scrotum and prostate

the testes are found within the _____

scrotum

within the scrotal sacs what do we find laying against the testicle

epididymis

what is the typically testicle size

3-5 × 2-4 × 3 cm

each testicle is divided into _______ conical lobules

250-400

what do the conical lobules contain

seminiferous tubules

what do the seminiferous tubules form

rate testis

where does the rete testis drain into

epididymis

where does the sperm go after passing through the vas deferens

seminal vesicles

what is the location of the seminal vesicles

posterior to the bladder

what combines to create the ejaculatory duct

seminal vesicles and vas deferens

what is also known as the bulbourethral gland

cowper gland

what secretes preseminal fluid for lubrication

cowper gland/ bulbourethral gland

what are the tiny echogenic tubular structures adjacent to the epididymal head

rete testis

what are the appendices of the scrotum

appendix testis, appendix epididymis, and appendix vas

what are appendices

small, inconsequential embryologic remnants

when might appendices be seen

in the event of a hydrocele

what is torsion of the appendix testes the most common cause of

acute scrotal pain in prepubscent boys

what causes the blue dot sign

torsion of the appendix testes

what is the normal size of the epididymis

6-7 cm long

what is the location of the epididymis in relation to the testicle

posterolateral and superior

what are the parts of the epididymis

head, body, tail

what is the largest portion of the epididymis

head h

what is the measurement of the head of the epididymis

6-15 mm

the epididymis is found ___ to the upper pole of the testis

superior

what drains the epididymis

ductus epididymis

what does the epididymis contain

10-15 ductules from rete testes

what does the epididymis become before it continues into the spermatic cord

vas deferens

what is the dense fibrous tissue that covers the testes

tunica albiguinea

what lines the inner walls of the scrotum

tunica vaginalis

what does the tunica vaginalis consist of

parietal and visceral layer

what is formed in the posterior aspect of the tunica albiguinea that is a vertical septum in the testicle

mediastinum testis

what is the mediastinum testis seen as

an echogenic line coursing through the middle of the testicle

what is the areas on the testicle where blood vessels, nerves, and spermatic ducts travel through on the back of each testicle

bare area

what is a continuation of the epididymis

vas deferens

what forms the ejaculatory duct

vas deferens and seminal vesicles

what does the ejaculatory duct empty into

urethra

what is the connection of the ejaculatory ducts emptying into the urethra

verumontanum

what makes up the spermatic cord

vas deferens, lymphatics, autonomic nerves, fibers of cremaster, and the venous pampiniform plexus

what suspends the testicles within the scrotum

spermatic cord

where does the testicular arteries arise from

below the renal arteries

the testicular arteries become _____ then ____

capsular arteries; centripetal arteries

the centripetal arteries course toward the mediastinum testis and form the _______

recurrent rami/ centrifugal arteries

what do the centrifugal arteries become

capillaries and arterioles

intratesticular arteries have a ____ resistance waveform

low

what arteries accompany the testicular artery within the spermatic cord and supply the extra testicular structures

cremasteric and deferential arteries

where does the cremasteric artery branch from

inferior epigastric artery

where does the inferior epigastric artery branch from

external iliac artery

where does the deferential artery arise from

vesicle artery

where does the vesicle artery branch from

internal iliac artery

what does the deferential artery supply

epididymis and vas deferens

what artery supplies the scrotal wall

branches of the pudendal artery

testicular artery → _______ → _________ → _________

capsular artery, centripetal artery, recurrent rami

venous drainage of the scrotum occurs through the _______

pampiniform plexus

the pampiniform plexus exits through the ______ and courses along the ______

mediastinum testes; spermatic cord

what does the pampiniform plexus contain

testicular veins, deferential veins, and cremasteric veins

where does the right testicular vein drain into

inferior vena cava

where does the left testicular vein drain into

left renal vein

where does the deferential veins drain into

pelvic veins

where does the cremasteric veins drain into

tributaries of the epigastric and deep pudendal veins

after trauma to the testicles ____% can be saved if surgery is done in ___ hours

90; 72

what are the two complications associated with trauma

hydrocele and hematocele

what is hydrocele

fluid collection buildup around the testicle

what is a hematocele

blood buildup around the testicle

what leads to an irregular looking testicular contour and interruption to the tunica albuginea and commonly scrotal wall thickening

rupture of the testicle

_____ is sometimes seen with a ruptured testicle

hematocele

what begins as free-floating echogenic debris that moves while bleeding is happening and then later on appear as septated low-level fluid echoes

acute hematoceles

a scrotal hematoma can cause ____ of the testicle

displacement

what does a scrotal hematoma appear as

large, heterogenous area within the testicle

overtime a scrotal hematoma can become more ___ and ____

complex; cystic

where can hematomas be

inside the testicle or the scrotal wall

what is one of the most urgent scrotum pathology

testicular torsion

how does it take testicular torsion to occur to lose a testicle

72 hours

what occurs when the testicle twists within the scrotal sac and this causes blood flow through the spermatic cord to be cut off

testicular torsion

what do we use to assess torsion

color doppler flow

using the color doppler why would we suspect torsion

one testicle has decreased flow compared to the other

who is at higher risk to have testicular torsion

men with bell clapper deformity

what is bell clapper deformity

when the testes is not properly secured to the back of the scrotum

what causes bell clapper deformity

when the tunica vaginalis completely covers the testes, epididymis, distal spermatic cord and allows them to move freely

____ of patients with bell clapper anomaly have it bilaterally

60%

who is 10x more likely to get testicular torsion

men with undescended testes

where are undescended testes found

in the inguinal fossa or abdomen

when surgery on testicular torsion is performed within ___ hours 80-100% of the testes can be saved

5-6

when surgery on testicular torsion is performed within ___ hours 70% of the testes can be saved

6-12

when surgery on testicular torsion is performed after ___ hours 20% of the testes can be saved

12

what is the peak incidence age for testicular torsion

14

what are the clinical symptoms for testicular torsion

severe pain, nausea/ vomiting, and swelling

what is an infection of the epididymis and testes

Epididymo-orchitis

what is an infection that only affects the testes

orchitis

what does epididymo-orchitis commonly result from

spread of lower urinary tract infection via spermatic cord

what is the most common cause of scrotal pain in adults

Epididymo-orchitis

what is the sonographic appearance of Epididymo-orchitis

epididymis appears enlarged and hypoechoic and may contain hyperechoic areas with hyperemic flow compared to the other side

what are some associated findings of Epididymo-orchitis

hydrocele and scrotal wall thickening

in serve cases of Epididymo-orchitis what can occur

pyocele

what is pyocele

pus that appears in the scrotum

what is a doppler appear as with epididymo-orchitis

high-resistance with little to no diastolic flow

where are most scrotal cysts found

in the tunica albiguinea or epididymis

where are tunica albiguinea cysts found

within the layer of the scrotal wall

what are the cystic dilations of efferent ductules of the epididymis

spermatoceles

where are spermatoceles found

always in the epididymal head

when do we see spermatoceles more often

after a vasectomy