scrotum anatomy

1. In utero, where will the testicles arise?

2. What will it be near?

1. In the fetal upper abdomen

2. Kidneys

In the 4th gestational month, the testes will descend to the level of the…

Urinary bladder

1. After the 7th gestational month, what will the testes descend through?

2. The descent will be ________ controlled.

1. The inguinal canal and into the scrotum

2. Hormonally

The scrotum is a (1)____________ sac composed of several layers of (2)__________ and _________.

1. Fibromuscular

2. Fascia and muscle

The layers of the fibromuscular sac include… (4)

• Tunica dartos

• External, middle, and internal spermatic fascia

• Cremasteric muscle

• Tunica vaginalis

The scrotum is divided into two compartments by a (1)________ septum, called the (2)_____________.

1. Midline

2. Median raphe

The median raphe is created by the tunica…

Dartos

Label the layers of the scrotum that are crossed out.

1. Tunica vaginalis

2. Cremasteric muscle

3. External spermatic fascia

4. Dartos muscle (Tunica dartos)

What is the name for the area pointed at by the red arrows?

Median raphe

What are the three major structures within the scrotum?

• Spermatic cord

• Epididymis

• Testes

Label the layers/structures within the scrotum that are crossed out here.

1. Spermatic cord

2. Body of epididymis

3. Head of epididymis

4. Tunica dartos

5. Tunica vaginalis

6. Testis

7. Tail of epididymis

The spermatic cords are paired and extend from the pelvis through the (1)____________ and into the (2)________.

1. Inguinal canal

2. Scrotum

The spermatic cord (1)_______ the testicles into the (2)________.

1. Suspends

2. Scrotum

What 6 parts make up the spermatic cord? (AVLNVC)

• Arteries

• Veins of the pampiniform plexus

• Lymphatics

• Nerves

• Vas deferens

• Connective tissue

List the 3 arteries in the spermatic cord.

• Testicular

• Cremasteric

• Deferential

Label the layers/structures of the spermatic cord that are crossed out here.

1. Vas deferens

2. Pampiniform plexus

3. Cremasteric muscle

A normal spermatic cord will appear as a (1)_____echoic, slightly (2)___________, linear structure.

1. Hypoechoic

2. Turtuous

A normal spermatic cord will measure up to __ mm in diameter.

2

An abnormal spermatic cord will measure over __ mm in diameter.

2

1. With color doppler, the normal spermatic cord will show how much flow?

2. Within what vessels?

3. At?

1. Minimal flow

2. Arteries and veins of the pampiniform plexus

3. Rest

For a normal patient, performing what maneuver will increase flow slightly on a color doppler scan?

Valsalva

1. What is this an image of?

2. What plane was image one taken in?

3. What plane was image two taken in?

1. Greyscale spermatic cord

2. Sagittal view

3. Transverse view

1. What is this an image of?

2. What plane was image one taken in?

3. What plane was image two taken in?

1. Colorscale spermatic cord

2. Sagittal view

3. Transverse view

1. What is this an image of?

2. What plane was image one taken in?

3. What plane was image two taken in?

1. Colorscale spermatic cord

2. Sagittal view

3. Transverse view

On an US scan, how will a spermatic cord appear after performing the Valsalva Maneuver?

• Significantly more color

• Dilated greater than 2mm in diameter

The epididymis is a (1)_________ structure that begins superiorly and then courses (2)_____________ to the testes.

1. Tubular

2. Posterolateral

What is the function of the epididymis?

To store, convey, and excrete sperm

What is the epididymis divided into anatomically?

• Head

• Body

• Tail

What structure is seen here, as indicated by the star?

Epididymal head

What structure is seen here, as indicated by the arrow?

Epididymal body and tail

What is another term for epididymis head?

Globus major

What part of the epididymis is seen most often, due to being the largest?

Epididymis head

The epididymis head is located __________ to the upper pole.

Superior

Compared to the testicle, how does the epididymis head appear?

• Homogenous

• Isoechoic to slightly more echogenic

1. The epididymis head is best seen in what plane?

2. How does it appear on US?

3. It will lie ________ to the testicle.

1. Sagittal

2. Triangle, crescent, or tear drop shaped structure

3. Superior

What structure is seen here?

Epididymis head

What is another term for the epididymis body?

Corpus

The body of the epididymis is much _________ than the head.

Smaller

The epididymis _____ is typically difficult to see with US.

Body

The epididymis body follows the (1)_____________ aspect of the testicle from the (2)______ to _______ pole.

1. Posterior/lateral

2. Upper, lower

What is another term for epididymis tail?

Globus minor

The epididymis tail is positioned to the _______ pole of the testicle.

Lower

A normal epididymal body and tail are (1)_______ and more (2)_________ in position.

1. Smaller

2. Variable

The epididymis tail is usually located (1)__________ and (2)_________ to the testicle.

1. Posterior

2. Inferior

The epididymis tail is best evaluated in what plane?

Sagittal

1. The epididymal head contains how many efferent ductules?

2. Where do they come from?

1. 10-15

2. Rete testes

What do the converged rete testis form?

A single duct in the body and the tail

1. What does the white circle outline?

2. What does the red arrow point to?

1. Efferent ducts

2. Rete testes

In a longitudinal view, the mediastinum testes are seen as an (1)__________ band that run (2)_________ to _________ within the testes.

1. Echogenic

2. Superior, inferior

In a transverse view, the mediastinum testes may appear more ________ shaped.

