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3002 > 64 Testis, epididymis, spermatic cord > Flashcards

64 Testis, epididymis, spermatic cord Flashcards

1
Q

Processus vaginalis overview

A
  • Testes migrate from posterior abdominal wall through the anterior abdominal wall and into the scrotum
  • Each testis takes with it the vas/ ductus deferent, the testicular vessels and and a loop of parietal peritoneum (processes vaginalis) that after birth should lies as a closed potential space around the testes (tunica vaginalis)
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2
Q

What is the processes vaginalis?

A
  • Loop of parietal peritoneum carried down developing spermatic cord
  • Eventually become the tunica vaginalis
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3
Q

What is the tunica vaginalis?

A

Closed potential space around the testes

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4
Q

What is the gubernaculum?

A

Shrinks to draw the testes down the posterior abdominal wall (outside the peritoneum) to the inguinal canal during the 8th and 9th months so that the testes are in the scrotum by birth

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5
Q

What is cryptorchidism

A

Undescended testis/ testes

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6
Q

If the proximal part of the tunica vaginalis stays open, what can it lead to?

A
  1. Indirect hernia

2. Hydrocele - excess fluid in tunica vaginalis

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7
Q

What are the layers of the anterior abdominal wall? (superficial to deep)

A
  1. Skin
  2. Subcutaneous tissues (Fatty/ membrane)
  3. External oblique muscle and fascia
  4. Internal oblique muscle and fascia
  5. Transversus abdominis muscle
  6. Transversals fascia
  7. Peritoneum
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8
Q

How is the inguinal canal created?

A

Descent of the testes “pushing” through the 3 layers of muscle (transverses abdominis, internal and external oblique)

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9
Q

How long is the inguinal canal and what does it connect?

A
  • Oblique passage: 4-6 cm long, though the anterior abdominal wall
  • Connecting the abdominal cavity to the scrotum in males or the labia major in females
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10
Q

Contents of inguinal canal?

A
  • Spermatic cord (males)
  • Round ligament of uterus (females)
  • Genital branch of genitofemoral nerve (L1/ 2)
  • Ilioinguinal nerve (L1)
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11
Q

Contents of spermatic cord?

A
  1. Vas/ ductus deferens
  2. Testicular artery
  3. Pampiniform venous plexus
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12
Q

What forms the internal spermatic fascia?

A

Transversals fascia at deep inguinal ring

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13
Q

What forms cremasteric (middle spermatic) fascia and cremaster muscle?

A
  • Transversus abdominis

* Internal oblique (deep and superficial layers of fascia)

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14
Q

What forms the external spermatic fascia?

A

External oblique (with its fascia)

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15
Q

What are the coverings of the spermatic cord? (superficial to deep)

A
  1. External spermatic fascia
  2. Cremasteric muscle
  3. Cremasteric fascia
  4. Internal spermatic fascia
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16
Q

What are the 3 arteries (with accompanying veins/ venous plexuses) in the spermatic cord?

A
  1. Testicular artery and pampiniform venous plexus
  2. Artery to vas/ ductus deferens
  3. Cremasteric artery and veins
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17
Q

What are the 3 tubes in the spermatic cord?

A
  1. Vas/ ductus deferens
  2. Lymphatic vessels from testes
  3. Vestige (obliterated tube) of processus vaginalis
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18
Q

What are the 2 nerves in the spermatic cord?

A
  1. Genital branch of genitofemoral (L1/ 2)

2. Sympathetics (efferents and afferents to testes)

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19
Q

What are the testicular vessels?

A
  1. Testicular artery - from aorta at L2
  2. Pampiniform venous plexus - converge as:
    • Left testicular vein draining into left renal vein
    • Right testicular vein draining into the IVC
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20
Q

Were does artery to vas/ ductus deferens originate?

A

From inferior vesical artery

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21
Q

Cremasteric artery and vein origin and supply?

A
  • From inferior epigastric artery

* Supplying cremasteric fascia and muscle

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22
Q

Where does the spermatic cord being and end?

A
  • Begins to form at deep inguinal ring

* Completed as it picks up the external spermatic fascia from the external oblique at the superficial inguinal ring

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23
Q

What does the vas/ ductus deferens do?

A

Conveys sperm from the epididymis to the ejaculatory duct

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24
Q

Lymphatic vessels from testes go to where?

A

Para-aortic (lumbar) nodes

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25
Q

What nerve supplies the cremaster muscle?

A

Genital branch of genitofemoral nerve

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26
Q

Sympathetic efferents and afferents to and from the testes:
• Derived from?
• Referred pain?

