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PROSTATE
The Scrotum, Testis, Epididymis
I. Introduction/ General Information
A. Scrotum
1. “Medial pendant pouch of loose
skin & superficial fascia” (Gray’s)
2. Raphe (Gr. “seam” or “suture”):
Superficial division
between compartments
3. Left side lower than right
Introduction, continued …
B. Testis
1. Suspended in scrotum by
spermatic cord
2. 4 - 5 cm long
3. Weigh 10.5 - 14 grams
3. Oval
Anatomy of the Male Pelvis
Testis, continued …
D. Appendages
1. Appendix of the testis
a. Lies beneath head of Epididymis
b. Remnant of the Mullerian duct
(gives rise to uterine tubes,
uterus in female)
c. May be referred to as “Hydatid
of Morgagni”
Testicular Anatomy, con’t…
Appendix of
Testis
Appendix of
Testis
Appendages, continued …
Appendix of
Epididymis
Appendix of
Epididymis
II. Detailed Anatomy
A. Superficial inguinal rings
(of inguinal canal)
1. Triangular openings in
abdominal muscle
2. Superior & lateral to pubic
tubercles
3. House contents of spermatic
cord
Anatomy of the Spermatic Cord
Deep inguinal
ring
Superficial
inguinal ring
Detailed Anatomy, continued …
B. Scrotum
1. Layers, beginning superficially
a. Superficial fascia
1. skin & tunica dartos
b. Colle’s fascia
1. membranous layer of
superficial fascia
2. continuous over penis &
scrotum
Scrotum, continued …
c. External spermatic fascia: derived
from
1. transversus abdominis
2. internal oblique muscle
d. Cremasteric fascia: derived from
1. transversus abdominis
2. internal oblique muscle
e. Internal spermatic fascia: derived
from transversalis muscle
Detailed Anatomy, Layers of the Scrotum, continued …
Colle’s Fascia
External Spermatic Fascia
Cremasteric Fascia
Tunica Albuginea
Skin
Scrotum, continued …
Efferent Ductules
Rete Testis
Seminiferous Tubules
Mediastinum Testis
Tunica Albuginea
Detailed Anatomy, continued …
C. Spermatic Cord
1. Coverings from abdominal wall
2. Each spermatic cord contains:
a. Ductus (vas) deferens
b. Deferential artery & vein
c. Sympathetic nervous system fibers
Spermatic Cord, detailed anatomy, continued …
d. Travels through
inguinal canal
to reach testis
e. Testicular
migration
follows this
path
Testicular Artery
Arteries, continued …
2. Cremasteric artery
a. Branch of
Testicular Artery
b. Supplies Ureter
& Cremaster
muscle
Arteries, continued …
3. Perineal artery
a. Branch of internal
pudendal artery
b. Gives rise to posterior
scrotal artery
c. Supplies perineum &
external genitalia
Arteries, continued …
Fetal hypogastric
artery
Superior vesical
artery
Arteries of the Reproductive Tract
Vessels & Nerves, con’t …
B. Veins
1. Pampiniform plexus
(major venous drainage)
a. Approximately a dozen
b. form a network
c. Become larger,
converge approaching
inguinal canal.
