Male Anatomy

Question 1

What is the scrotum derived from?

What is it homologous to in females?

Answer 1

Genital folds which fuse in the midline, marked by scrotal raphae
Labia majora

Question 2

Contents of the scrotum?

Answer 2

Testis
Epididymis
Spermatic cord
Dartos muscle - a sheet of smooth muscle immediately underneath skin which wrinkles it to reduce heat loss

Question 3

Vascular supply to the scrotum?

Answer 3

Anterior scrotal artery derived from the external pudendal artery
Posterior scrotal artery derived from the internal pudendal artery

Scrotal veins follow arteries and drain into the external pudendal vein

Question 4

Cutaneous innervation to the scrotum?

Answer 4

Genital branch of genitofemoral nerve - derived from femoral plexus and supplies anterolateral scrotum

Anterior scrotal nerves - from ilioinguinal nerve, supplies anterior aspect

Posterior scrotal nerve derived from perineal nerve - posterior aspect of scrotum

Perineal branches of posterior femoral cutaneous nerve - derived from sacral plexus, inferior aspect

Question 5

Lymphatic drainage of the scrotum?

Answer 5

Superficial inguinal nodes

Question 6

Causes of scrotal swelling?

Answer 6

Inguinal hernia
Hydrocoele
Haematocoele
Varicocoele
Epididymitis

Question 7

What is an indirect inguinal hernia?

Answer 7

Reopening of the processus vaginalis

Question 8

What is a hydrocoele?

Answer 8

Collection of serous fluid within the tunica vaginalis

Most commonly due to failure of the processes vaginalis to close

Question 9

What is a haematocoele?

Answer 9

Collection of blood in the tunica vaginalis

Question 10

How to distinguish between a haematocoele and a hydrocoele?

Answer 10

Transillumination

Light won’t pass through blood

Question 11

What is a varicocoele?

Answer 11

Dilation of the veins that drain the testes

Question 12

Which side is more commonly affected in a varicocoele?

Answer 12

Left testicle more commonly affected as left testicular vein drains into a smaller vessel, left renal vein, at a perpendicular angle

Question 13

Presentation of a varicocoele?

Answer 13

Can look and feel like a bag of worms

Question 14

What is the scrotum?

Answer 14

A fibrosus ulnar cutaneous sac

Dual chambered, forming an expansion of the perineum

Question 15

Where is the epididymis located in relation to each testicle?

Answer 15

Posterolateral aspect of each testicle

Question 16

What are the testes suspended from the abdomen by?

Answer 16

The spermatic cord

Question 17

How do the testes descend during development?

Answer 17

Follow an evagination of peritoneum as they descend - the processus vaginalis which buds off from the peritoneum to form the tunica vaginalis
Begins on posterior abdominal wall, descend through the inguinal canal to the scrotum

Question 18

Where are sperm stored?

Answer 18

In the epididymis

Question 19

What are the testes covered in?

Answer 19

Covered externally by tunica vaginalis anteriorly and on the sides
Tunica albuginea is a fibrous capsule which penetrates into the parenchyma, dividing the testicle into lobules

Question 20

What are the parts of the epididymis?

Answer 20

A single coiled tube
Head - formed by efferent tubules
Body - heavily coiled duct
Tail - most distal part, marks origin of the vas deferens

Question 21

Innervation of the testes and epididymis?

Answer 21

Testicular plexus derived from renal and aortic plexi

Receives autonomic and sensory fibres

Question 22

Vascular supply of the testes and scrotum?

Answer 22

Testicular arteries which arise directly from abdominal aorta at L2/3
Pass into the scrotum via the inguinal canal
Venous drainage - testicular veins (left into renal vein…)

Question 23

Lymphatic drainage of testes and epididymis?

Answer 23

Lumbar and preaortic lymph nodes at L1

Question 24

Anatomical course of the spermatic cord?

Answer 24

Formed at opening of the inguinal canal in the deep inguinal ring, lateral to inferior epigastric vessels
Passes through the canal, enters the scrotum via superficial ring
Ends at posterior border of the testes

Question 25

Where are the fascial coverings of the spermatic cord derived from?

Answer 25

Anterior abdominal wall

Question 26

What are the fascial coverings of the spermatic cord?

Answer 26

External spermatic fascia - derived from aponeurosis of external oblique
Cremaster muscle and fascia - derived from internal oblique and its fascial coverings
Internal spermatic fascia - derived from transversalis fascia

Question 27

What are those three fascial layers of the spermatic cord covered in?

Answer 27

Superficial fascia which lies directly below the scrotal skin

Question 28

What does the cremaster muscle form?

Answer 28

A discontinuous layer of striated muscle, orientated longitudinally

Question 29

What is the cremasteric reflex? Spinal reflex pathway?

Answer 29

If superior medial thigh is stroked, produces an immediate contraction, elevating testes on that side
Afferent limb - iliolingual/genitofemoral nerve
Efferent limb - genital branch of genitofemoral nerve

Question 30

Contents of the spermatic cord?

Answer 30

Testicular artery
Cremasteric artery and vein (supplying cremasteric muscle and fascia)
Artery to vas deferens (branch of inferior vesicle, of internal iliac)
Pampiniform plexus of testicular veins
Genital branch of genitofemoral nerve
Vas deferens
Lymph vessels - drain into para-aortic nodes
Processus vaginalis
Autonomic nerves

Question 31

What is the vas deferens?

Answer 31

Thick muscular tube conveying sperm from epididymis to ejaculatory duct

Question 32

Structure of the wall of the vas deferens?

Answer 32

3 smooth muscle layers

Inner and outer longitudinal, middle circular

Question 33

Anatomical course of the vas deferens?

Answer 33

Continuous with tail of epididymis
Travels through inguinal canal
Moves down lateral pelvic wall in close proximity to the ischial spine
Turns medially to pass between the bladder and urethra
Joins duct from seminal vesicle to form the ejaculatory duct

Question 34

What is testicular torsion?

Complications?

Answer 34

When the spermatic cord twists upon itself

Occlusion of testicular artery causing necrosis of testes

Question 35

How to diagnose testicular torsion?

Answer 35

Ultrasound and colour Doppler scanning
Present with severe sudden pain in one of both testes
Often from exercise/physical activity

Question 36

What is a spermatocoele?

Answer 36

Retention cyst within the epididymis