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59

anatomy of thE malE rEProdUctivE systEm

Table 4.1. connection between layers of the testis and layers

at about gestational week 4, gonadal rudiments

of the ventral body

 

are present within the intermediate mesoderm

Layers of testis

Layers of ventral body

adjacent to developing kidneys. At about gesta-

Epiorchium and

Peritoneum

tional week 6, sex cords develop within

the

forming testes comprising early Sertoli

cells

periorchium

 

 

that surround germ cells which migrate into

fascia spermatica

fascia transversalis

the gonads shortly before sex determination

interna

 

starts. The sexual differentiation is depicted in

 

 

m. cremaster

m. obliquus internus

Fig. 4.5. The transformation of testosterone to

 

abdominis and m.

dihydrotestosterone due to the activity of 5a-

 

transversus abdominis

reductase is the decision step for the formation

fascia spermatica

fascia superficialis and

of the penis, the scrotum, and the prostate. The

sex-specific gene SRY that is found on

the

externa

fascia of m. obliquus

Y-chromosome initiates sex determination by

 

externus abdominis

tunica dartos and

subcutaneous connective

downstream regulation of sex-determining fac-

tors, which leads to the development of the male

skin of scrotum

tissue and skin

phenotype including directing development of

 

 

 

 

the early bipotential gonad down the male path

 

 

of development.2

 

Retentio testis

Spermatogenesis

abdominalis

Spermatogenesis occurs within the seminiferous

 

Retentio testis

epithelium on the surface of the somatic Sertoli

inguinalis

cells (Fig. 4.6a, b). Functional Sertoli cells are

 

required for normal spermatogenic progression

 

Ectopic testis resulting in the continuous production of numer-

 

ous fertile spermatozoa, which in turn is neces-

 

sary to maintain Sertoli cells in their functional

 

differentiation state. Adjacent Sertoli cells form

 

Sertoli-Sertoli junctional complexes dividing the

 

seminiferous epithelium into a basal and an

 

adluminal compartment. During spermatogene-

 

sis, germ cells migrate through the Sertoli-Sertoli

Figure 4.4. various forms of cryptorchidism.

junctionalcomplexessuccessivelypassingthrough

 

the following three developmental stages:

The testicles are covered by the tunica albuginea consisting of an outer epiorchium and an inner tunica vaginalis. The latter divides the testicular parenchym via septula testis (contain blood and lymph vessels) into lobuli testis. Beneath the tunica albuginea, the testis comprises fine coiled seminiferous tubules (diameter: 180–200 mm) containing the seminiferous epithelium where spermatogenesis takes place. Tubules are surrounded by a lamina propria. Between the tubules, intertubular tissue contains Leydig cells, which produce the male sex hormone testosterone that stimulates spermatogenesis and sperm production.

Within the embryo, gonads are at first capable of becoming either ovaries or testes.Starting

1.Mitosis: Following mitosis of a spermatogonial stem cell, one spermatogonium is conserved as a spermatogonial stem cell, while the other spermatogonium undergoes further mitoses and, subsequently, enters meiosis.

2.Meiosis: During the first meiotic division, one primary spermatocyte gives rise to two secondary spermatocytes. During the second meiotic division, each of the two secondary spermatocytes gives rise to two round spermatids. In order to preserve the number of chromosomes in the offspring, each gamete must have half the usual number of chromosomes present in somatic cells. Otherwise,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Practical Urology: EssEntial PrinciPlEs and PracticE

Figure 4.5. development of male

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex Determining region Y

 

 

 

 

 

 

 

genital organs.

 

 

 

 

 

 

 

 

 

Y-Chromosome

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gonadal

 

 

 

 

 

 

 

 

 

 

Testicles

 

 

 

 

 

 

 

formation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sertoli cell

 

 

 

Leydig cell

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Testosterone

 

 

 

 

 

 

 

AMH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5a reductase

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wolffian duct

 

 

 

DHT

 

 

 

Regression of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Muellerian duct

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Epididymis

 

 

 

Penis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vas deferens

 

 

 

Scrotum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seminal vesicles

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prostate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a

Elongated spermatid

Round spermatid

Primary spermatocyte

Sertoli cell (nucleus)

Spermatogonium

b

Elongated spermatid

Round spermatid

Primary spermatocyte

Sertoli cell (nucleus)

Spermatogonium

Figure 4.6. organization of the seminiferous epithelium. (a) histology, h&E. (b) scheme.

the offspring will have twice the normal number of chromosomes resulting in serious abnormalities.

3.Spermiogenesis: Round spermatids do no longer divide, but differentiate into mature spermatozoa undergoing numerous morphological, biochemical, and physiological modifications. Nuclear chromatin condensation, development of the acrosome, and formation of the flagellum occur simultaneously in haploid spermatids.

Each cell division – from spermatogonium to spermatid – is incomplete, as germ cells remain connected to one another by intercellular bridges. This is a prerequisite for synchronous development. Germ cells are subjected to permanent proliferation and differentiation processes resulting in the appearance of various germ cell populations each representing a particular phase of germ cell development. A defined arrangement of germ cell populations is called the stage of the seminiferous epithelium (Fig. 4.7). A complete series of changes in stages arranged in the logical sequence of germ cell maturation is called the cycle of the seminiferous epithelium. In men, the seminiferous epithelial cycle is divided into six stages (I–VI).3 Due to the nuclear morphology of the spermatids and the reactivity of spermatid nuclei with periodic-acid-Schiff (PAS), spermatid differentiation is further subdivided into eight steps (1–8). Development from spermatogonia to spermatozoa lasts 74 days.As maturation within the epididymis lasts 8–17 days, the generation of a spermatozoon from a stem spermatogonia lasts at least 82 days.

