Inguinal Region,

Testes and Scrotum

Dr. Ashley Stephen

AshleyStephen@RossU.edu
Department of Anatomy
Room 36

Recommended reading: Practice questions:

Clinically Orientated Anatomy - 7th Edition: Pages 202-216 Located on eCollege below this lecture file
 Learning Objectives
✓ Define the boundaries of the inguinal canal and differentiate from the inguinal ligament
✓ Outline why the inguinal canal is a potential site for herniation (how do the femoral or umbilical regions differ?) and
differentiate a direct inguinal hernia from an indirect inguinal hernia
✓ Distinguish the fascial layers of the scrotum in relation to the associated layers of the anterior abdominal wall
✓ Describe the spermatic cord in terms of the contents as well as the associated fascial layers
✓ Define the functional anatomy of the testes, describe the epididymis and identify the neurovasculature
(arterial supply, venous drainage and lymphatic drainage)
✓ Discuss and outline the following clinical correlates:
 Hematocele
 Canal of Nuck  Hydrocele
 Cremasteric reflex  Vasectomy
 Cryptorchid testis  Varicocele
 Inguinal hernias and Hesselbach’s Triangle  Rupture of the male urethra
 Lymphatic spread of testicular and scrotal cancer  Spermatic cord torsion
Recommendation:
**Link the anatomical and clinical information provided in the lecture to the gross anatomy laboratories** 2
 Preview: Development of the Inguinal Canal in Females
Primordial Upper Gubernaculum
ovaries becomes Suspensory Ligament of the Ovary

Deep
Lower Gubernaculum Inguinal Ring
becomes Round Ligament of the Uterus

Round Ligament Superficial

(of uterus) Inguinal Ring

8 weeks 15 weeks

Deep inguinal ring

Round ligament
(of uterus)
Superficial inguinal ring

Mature Clinically Orientated Anatomy (2014)

3
 Preview: Development of the Inguinal Canal in Males
Primordial
testes

Gubernaculum
Site of future
Deep Inguinal Ring
Site of deep inguinal ring
Site of future
Superficial Inguinal Ring
Processus vaginalis
Gubernaculum becomes the tunica vaginalis Gubernaculum
becomes the scrotal ligament (positioned posterior to processus vaginalis)

7 weeks 28 weeks

Tunica vaginalis
(the serous sheath of the testis and epididymis) Right testis

New Born (42 weeks) Clinically Orientated Anatomy (2014)

4
 Preview: Development of the Inguinal Canal in Males
Parietal peritoneum Extraperitoneal fascia Processus vaginalis
becomes the tunica vaginalis
Transversalis
fascia Transversus abdominis m.

Internal oblique m.

External oblique m.
Primordial
testis

Gubernaculum Gubernaculum
becomes the scrotal ligament (positioned posterior to processus vaginalis)

7 weeks 28 weeks
Ductus (vas) deferens

New Born (42 weeks) Gray’s Anatomy for Students (2005)

5
Inguinal Region: Relationship to the anterior abdominal wall
Linea semilunaris Linea alba

EO m.

IO m. Anterior lamina
Anterior superior of rectus sheath
iliac spine
TA m.
Location of
deep
inguinal ring Inferior
epigastric vessels
External
oblique Conjoint tendon
aponeurosis

Location of
superficial
Spermatic cord inguinal ring

Inguinal ligament
6
 Inguinal Ligament & associated ligaments
Superficial inguinal ring

Lacunar ligament:
• Deeper fibers of external oblique aponeurosis pass
posteriorly to attach LATERAL to the pubic tubercle
to form an arch

Pectineal ligament:
Acetabulum
• Most lateral lacunar ligament fibers continue to run
along pecten pubis
• MEDIAL to femoral canal
Inguinal ligament of Poupart:
▪ The fibrous, thickened, folded margin (inferior edge) of the
external oblique aponeurosis Reflected inguinal ligament:
▪ Forms the floor of the inguinal canal • Superior fibers of external oblique aponeurosis and
▪ Extends from: lacunar ligament fan upwards crossing the linea alba
instead of inserting into the pubic tubercle
Anterior Superior Iliac Spine (ASIS)
Pubic tubercle 7
 Boundaries of the Inguinal Canal
TA IO EO
m. m. m. Anterior wall:
• External oblique aponeurosis
Laterally this wall is reinforced by internal oblique m. fibers
Transversalis Camper’s fascia
fascia
Posterior wall:
Scarpa’s fascia
• Transversalis fascia
Extraperitoneal Medially this wall is reinforced by the conjoint tendon formed by the
fat aponeuroses of the internal oblique and transversus abdominis mm.
Spermatic cord
Parietal
peritoneum Floor of the Roof:
inguinal canal
Pubis
• Conjoint tendon
→ This forms from the arching fibers of internal oblique &
Fascia lata transversus abdominis aponeuroses

