7 - Repro - Male repro system

Question 1

Name the 2 muscles which lie in the scrotum:

Answer 1

• Cremaster muscle

- Dartos muscle

Question 2

What is the Cremasteric reflex, and what does it test?

Answer 2

• Lightly stroke superior medial thigh in downward direction, should cause contraction of cremaster = retraction of testicle
• Tests L1/2 (Ilioinguinal + Genital branch of Genitofemoral nerves)

Question 3

Name the muscle which causes the scrotum to wrinkle in the cold, and explain why this is important:

Answer 3

Dartos muscle

Decreases SA, minimising heat loss, to maintain optimum temperature for sperm.

Question 4

What is the tunica vaginalis?

Answer 4

Serous pouch which covers the testes. Derived from the processus vaginalis of the peritoneum.

Question 5

To which lymph nodes does the scrotum drain to?

Answer 5

Superficial inguinal nodes

Question 6

Name the fibrous covering of the testes:

Answer 6

Tunica albuginea

Question 7

What is the arterial supply to the testes?

Answer 7

Testicular arteries (from abdominal aorta ~ L1/2)

Question 8

What is the venous drainage of the testes?

Answer 8

Testicular veins from the Pampiniform plexus in scrotum:
Left testicular vein - drains into left renal vein
Right testicular vein - drains into IVC

Question 9

To which lymph nodes do the testes drain to?

Answer 9

• Paired lumbar nodes and para-aortic nodes @ L1 level (retroperitoneal)

Think of origin of testes

Question 10

Name the fascial layers of the spermatic cord, and where they are derived from:

Answer 10

1) External spermatic fascia - from aponeurosis of external oblique
2) Cremasteric muscle + fascia - from internal oblique
3) Internal spermatic fascia - from transversalis fascia

Question 11

Describe the location of the deep inguinal ring in terms of the inferior epigastric vessels:

Answer 11

The deep inguinal ring is lateral to the inferior epigastric vessels

Question 12

List the contents of the spermatic cord:

Answer 12

Arteries: Testicular, Cremasteric, Artery to Vas
Veins: Pampiniform venous plexus
Nerves: Autonomics + Genital branch of the Genitofemoral nerve to Cremaster
Lymphatics
Vas deferens
Processus vaginalis

Question 13

List some causes of a scrotal swelling:

Answer 13

• Hydrocoele
• Haematocoele
• Varicocoele
• Spermatocoele
• Epididymitis
• Inguinal hernia
• Testicular torsion
• Testicular cancer
• Orchitis

Question 14

What is a hydrocoele?

Answer 14

Serous fluid in tunica vaginalis, usually due to failure of processus vaginalis to close

Question 15

What is a haematocoele?

Answer 15

Blood in tunica vaginalis

Question 16

What is a varicocoele?

Answer 16

Gross dilation of veins draining testes. Usually affects left testicle, as left testicular vein drains vertically into left renal vein, and lacks valves.

Question 17

What is a spermatocoele?

Answer 17

Benign cystic accumulation of sperm, usually from head of epididymis

Question 18

What is epididymitis?

Answer 18

Inflammation of epididymis usually due to viral or bacterial infection

Question 19

What is the difference between a direct and indirect inguinal hernia?

Answer 19

Direct = via Hesselbach's triangle = medial to inferior epigastric vessels
Indirect = via deep inguinal ring = lateral to inferior epigastric vessels

Question 20

How can you differentiate between a haematocoele, and a hydrocoele?

Answer 20

Transillumination

- Light is unable to pass through the dense blood of a haematocoele

Question 21

What is the most common age for testicular torsion to occur?

Answer 21

13-17 yrs

Question 22

Where does testicular cancer most commonly metastasise to?

Answer 22

Para-aortic lymph nodes

- from here may spread to cervical lymphatics = Virchow’s node

Question 23

How can testicular cancer cause an enlarged left supraclavicular lymph node (Virchow’s node)?

Answer 23

Testicular lymphatics drain via the thoracic duct into the left subclavian vein

Question 24

What is oligozoospermia?

Answer 24

Abnormally low spermatozoa count in semen

Question 25

What is azoospermia?

Answer 25

No spermatozoa in semen

Question 26

What is Cryptorchid, and why is associated with low sperm count?

Answer 26

Maldescended testes

Increased temperature is suboptimal for spermatogenesis

Question 27

What is orchitis?

Answer 27

Inflammation of the testes, usually due to bacterial infection (STI), or the mumps virus

Question 28

What is the course of the vas deferens?

Answer 28

• From tail of epididymis, ascends in spermatic cord through inguinal canal
• Curves lateral then medial, looping over epigastric artery on lateral pelvic wall
• Travels medial to distal ureter along posterior wall of bladder
• Forms dilated ampulla and opens into ejaculatory duct

Question 29

The seminal vesicles are a diverticulum of what structure?

Answer 29

Dilated ampulla of vas deferens

Question 30

What is a vasectomy?

Answer 30

Both vas deferens are sectioned and ligated, from the superoanterior scrotal wall.