Anatomy of the Scrotum and Spermatic Cord

Study Notes

An outpouching of the lower anterior abdominal wall
Contains the testes, epididymis, and spermatic cords
Divided into two compartments by the scrotal septum
Wall layers:
- Skin: Heavily pigmented
- Dartos Fascia: Fatty-free fascial layer
- Dartos smooth muscle fibers
Nerve supply:
- Ilio-inguinal (L1)
- Scrotal from perineal nerve
- Perineal branch of posterior cutaneous of the thigh (both are S3)
Arterial supply:
- Superficial and deep external pudendal (femoral artery)
- Posterior scrotal (from internal pudendal artery)
- Cremasteric (from inferior epigastric)

Collection of structures passing through the inguinal canal to and from the testes
Left cord is longer than the right
Coverings:
- External spermatic fascia: Derived from external oblique muscle
- Cremasteric muscle and fascia: Derived from the internal oblique muscle
- Internal spermatic fascia: Derived from the fascia transversalis
Structures:
- Vas deferens and artery of the vas (inferior vesical artery)
- Testicular artery (arises from abdominal aorta at level of L2)
- Pampiniform plexus of veins: Reduced to a single testicular vein, right vein drains into IVC, left vein drains into the left renal vein
- Testicular lymph vessels
- Autonomic nerves forming testicular plexus
- Remnants of processus vaginalis
- Cremasteric artery
- Genital branch of genitofemoral nerve to supply cremasteric muscle

Ilio-inguinal nerve below the cord in the inguinal canal
Tendon of adductor longus behind the cord below the superficial inguinal ring
Superficial external pudendal artery crosses in front of the cord at the superficial inguinal ring
Deep external pudendal artery passes deep to the cord

Firm mobile organ lying within the scrotum
Left testis is usually lower than the right
Upper pole of the gland is slightly tilted forward
Surrounded by tunica albuginea, a tough fibrous tissue capsule
Tunica albuginea sends fibrous septa dividing the testis into lobules: Each lobule contains 1-3 seminiferous tubules
Tunica vaginalis covers the testis except posteriorly
Coverings of the spermatic cord also surround the testis
Blood supply:
- Testicular artery: Arises from abdominal aorta at the level of L2
- Pampiniform plexus of veins: Reduced to a single testicular vein, right vein drains into IVC, left vein drains into the left renal vein
Lymph drainage: Lumbar or paraaortic lymph nodes on the side of the aorta
Nerve supply: Autonomic testicular plexus surrounding the testicular artery

Highly coiled tube (20 feet)
Lies posterior to the testis, with the vas deferens on its medial side
Expanded upper end termed head, followed by body and tail inferiorly
Sinus of the epididymis is a groove between the epididymis and lateral surface of the testis
Length provides storage space for sperm and allows them to mature

Long muscular duct (45 cm) with a narrow lumen
Arises from the tail of the epididymis
Passes through the inguinal canal, emerging from the deep inguinal ring around the lateral margin of the inferior epigastric artery
In the lateral wall of the pelvis, it passes backward crossing the external iliac vessels, the obturator nerve and vessels, and the ureter at the region of the ischial spine
At the posterior surface of the bladder, the vas deferens dilates