Click here:
Floor:
What is the inguinal • Inguinal ligament
canal? Medially supported by the lacunar ligament
8
Boundaries of the Inguinal Canal
Anterior wall:
• External oblique aponeurosis
→ EXIT of the inguinal canal is located in this wall
SUPEROLATERAL to the pubic tubercle

Posterior wall:
• Transversalis fascia
→ ENTRANCE of the inguinal canal is located in this wall
LATERAL to the inferior epigastric artery and vein

Roof:
• Conjoint tendon
→ This forms from the arching fibers of internal oblique &
transversus abdominis aponeuroses

Floor:
• Inguinal ligament
9
 Inguinal Canal Openings: Superficial Inguinal Ring
External oblique m.
Internal oblique m. Rectus abdominis m.
(reflected)

The superficial inguinal ring:

Superficial
inguinal ring ▪ Also known as the “external”
(open/cut)
inguinal ring
▪ Opening in the external oblique
aponeurosis
Inguinal ligament ▪ Exit of the inguinal canal
Medial
crus
▪ Located superolateral to the pubic
tubercle
▪ MEDIAL to the inferior epigastric
vessels (artery and vein)
Deep fascia of the thigh External oblique aponeurosis Spermatic cord 10
 Inguinal Canal Openings: Deep Inguinal Ring
Transversalis
Internal oblique m. Conjoint tendon
fascia
The deep inguinal ring:
Deep inguinal
ring Rectus
▪ Also known as the “internal”
abdominis m.
inguinal ring
▪ Opening in the
transversalis fascia
▪ Entrance of the inguinal canal
▪ Located ½ way along the inguinal
ligament
▪ LATERAL to the inferior epigastric
Inguinal ligament vessels (artery and vein)

Deep fascia of the thigh Spermatic cord 11

 Inguinal Canal: Contents
Internal oblique m.
Transversus abdominis
The inguinal canal passes obliquely and m.

is approximately 4cm long Scarpa’s fascia

Parietal
peritoneum

▪ Females (narrower canal): Transversalis

fascia
External oblique
 Round ligament of the uterus aponeurosis
Inguinal
ligament
 Ilioinguinal nerve
Lacunar
 Genital branch of genitofemoral nerve Ilioinguinal nerve ligament
 Blood and lymphatic vessels Spermatic cord &
contents:
• Artery to ductus (vas) deferens
▪ Males (wider canal): •
•
Ductus (vas) deferens
Lymphatics
• Testicular a.
▪ Spermatic cord • Cremasteric a. and v. Superior pubic
• Obliterated processus vaginalis ramus
▪ Ilioinguinal nerve • Pampiniform plexus of vv.
• Genital branch of genitofemoral n. Pectineus m.
▪ Genital branch of genitofemoral nerve
▪ Blood and lymphatic vessels Fascia lata
12
 Spermatic Cord
The spermatic cord suspends the testis in the scrotum and
contains the structures that run to and from the testis.

▪ Begins: Deep inguinal ring

▪ Travels through: Inguinal canal

▪ Emerges: Superficial inguinal ring

▪ Ends: Scrotum (posterior border of the testis)

13
 Spermatic Cord: Coverings
Internal oblique m. Transversus abdominis m. ① External spermatic fascia:
External oblique m. Transversalis fascia
Parietal peritoneum
❖ Derived from the investing fascia of
Scarpa’s fascia external oblique muscle
Skin