A
  • Derived from lesser splanchnic nerve, T10- T11

* Referred pain from the testes is to the periumbilical region

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27
Q

Where does the ilioinguinal nerve (L1) go to?

A

Superior medial thigh

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28
Q

What is the cremasteric reflex (L1)?

A

Ipsilateral testicular retraction on stroking superior medial thigh

• Reflex absent in testicular torsion

29
Q

Scrotum and coverings of testis (superficial to deep)?

A
  1. Skin
  2. Subcutaneous tissue (dartos fascia) and dartos muscle
  3. External spermatic fascia
  4. Cremaster muscle
  5. Cremaster fascia
  6. Internal spermatic fascia
  7. Tunica vaginalis (visceral and parietal layers)
30
Q

What is direct inguinal hernia (simple)?

A
  • Passes medial to inferior epigastric vessels

* Not covered by layers of the spermatic fascia

31
Q

What is direct inguinal hernia (advanced)?

A
  • Direct inguinal hernia pushing ahead of the peritoneum, transversals fascia and combines transverses abdominis with internal oblique (conjoint tendon)
  • Through the superficial inguinal ring (in external oblique that extends as the external spermatic fascia) to enter the scrotum
  • Advanced direct inguinal hernia ends up in scrotum parallel to spermatic cord and with its own coverings of peritoneum, transversals fascia, conjoint tendon and external oblique that extends as the external spermatic fascia
32
Q

What is indirect inguinal hernia?

A
  • Bowel in the spermatic cord, covered by parietal peritoneum
  • Passing through the deep inguinal ring of transversalis fascia
  • Covered by internal, cremasteric and external spermatic fascia passing lateral to the inferior epigastric vessels
33
Q

What 2 points are on the same coronal plane on a pelvis?

A

ASIS and pubic tubercle

34
Q

Where is scrotum suspended inferior to?

A

Urogenital triangle

35
Q

What does pectineal line continue as?

A

Arcuate line

36
Q

What are the 2 layers of superficial fascia in the abdomen and pelvis? Continuous with?

A

• Abdomen:

  1. Superficial fatty layer - Camper’s fascia
  2. Deep membranous layer - Scarpa’s fascia

• Pelvis:

  1. Superficial fatty layer - Camper’s fascia
  2. Deep membranous layer - Colles’/ perineal fascia

• Scarpa’s fascia is continuous with Colles’/perineal fascia

• Camper’s fascia is continuous with the superficial fatty layer of the
superficial fascia/subcutaneous tissue of the perineum

37
Q

What is the function of scrotum?

A

Suspends the testes outside the body allowing for optimal thermoregulation with temperatures lower that the body core for normal spermatogenesis

38
Q

Outer structural features of the scrotum?

A
  • Rugose skin with no fat
  • Containing dartos muscle (smooth muscle supplied by sympathetic fibres in the genital branches of the genitofemoral nerves)
  • Has a midline raphe and is divided by a septum
39
Q

What nerves supply dartos muscle?

A

Smooth muscle supplied by sympathetic fibres in the genital branches of the genitofemoral nerves

40
Q

What are the scrotal layers (deep to superficial)?

A
  1. Tunica vaginalis (visceral and parietal layers - hydrocele)
  2. Internal, cremasteric and external spermatic fascia
  3. Dartos fascia
  4. Skin
41
Q

What is dartos fascia a combination of?

A
  • Colles’/ perineal fascia -continuous with Scarpa’s fascia-

* Dartos muscle - derived from Camper’s fascia

42
Q

What is Camper’s fascia replaced by in the scrotum?

A

Replaced by dartos muscle

43
Q

What does Scarpa’s fascia extend as into the scrotum?

A
  • Extends as Colles’/ perineal fascia

* Fuses with the fascia late of the thigh below the inguinal ligament and with the perineal body posteriorly

44
Q

What does the clinical phrase “Blue swimming trunks” mean?

A

Bruising trapped under Scarpa’s and Colles’/ perineal fascia in the front only

45
Q

Nervous supply of the scrotum?

A
  1. Anterior 1/3:
    • L1 with ilioinguinal and genitofemoral nerves
  2. Posterior 2/3:
    • S2 and S3 via scrotal branches of the perineal branches of the pudendal nerve
46
Q

Blood supply of the scrotum?

A
  1. Anterior 1/3:
    • Derived form the deep and superficial external pudendal branches of the femoral artery
  2. Posterior 2/3:
    • Derived from branches of the internal pudendal branch of the internal iliac
47
Q

Venous drainage of the scrotum?