Ovoid

The mediastinum testes function as a supporting system for what 4 structures?

• Arteries

• Veins

• Lymphatics

• Seminiferous tubules

The seminiferous tubules converge to form what?

Tubuli recti

The tubuli recti is formed from the convergence of what?

Seminiferous tubules

What does the tubuli recti help connect?

The seminiferous tubules to the rete testes

What is another term for tubuli recti?

Straight tubes

Label the parts of the testicle that are crossed out.

1. Tubuli recti

2. Seminiferous tubule

3. Head of epididymis

4. Efferent ductules

5. Rete testis

6. Body of epididymis

7. Tail of epididymis

What part of the testicle is seen here?

Mediastinum testis

What part of the testicle is seen here?

Mediastinum testis

The rete testis are a network of (1)_________ lined channels within the (2)_________________.

1. Epithelial

2. Mediastinum testis

1. What does the rete testi drain into?

2. It drains through what structure?

1. Epididymis

2. Efferent ductules

Normal rete testis can be seen as (1)_________ areas with striations located adjacent to or within the (2)_________________.

1. Hypoechoic

2. Mediastinum testis

What does the rete testi play a major role in?

Carrying sperm to the epididymis

What is this hypoechoic striated structure seen within the mediastinum testi?

Rete testi

The creation of sperm occurs where?

Seminiferous tubules

Where does the seminiferous tubule empty sperm?

In the tubuli recti

Where does the tubuli recti converge?

At the rete testes

Between the seminiferous tubules are what cells?

Leydig cells

What are the leydig cells responsible for?

Producing testosterone and androgens

Label the parts crossed out on the image.

1. Straight tubule

2. Seminiferous tubule

3. Efferent ductules

4. Rete testi

The seminal vesicles are paired glands surrounded by __________ tissue.

Connective

1. The seminal vesicles lie anterior to the ________.

2. It lies posterior to the _________.

3. It lies medial to the _________.

4. And it lies lateral to the __________.

1. Prostate

2. Bladder

3. Ureters

4. Vas deferens

Each seminal vesicle joins with its corresponding…

Ductus deferens

What makes up a portion of semen and helps aid in sperm mobility?

Secretions

What forms the ejaculatory ducts?

Ductus deferens

The 2 ejaculatory ducts course through the (1)_______ and empty into the (2)________________.

1. Prostate

2. Prostatic urethra

Label the parts crossed out on this image.

1. Vas deferens

2. Seminal vesicle

3. Prostatic urethra

4. Ejaculatory duct

5. Prostate

List the 10 step pathway of sperm from the testes to the urethra.

1. Seminiferous tubules

2. Tubuli recti

3. Rete testes

4. Efferent ductules

5. Epididymis

6. Vas deferens

7. Seminal vesicles

8. Ejaculatory duct

9. Prostate

10. Urethra

What are the testicles?

Bilateral, symmetrical ovoid structures within the scrotum

1. The testicles get to their max size around ______.

2. What is the measurement for length?

3. AP and width?

1. Puberty

2. 3-5 cm

3. 2-3 cm

What is the endocrine function of the testes?

Testosterone production

What is the exocrine function of the testes?

Sperm and semen production

What occurs to both testes and epididymis with age?

It will decrease in size

How does a normal teste appear on US?

• Homogenous

• Medium level echoes

• Smooth contour

• Similar to thyroid

1. What is this image of?

2. What plane is this taken in?

3. What measurements are taken here?

1. Teste

2. Sagittal

3. Length and AP

1. What is this image of?

2. What plane is this taken in?

3. What measurements are taken here?

1. Teste

2. Transverse

3. Width

What are the names for the two layers crossed out?

1. Parietal layer

2. Visceral layer

The tunica vaginalis is a (1)_________ sac, composed of two layers that cover and surround the (2)_________ and (3)________.

1. Peritoneal

2. Testis

3. Epididymis

The visceral layer of the tunica vaginalis is a (1)________ membrane that produces secretions and covers the (2)__________ and (3)___________.

1. Serous

2. Testis

3. Epididymis

The parietal layer is the (1)______ lining of the scrotal wall containing (2)_________ for (3)_______ absorption.

1. Inner

2. Lymphatics

3. Fluid

There is a small bare area not covered by the tunica vaginalis, where is it located?

On the posterior aspect of the testicle

1. At the bare area site, not covered by the tunica vaginalis, what is occurring?

2. What can this area prevent?

1. The testicle is adhered to the scrotal wall

2. Torsion

What are the parietal and visceral layers of the tunica vaginalis separated by?

A potential space containing a few mL of fluid

In the normal scrotum, visualizing a small amount of fluid should not be mistaken for what pathology?

Hydrocele

Visualizing an excessive amount of fluid in the scrotum could indicate what pathology?

Hydrocele

What are three examples of pathology that can be seen in the potential space between the parietal and visceral layers?

• Scrotal hernia

• Hydrocele

• Hematocele

A scrotal hernia will have what on the US between the parietal and visceral layer?

Bowel

What is the name for this space indicated by the red arrow?

Potential space

The tunica dartos is a thin layer of (1)_________ fibers around the (2)_____ of the scrotum.

1. Muscular

2. Base

The tunica dartos will form what?

The median raphe

The median raphe will divide the (1)____________ into two (2)________ for the testes.

1. Scrotal pouch

2. Cavities