Internal spermatic ② Cremaster fascia and muscle:

fascia
Cremaster m.
Ductus (vas)
❖ Derived from the investing fascia of
& fascia
deferens internal oblique muscle.
External spermatic
fascia
❖ Cremaster muscle is striated and innervated by the
SPERMATIC
CORD genital branch of the genitofemoral nerve to elevate
Epididymis
the testis (GSE)
Parietal layer (draws testis closer to body for protection
Visceral layer e.g. in response to cold temperatures)
Skin
Dartos m. &
Tunica vaginalis fascia
③ Internal spermatic fascia:
❖ Derived from transversalis fascia
14
 Spermatic Cord: Contents
Mnemonic:
All Doctors Love Taking Care Of Patients Genitals
Testicular artery
Artery to ductus deferens
Cremasteric artery (and vein)
Pampiniform plexus of veins
(Right drains to IVC & Left drains to Left renal vein)
Lymphatic vessels
Genital branch of genitofemoral nerve (GSE)
Autonomic nerve fibers (GVE)
Sympathetic innervation from para-aortic ganglion
Remnant of obliterated processus vaginalis
Ductus (vas) deferens 15
 Scrotum
The scrotum is part of the male external genitalia and is a cutaneous, muscular sac that has a
wrinkled appearance.
▪ Rugose (wrinkled) appearance is due to smooth muscle fibers known as Dartos muscle that are extremely thin and
insert onto the skin.

▪ The scrotum can protect the testes by regulating temperature

(as it can decrease the exposed surface area of skin)

▪ The scrotum develops from two labioscrotal swellings

which fuse to form a pouch:

• Divided internally = Scrotal septum (continuation of the Dartos fascia)

• Demarked externally = Scrotal raphe

16
 Scrotum: Coverings
Internal oblique m. Transversus abdominis m.
① Skin
External oblique m. Transversalis fascia
Parietal peritoneum ② Dartos muscle & Superficial fascia
Scarpa’s fascia
Skin ➢ Derived from Scarpa’s fascia
Internal spermatic
fascia ➢ Dartos muscle is smooth and
recieves autonomic innervation (GVE)
Cremaster m. & fascia Ductus (vas)
deferens ➢ Works in conjunction with the striated cremasteric
External spermatic muscle
fascia
SPERMATIC ③ External spermatic fascia
CORD
Epididymis
➢ Derived from external oblique m./fascia
Parietal layer
Visceral layer Skin ④ Cremaster fascia and muscle
Dartos m. &
Tunica vaginalis ➢ Derived from internal oblique m./fascia
fascia

External spermatic
fascia
⑤ Internal spermatic fascia
Cremasteric fascia ➢ Derived from transversalis fascia
Internal spermatic fascia 17
 Scrotum: Arterial Supply
External pudendal
artery
Internal iliac
artery

Femoral
artery

Internal pudendal
artery
Perineal artery

Anterior scrotal Posterior scrotal

branches branches
18
 Scrotum: Venous and Lymphatic Drainage
Ilioinguinal nerve
Common iliac
lymph nodes

Femoral v. External iliac

lymph nodes

Great
saphenous v. Internal iliac
lymph nodes

Deep inguinal
lymph nodes

▪ Anterior scrotal veins → External pudendal v.

Lymph from the skin of the scrotum initially drains →
▪ Posterior scrotal veins → Internal pudendal v. Superficial Inguinal lymph nodes 19
 Scrotum: Innervation

Anterior cutaneous innervation:

▪ Ilioinguinal nerve → Anterior scrotal nerves
(L1)

▪ Genital branch of genitofemoral nerve: Travelling within the spermatic cord

(L1 – L2)

Ilioinguinal nerve

Genitofemoral nerve
(genital branch)
Posterior cutaneous innervation:
Pudendal nerve
Posterior scrotal
▪ Pudendal nerve → Posterior scrotal nerves
nerves (S2 – S4)
Posterior femoral
cutaneous nerve
▪ Perineal branches of posterior femoral cutaneous nerve
Anterior scrotal
(S2 – S3)
nerves
20
 Testes (Testis = singular)
Skin A testis is a firm yet mobile organ suspended
Dartos fascia
within the scrotum (by the spermatic cord)
External
spermatic fascia and is anchored inferiorly by the scrotal ligament.
Cremaster
muscle & fasica
▪ The testes are paired ovoid reproductive glands
Internal
spermatic fascia ▪ Produce:
• Sperms (spermatozoa)
Tunica vaginalis: • Male hormones (testosterone)
• Parietal layer
• Visceral layer
▪ Approximately 5cm in length
▪ Function below body temperature
21
 Testes: Coverings
Peritoneal cavity
Lobules of scrotum ① Skin

