CHAPTER 23 THE SCROTUM Flashcards
terminal intratesticular artery arising from the capsular arteries
centripetal artery
small artery arising from the inferior epigastric artery (a branch of the external iliac artery), which supplies the peritesticular tissue, including the cremasteric muscle
cremasteric artery
an extension of the internal oblique muscle that descends to the testis with the spermatic cord; contraction of the cremasteric muscle shortens the spermatic cord and elevates the testis
cremasteric muscle
also called undescended testes; testicles remain within the abdomen or groin and fail to descend into the scrotal sac
cryptorchidism
arises from the vesicle artery (a branch of the internal iliac artery) and supplies the vas deferens and epididymis
deferential artery
connect the seminal vesicle and the vas deferens to the urethra at the verumontanum
ejaculatory ducts
cyst filled with clear, serous fluid located in the epididymis
These patients are usually asymptomatic but may feel the mass
epididymal cyst
anatomic structure formed by the network of ducts leaving the mediastinum testis that combine into a single, convoluted epididymal tubule; located on the posterolateral aspect of the testis; the epididymis consists of the head, the body, and the tail; spermatozoa mature and accumulate within the epididymis
epididymis
inflammation of the epididymis
epididymitis
blood located between the visceral and parietal layers of the tunica vaginalis
hematocele
fluid formed between the visceral and parietal layers of the tunica vaginalis
Most common in epididymo-orchitis or after trauma
hydrocele
central linear structure formed by the convergence of multiple thin septations within the testicle; the septations are invaginations of the tunica albuginea
mediastinum testis
plexus of veins in the spermatic cord that drain into the right and left testicular veins; when a varicocele is present, dilation and tortuosity may develop
pampiniform plexus
the internal and external pudendal arteries partially supply the scrotal wall and epididymis and occasionally the lower pole of the testis
pudendal artery
pus located between the visceral and parietal layers of the tunica vaginalis
pyocele
terminal ends of the centripetal (intratesticular) arteries that curve backward toward the capsule
recurrent rami
network of channels formed by the convergence of the straight seminiferous tubules in the mediastinum testis; these channels drain into the head of the epididymis
rete testis
sac containing the testes and epididymis
scrotum
reservoirs for sperm located posterior to the bladder
seminal vesicles
multiple septa formed from the tunica albuginea that course toward the mediastinum testis and separate the testicle into lobules
septa testis
structure made up of vas deferens, testicular artery, cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum
spermatic cord
cystic dilation in the efferent ductules of the head of epididymis containing sperm
This is often seen after vasectomies.
spermatocele
male gonad that produces hormones that induce masculine features and spermatozoa
testicle
artery arising from the aorta just distal to each renal artery; it divides into two major branches, supplying the testis medially and laterally
testicular artery
the pampiniform plexus forms each testicular vein; the right testicular vein drains directly into the inferior vena cava, whereas the left testicular vein drains into the left renal vein
testicular vein
inner fibrous membrane surrounding the testicle
tunica albuginea
membrane consisting of a visceral layer (adherent to the testis) and a parietal layer (adherent to the scrotum) lining the inner wall of the scrotum; a potential space between these layers is where hydroceles may develop
tunica vaginalis –
small membranous canal that extends from the bladder to the end of the penis
urethra
dilated veins in the pampiniform plexus caused by obstruction of the venous return from the testicle
More common on left and can cause infertility.
varicocele
tube that connects the epididymis to the seminal vesicle
vas deferens
junction of the ejaculatory ducts with the urethra
verumontanum
If a patient comes in with cryptorchidism, what would the sonographic findings be?
What is the surgery to fix this?
smaller, less echogenic, and usually oval and homogenous
orchiopexy
Males with cryptorchidism are at risk for?
Infertility, testicular cancer, and torsion.
What are the measurements for the scrotum?
Long- 3-5 cm
Wide- 2-4 cm
High- 3 cm
The rt testicular vein drains into
IVC
The left testicular vein drains into the
left renal vein then the IVC
What is the most common cause of acute scrotal pain?
Epididymo-orchitis
What is the most common cause of torsion?
Bell-Clapper
Undescended testicles are 10X more likely to be affected by torsion.
True or False
True
What is the most common cause of acute scrotal pain in ADOLESCENCE?
Torsion
Varicoceles are more common on right or left testicles?
Left
What is the most common herniated structure followed by omentum?
bowel
What is the most common cause of painless scrotal swelling?
Hydrocele
Sperm granuloma is most frequent in patients with a history of?
vasectomy
What is the most common germ cell tumor?
seminoma
Cryptorchidism is most commonly in the _______ canal
inguinal
The _____ is the inner lining of scrotal wall?
Parietal
The _______ surrounds the testis and epididymis
Visceral
Rete testis drains into ______ of epididymis through the efferent ductules
head
The largest part of the epididymis is the ________
head ( 6-15 mm in width)
What are some questions to ask the patient before exam?
1) Vasectomy procedure? when?
2) Can you feel a mass? (Find the lump and place the probe right on that place)
3) What are your symptoms and how long have they been going on?
4) Experience any trauma? When did it occur (IMPORTANT) Describe what happened?
5) Were you referred because of a palpable mass, scrotal pain, swollen scrotum or other reason?
Why is it important to ask the patient how long the trauma/rupture occured?
because the longer they wait, the lesser the chance to salvage the testicle
Within 72 hours-90%
After 72 hours- 45%
Peak incidence of torsion?
age 14
bowel, omentum ( but more commonly just bowel) or other structures herniate into the scrotum.
Scrotal hernia
Which type of mass has a higher rate of malignancy?
Intratesticular
Extratesticular
Intratesticular. If it is is in the testicle, suspect malignancy.
Testicular cyst are more common in men or women??
HAHAHA TRICK QUESTION :) just making sure you’re paying attention!
SMILE :P
Testicular cysts are more common in men older than 40. Do they require treatment?
NO.
tiny calcifications within testis
microlithiasis
Microlithiasis has a high association with
testicular malignancy
Make sure to follow up with this case.
Malignancy is more frequent between the ages of
20-34 years old.
