Testicles Flashcards
What are the layers that cover the testes from outer to inner?
Skin
Dartos muscle and fascia
External spermatic fascia
Cremasteric fascia
Internal spermatic fascia
Tunica vaginalis
Tunica albuginea
What do the external spermatic fascia, cremasteric fascia and internal spermatic fascia come from?
External spermatic fascia - external oblique
Cremasteric fascia - internal oblique
Internal spermatic fascia - transversalis fascia
What is the cause of infantile hydrocele?
Patent processus vaginalis
What is the arterial supply of the testes?
Testicular artery - arises from the abdominal aorta at L2
Cremasteric artery
Artery to the vas
What is the venous drainage of the testes?
Pampiniform plexus
This surrounds the testis and drains into the testicular vein
The left testicular vein drains into the left renal vein whereas the right testicular vein drains directly into the IVC
What is the lymphatic drainage of the testes?
Para-aortic lymph nodes at L1
What are the contents of the spermatic cord?
The Three 3s
3 arteries: testicular, cremasteric, artery to the vas
3 nerves: genital branch of the genitofemoral, sympathetic and parasympathetic nerves
3 others: pampiniform plexus, vas deferens, lymph nodes
Normal spermatogenesis requires a lower body temperature. How is this achieved?
Testes dangle down outside the abdomen
Dartos muscle provides a lower body temperature
Countercurrent heat exchange between the arteries and the pampiniform plexus
What is Prehn’s sign?
Relief of pain when the testis is lifted - indicates epidiymo-orchitis
What are the differentials for younger patients with testicular pain?
How would this change in an older patient?
Testicular torsion
Epididymo-orchitis
Torsion of hydatid of Morgagni
Renal colic
Appendicitis
Hernia
In older patients, prostatitis should be considered, whereas torsion would be unlikely
What is testicular torsion?
A urological emergency which occurs when the testis twists on the spermatic cord within the tunica vaginalis. This results in venous congestion and eventual infarction of the testis.
This commonly affects young men between the age of 10 and 16.
How to manage torsion?
This is a surgical emergency as the testis needs to be surgically released within 6 hours
Rapid resuscitation, focused history and examination, inform seniors, surgical bloods, IV fluids and analgesia
Book and consent for scrotal exploration +/- bilateral orchidopexy +/- orchidectomy
How to classify testicular tumours?
Germ cell (95%) vs non-germ cell tumours
Germ cell tumours can be divided into seminomas (most common in adults and those with cryptorchidism) and non-seminoma (yolk sac or teratomas, generally more aggressive) tumours
Non-germ cell tumours include Leydig and Sertoli cell tumours and lymphoid tumours
How do testicular tumours present?
Typically present as painless testicular nodule/mass/induration
Hydrocele
Systemic disease e.g. respiratory features in lung metastases
How to manage testicular cancer?
Staging and MDT
Radical inguinal orchidectomy (achieves definitive diagnosis and curative in 80% of cases)