61

anatomy of thE malE rEProdUctivE systEm

Figure 4.7. stages of the seminiferous epithelial cycle.B spermatogonium type B; PL primary spermatocytes

in preleptotene; L leptotene;

Z zygotene; P pachytene; SS secondary spermatocytes; 1-8 spermatids in steps; RB residual body.

Hormonal Regulation of Spermatogenesis

hormones within the pituitary, luteinizing hor-

Spermatogenesis is highly sensitive to fluctua-

mone (LH) and follicle stimulating hormone

(FSH). While high pulse rate of GnRH release (1

tions in hormones. Testosterone is required in

impulse per 1 h) results in the production of

high local concentrations to maintain sper-

LH, low pulse rate of GnRH release (1 impulse

matogenesis. This is achieved via binding of

per 2 h) results in the production of FSH.Within

testosterone by androgen-binding protein (ABP)

the testis, LH causes synthesis of testosterone

present in seminiferous tubules. Hormonal reg-

by intertubular Leydig cells, which negatively

ulation of spermatogenesis is organized as con-

influences hormone release in hypothalamus

trol circuit with a negative feedback mechanism

and pituitary. By contrast, FSH acts on intratu-

involving hypothalamus, pituitary, and testis

bular Sertoli cells. It induces the production of

(Fig. 4.8). Specific neurons of the hypothalamus

ABP by means of which testosterone can pass

synthesize gonadotropin releasing hormone

the Sertoli–Sertoli junctional complexes, as well

(GnRH), which induces the production of two

as the production of activin and inhibin by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hypothalamus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GnRH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pituitary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Testosterone

LH

FSH Inhibin Activin

 

 

Testosterone

 

 

Leydig cell

Sertoli cell

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Testosterone + ABP

Figure 4.8. hormonal regulation of

 

 

 

 

 

Germ cell

spermatogenesis.

 

 

 

 

 

 

 

 

62

 

 

 

 

 

 

 

 

Practical Urology: EssEntial PrinciPlEs and PracticE

Sertoli cells, which influences hormone release

Blood Vessels, Lymphatic Drainage, and

both in hypothalamus and pituitary.

Nerves

 

 

 

 

 

 

The testicular artery originates from the abdom-

Genetic Regulation of Spermatogenesis

inal aorta. Due to the descensus testis, the

testicular artery is located within the retroperi-

 

 

 

The differentiation of spermatogonial stem cells

toneum. It crosses the psoas muscle and the ure-

ter, passes the canalis inguinalis and enters the

into fertile sperm requires stringent temporal

spermatic cord where it makes anastomoses

and stage-specific gene expression.This becomes

with the arteria ductus deferentis and the arte-

evident when studying the sequential nucleo-

ria cremasterica. The arteria testicularis passes

protein expression in developing germ cells

the testis dorsal and enters the tunica albuginea

resulting in histone to protamine exchange in

from ventral basal to ventral apical branching

haploid spermatids.4 Although, in man, replace-

into the septula testis. From the rete testis, arte-

ment of histones is only about 85% complete,5

riae recurrentes supply the tubuli seminiferi

protamines represent the predominant nucleo-

(Fig. 4.9). This special schedule of arterial sup-

proteins of elongated spermatids and mature

ply is the rationale for the operation approach to

spermatozoa.

 

 

retrieve testicular material coming always rom

Protamines bind lengthwise within the minor

the free rim of the testicle.

groove of the DNA double helix with their cen-

The testicular artery is surrounded by the

tral polyarginine

segment cross-linking and

plexus pampiniformis. Veins merge to the vena

neutralizing the

phosphodiester backbone of

testicularis dextra which opens into the vena

the DNA. These DNA-protamine complexes of

cava inferior and the vena testicularis sinistra

one DNA strand fit exactly into the major

which opens into the vena renalis sinistra.

grooves of a parallel DNA strand and are packed

 

 

side by side in a linear array within the sperm

A. testicularis

nucleus.6 In addition to DNA binding,protamine

molecules interact with other protamine mole-

A.ductus deferentis

cules by forming disulfide bonds between

 

 

cysteine residues, thereby facilitating DNA com-

A.cremasterica

paction. Ward7 performed a model for the pack-

ing of the entire haploid genome into the sperm

 

 

nucleus in which DNA loop domains are packed

 

 

as doughnuts attached to the sperm nuclear

 

 

matrix. Protamine bound DNA is coiled into

 

 

large concentric circles that collapse into a

 

 

doughnut in which the DNA-protamine com-

 

 

plexes are tightly packed together by van der

 

 

Waal’s forces.

 

 

 

Protamine-DNA interactions result in chro-

 

 

matin condensation causing cessation of tran-

 

 

scription in elongating spermatids. This occurs

 

 

at a time when many proteins need to be synthe-

 

 

sized and assembled for the complete condensa-

 

 

tion of the chromatin, the development of the

 

 

acrosome, and the formation of the flagellum.

 

 

Therefore, it is evident that precise temporal reg-

 

 

ulation of gene expression via transcriptional

 

 

and translational control mechanisms is of fun-

 

 

damental importance to ensure complete differ-

 

 

entiation of round spermatids into mature

 

 

 

 

spermatozoa.4

 

Figure 4.9. Blood supply of testicle.