A
  1. Anterior 1/3:
    • Deep and superficial external pudendal veins to the great (long) saphenous
  2. Posterior 2/3:
    • Internal pudendal veins
48
Q

Lymphatic drainage of the scrotum?

A

Drainage to the superficial inguinal nodes

49
Q

Testes overview

A
  • Left lower than right testis
  • Produce sperm and testosterone
  • Packed with seminiferous tubules that create sperm
  • Each surrounded by tunica vaginalis
  • Suspended in scrotum to keep cool
50
Q

How does sperm pass through male reproductive tract?

A

Sperm pass from the seminiferous tubules –> rete testis in its mediastinum –> epididymis (via efferent ductules)

51
Q

Clinical presentations of scrotal pain in testes

A
  1. Torsion of appendix testis (heated of Morgagni) remnant from the paramesonephric ducts
  2. Torsion of appendix epididymis remnant from the mesonephric duct
  3. Testicular torsion in which a testis rotates on its peddle with twisting of its spermatic cord compromising its arterial supply (necrosis)
52
Q

Structural features of epididymis?

A
  • ~ 6m long highly coiled tube

* Head, body and tail becoming the vas/ ductus deferens

53
Q

What does tunica albuginea do?

A

Tough capsule which maintains internal pressure to help transport of sperm

54
Q

What are the testes layers? (superficial to deep)

A
  1. Tunica vaginalis:
    • With visceral and parietal layers -potential space for movement of testis (hydrocele)
    • Sinus of the epididymis - recess of tunica vaginalis
  2. Tunica albuginea:
    • Tough and fibrous - maintains internal pressure to help sperm transport
    • Forms mediastinum and septae
  3. Tunica vasculosa:
    • With branches of testicular vessels
55
Q

Blood supply of testes?

A

Testicular artery from aorta at L2 (plus anastomosis with cremasteric artery and artery to vas/ ductus deferens

56
Q

Venous drainage of testes?

A

Testicular vein starting as a pampiniform venous plexus (converge as left testicular vein draining into left renal vein and right testicular veins draining into the IVC)

57
Q

Nerve supply of the testes?

A

Sympathetic lesser splanchnic nerve (T10-T11)

58
Q

Referred pain of testes?

A

Peri-umbilical

59
Q

Lymphatic drainage of testes?

A

Para-aortic (lumbar nodes)

60
Q

What is varicocele?

A
  • Dilated and tortuous pampiniform venous plexus (feeling like a bag of worms)
  • Moree common on the left side due to the almost right angle at which the left testicular veins drains into the left renal veins
61
Q

What is the vas/ ductus deferens?

A
  • Thick-walled, cord-like tube ~ 45cm long

* Carries sperm from testis and epididymis

62
Q

Vas/ ductus deferens pathway and anatomical relations

A
  • Lies posterior to the testis and medial to the epididymis
  • Leaves the scrotum and passes through the abdominal wall within the spermatic cord in the inguinal canal
  • Emerges into the abdomen lateral to the inferior epigastric artery and lies on the lateral wall of the pelvis
  • Lies medial to the pelvic vessels before passing antero-medially to the ureter (anterior to the rectum)
  • Joins with duct from the seminal vesicle to form the ejaculatory duct that passes through the prostate glands and into the urethra
63
Q

Blood supply of vas/ ductus deferens?

A

Artery to the vas/ ductus deferens (usually from inferior vesical artery)

64
Q

Position and role of seminal vesicles?

A
  • Left and right seminal vesicle (glands) lie just above the prostate gland between the bladder and rectum
  • Secrete seminal fluid to nourish sperm
65
Q

Formation of ejaculatory duct?

A

• Dilated ampullary end of the vas/ ductus deferens unites with the duct from the seminal vesicle

=> Form the ejaculatory duct that passes through the prostate gland to enter the urethtra

66
Q

4 parts of male urethra?

A
  1. Preprostatic - internal urethral sphincter (smooth muscle; involuntary)
  2. Prostatic - receiving ejaculatory duct
  3. Membranous - external urethral sphincter (striated muscle)
  4. Spongy - bulbar and penile
67
Q

What happens in internal urethral sphincter during ejaculation?

A

During ejaculation (sympathetic), the internal urethral sphincter at the bladder neck contracts to prevent semen back flowing into the bladder (retrograde ejaculation)

68
Q

Where do the ejaculatory ducts enter the prostatic urethra?

A

Verumontanum/ seminal colliculus

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