Veins, continued …
2. Testicular vein
a. From
convergence of
pampiniform plexus
veins
b Enters IVC on
right
c. Enters renal vein
on left
Vessels & nerves, continued …
C. Testicular Lymphatics
1. Follow arteries, veins
2. End in lumbar nodes
3. From scrotum, penis, prepuce:
terminate in superficial
inguinal nodes
4. From testis, spermatic cord:
drain into external iliac &
lumbar nodes
Vessels & Nerves, continued …
D. Nerves
1. Ilioinguinal nerve (L-1)
a. Into inguinal canal
b. Through superficial inguinal
ring
c. Supplies skin of upper
scrotum & medial thigh
d. via anterior scrotal nerve
Nerves, continued …
2. Genitofemoral nerve
a. Genital branch supplies
cremaster muscle
b. Receives branch of
iliohypogastric nerve
c. Femoral branch supplies
medial portion of thigh
d. Cremasteric reflex (scratch
medial thigh, causes
scrotum to contract)
IV. Embryology/Descent of Testis
A. Development
1. Scrotal swellings appear at ~ 7
weeks in lower abdominal wall
2. Processus Vaginalis:
a. evagination of peritoneum
b. push into scrotal swellings
3. Layers of abdominal muscle, fascia
4. Give rise to inguinal canal
Embryonic Development, continued …
Gubernaculum
Development, continued …
Descent begins at
~3 months
Adult Configuration
Development, continued …
Deep inguinal
ring
Superficial
inguinal ring
Descent, continued …
Gubernaculum
Descent of Testes
Fused
Processus
Vaginalis
Descent begins at
~3 months
Adult Configuration
V. Anomalies/Diseases
• Hernias
1. Indirect (oblique) inguinal hernia
a. Results when processus
vaginalis fails to close at
birth
b. May allow for loops of small
bowel, greater omentum to
enter processus vaginalis &
scrotum
c. causing bowel obstruction
Hernias, continued …
2. Peritoneal cyst
a. Results from persistent connection
between peritoneal cavity & tunica
vaginalis
(due to partial closure of tunica vaginalis)
b. A cyst forms in the “connection”
space
c. May not be noticeable at birth;
later, accumulation of fluid may
form a Hydrocoele
Normal vs. Abnormal Scrotum
Note:
Hydrocele
Testicular torsion
Normal Testis
Testicular Microlithiasis, Hydrocele
Hernias, continued …
3. Femoral hernia:
a. Opening in fascia covering
femoral canal
b. May allow small bowel to slide
through, causing obstruction
Hernias, continued …
Normal Partially
Patent
Completely
Patent
Deep and
Superficial Herniation
Rings in
Infancy
Anomalies/Diseases, continued …
B. Varicocoele
1. Expansion of pampiniform plexus
2. Usually seen on left (why??)
3. Can be palpated
a. feels like a “bag of worms”
Pampiniform Plexus
Anomalies/Diseases, continued …
G. Lymph Edema
1. Due to abdominal venous compression
2. Abdominal aortic aneurysm (AAA)
3. Intra-abdominal tumor
4. Cirrhosis with ascites
5. Filariasis
a. From filarial worms in drinking water
b. Can cause elephantiasis
Anomalies/Diseases, continued …
H. Testicular tumor
1. Generally have unknown etiology
2. Most arise from primordial germ cells
3. Usual symptom: scrotal mass of
increasing size
4. May be associated with pain
5. Any firm mass or cystic mass in
scrotum should be checked
Testicular Tumor: Doppler U/S
Testicular Tumor, continued …
F. Walnut sized
1. 4 cm trans x 2 cm A/P x 3 cm Sup/Inf
G. Lightly encapsulated
1. Fibrous connective tissue
2. Smooth muscle
3. Capsule extends into lobes
II. Prostate Gland: Detailed Anatomy
A. Largest male
accessory
gland
B. Located in
subperitoneal
compartment
(between pelvic
diaphragm & Prostate Gland, Mid-sagittal Section
peritoneum)
Prostate Gland: Detailed Anatomy
D. Double Capsule
1. Fibrous portion contacts gland
2. External capsule formed by pelvic
fascia
3. Venous plexus lies between
Male Reproductive System, Posterior View
Detailed Anatomy, contined …
Prostatic Urethra
Detailed Anatomy, contined …
3. Apex: inferior
a. Rests on superior fascia of urogenital
diaphragm muscle
b. Associated with sphincter urethrae
c. Contacts medial margins of levator ani
muscles
Detailed Anatomy, contined …
3. Median lobe
a. Lies posterior and superior to
prostatic utricle and ejaculatory
ducts
b. May project into urinary bladder
c. Utricle lies within lobe
1. Vestigial remains of uterine
homolog
2. Sometimes called “uterus
masculinis”
Lobes of the Prostate, continued …
4. Lateral lobes
a. Comprise the greatest mass of
the gland
b. Contain most secretory tissue
c. Are continuous posteriorly
Prostate Gland
in situ
Detailed Anatomy, continued
…
H. Glandular tissue
1. 30 - 50 different glandular elements
a. Serous glands
b. 20 - 30 ducts empty into prostatic
urethra
3. Prostatic secretions
a. Thin, milky, alkaline (looks like
skim milk)
b. Discharged at ejaculation
c. Make up ~ 1/3 of semen
Detailed Anatomy, continued …
A. Benign
prostatic
hypertrophy
(BPH):
1. Affects ~90%
of men >50
BPH, continued …
2. Common cause of urethral obstruction:
causes
a. Nocturia
b. Dysuria
c. Urgency
d. Back-pressure effects
e. Complete obstruction can occur
Pathology, continued …
B. Prostate cancer
1. Most common
cancer in males
Pathology, continued …