Scrotum and Prostate

3 structures of scrotum

spermatic cord

epididymis

testes

raphe

divides scrotal pouch into left and right compartments

normal testes size

lxwxh = 5×4×3

rete testis

facilitate transportation of sperm from testes to penis

tunica albuginea

dense, fibrous tissue completely covering the testicles

thick part of t.a. reflects into testis to form a septum called mediastinum

3 layers of tunica

vasculosa, albuginea, vaginalis

mediastinum

supports the vessels and ducts coursing through testicles

receives blood vessels, lymphatics, nerves, and ducts

bare area

small area of testicle not covered by visceral layer of tunica vaginalis

blood vessels, lymphatics, nerves and spermatic ducts travel through this space

where hydroceles form

hydrocele

when fluid fills a man’s scrotum causing it to swell

two primary functions of the testes

spermatogenesis and secretion of hormones (testosterone)

spermatogenesis

production of sperm

seminiferous tubules are starting point for production of sperm and maturation in the epididymis

testosterone

androgen hormone

produced by Leydig cells that lie between tubules

spermatic cord

paired and pass from abdominal cavity through inguinal canal down to scrotum

composed of arteries, veins of pampiniform plexus, nerves, lymphatics, vas deferens, and conn. tissue

normal veins < 2 mm

pampiniform plexus

loose network of small veins found w/in male spermatic cord

if testicles too hot, healthy sperm cannot be made so plexus helps cool the blood before it travels

*essential that veins can cool down the blood

varicocele

enlarged pampiniform plexus

valves in veins may not work well or be missing

common in low sperm production (can cause infertility)

epididymis

6-7 cm, coiled tube on backside of each testicle

carries and stores sperm cells

bring sperm to maturity

divided into head, body, and tail

epididymis head, body, and tail

head (globus major)

body (corpus)

tail (globus minor)- becomes vas deferens

epididymitis

inflammation of the epididymis

vascularity

arteries arise from aorta and venous drainage of right testicle into IVC and left testicle into left renal vein

clinical problems of scrotum

mass, testicular pain, infertility, testicular trauma, undescended testicle

appendix testis

small appendage of normal tissue on top of the epididymis

polyorchidism

cryptorchidism

multiple testes

undescended testes

scrotal protocol

begin in trans, document midline scrotum to compare both testes in gray scale and color

trans superior to inferior on affected testes

long lateral to medial

image epididymis

document PW flow

measure abnormalities in 2 planes

repeat for other side

prostate anatomy

walnut sized gland

below bladder and in front of rectum

surrounded by fibrous capsule

composed of glandular and fibromuscular tissue

surround urethra

base by bladder and apex by exit of urethra

prostate function

produced fluid that makes up part of the semen which enriches and protects sperm

zones of prostate

peripheral- 70% of gland tissue, posterior/lateral portions

central- 25% of gland tissue, at base of prostate

transition- 5% of gland tissue, 2 glands lateral and above central

vascularity

arterial supply from inferior vesical artery

venous drainage via prostatic venous plexus

indications for prostate exam

abnormal digital rectal exam

blood tests w/high levels of PSA

TRUS for diagnosis

TRUS for biopsy

renal ultrasound to include bladder

request for prostate US

enlarged

decreased amount of urine

dysuria

infertility

biopsy

elevated PSA

routine screening

cystic vs. solid masses

PSA test

protein that keeps semen in liquid form so sperm can swim

test levels can rise due to # of reasons including cancer

verumontanum

longitudinal ridge within urethra where orifices of ejaculatory ducts are located on either side

eiffel tower sign showing in area of urethra

BPH

enlarged prostate