastric
artery. It is in the true pelvis, and exits the pelvis through the obturator foramen. The pelvic
splanchnic nerves represent the sacral portion of the craniosacral outflow (parasympathetic) of
the autonomic nervous system. They come from the ventral rami of the second, third, and fourth
sacral nerves. So, that puts them in the true pelvis, too they too supply the area above the
pectinate line in anal columns.

The prostate gland encircles the urethra. It circles around the first part of the urethra, the
prostatic urethra. This is why urinary retention is one symptom of prostatic hypertrophy--if the
prostate is enlarged, it may close around the urethra, occluding this passage and preventing
urine from exiting the bladder.

The uvula of the bladder is an elevation on the posterior wall of the bladder. The uvula is caused
by the middle lobe of the prostate gland. If the prostate becomes enlarged (either by benign
hypertrophy or malignancy), the uvula can constrict the internal urethral orifice and cause
difficulty in voiding the bladder.

The uterine vessels are found in the inferior portion of the broad ligament, while the ovarian
vessels are found in the suspensory ligaments of the ovaries. Uterine artery is found in the
broad ligament.

When this cord is ligated, sperm cannot enter the ejaculatory duct, so there will be no sperm in
the subsequent ejaculate. The seminal vesicles and prostate also contribute fluid to the
ejaculate. However, ligating the ductus deferens will not interrupt the path of seminal fluid or
prostatic fluid. So, the ejaculate will still contain both of these fluids.

The pectinate line is the line of transition between the mucosal lining of the anal canal and the
skin lining of the anal canal. So, this is the point where the mucosal zone ends and the skin
begins.

Remember, the pectinate line (the line in the anus where mucosa changes to skin) is the dividing
line for lymphatic drainage. Structures above the pectinate line drain into the inferior mesenteric
and internal iliac nodes. Structures below the pectinate line drain into the superficial inguinal
nodes. Since the tumor is in the cutaneous (skin) region of the anal canal, it is going to be
drained by the superficial inguinal nodes.

There are usually three transverse rectal folds in the lower rectum. These are specializations of
the circular layer of musculature that are designed to support fecal mass.

Prostate gland is extraperitoneal