Tunica Dartos ② Tunica Dartos a.k.a Dartos m./fascia

 Derived from Scarpa’s fascia
External spermatic
fascia
Cremaster ③ External spermatic fascia
muscle & fasica  Derived from external oblique m./fascia

Internal spermatic
fascia ④ Cremaster muscle & fascia
 Derived from internal oblique m./fascia
Parietal layer of
tunica vaginalis

⑤ Internal spermatic fascia

Visceral layer of
tunica vaginalis  Derived from transversalis fascia

Tunica
⑥ Tunica vaginalis
albuginea
Ductus (vas) Head of
 Parietal layer
deferens epididymis  Visceral layer 22
 Epididymis
The epididymis is an elongated, tightly coiled,
Head
convoluted tube that is located on the posterior
surface and superior pole of the testis.
Body
▪ Stores spermatozoa until maturation occurs

▪ Arterial supply is provided by the testicular artery

Tail
▪ Three parts of the epididymis:
1. Head: Recieves efferent ductules (approx. 12-14)

2. Body: Narrower in diameter

Visceral layer of tunica vaginalis with the
white tunica albuginea 3. Tail: Continuous with ductus deferens
layer seen immediately deep 23
 Testicular Mediastinum
Efferent ductules
Testicular a.
The testicular mediastinum is where the
Pampiniform
Rete testis plexus of veins neurovascular structures enter and leave the testis.
Ductus (vas)
deferens ▪ Located on the posterior aspect

▪ Area is not covered by tunica vaginalis layers

▪ A testis contains 200-300 lobules:

➢ Lobules are separated from each other by a septum
➢ Each lobule contains 2 or 3 coiled seminiferous tubules
➢ Seminiferous tubules produce spermatozoa

▪ Seminiferous tubule → Straight tubule → Rete testis

Septum → Efferent ductules → Head of the epididymis

Lobules 24
 Testes: Arterial Supply
Pampiniform plexus
(testicular veins) Testicular artery

Artery of ductus
(vas) deferens
Veins of ductus L
(vas) deferens
Cremasteric
artery

Testicular arteries
branch directly (anterolaterally) from the abdominal aorta at approx. L2 25
 Testes: Venous Drainage
Inferior Vena Cava
Pampiniform plexus Left renal vein
(testicular veins) Testicular artery

Artery of ductus L
(vas) deferens R
Veins of ductus
(vas) deferens
Cremasteric Right Left testicular
artery testicular vein vein

Location of
inguinal canals

Pampiniform plexus
of veins
26
 Testes: Lymphatic Drainage
Pre-aortic lymph
nodes Para-aortic (Lumbar) lymph nodes
Common iliac lymph
nodes Testicular artery

External iliac
lymph nodes

Deep inguinal lymph

nodes

Lymph from the testes initially drains → Lumbar (a.k.a Para-aortic) lymph nodes 27
 Testes: Innervation
The testes are visceral organs and therefore receive autonomic innervation!

▪ Sympathetic (fight or flight):

▪ Paravertebral ganglia → Lesser splanchnic nerve → Prevertebral (pre-aortic) ganglia
▪ Testicular plexus of nerves is involved
▪ Wraps around the testicular artery to reach the testis, epididymis and ductus deferens
▪ Promotes ejaculation: Propels semen along the duct system
▪ Increases glandular secretions

▪ Parasympathetic innervation (rest and digest):

▪ Erectile tissues of the penis and prostate gland receive parasympathetic innervation from the
pelvic splanchnic nerves
▪ Promotes sexual arousal
28
 Clinical
Correlates

29
 Carcinoma: Testes
▪ Metastatic spread can be via the lymphatic system:
Testicular a.
surrounded by
testicular v.v.
▪ Lumbar (para-aortic) lymph nodes first!
Ductus (vas) ▪ These retroperitoneal lymph nodes lie just inferior to the renal veins and
deferens
are parallel to the abdominal aorta
Epididymis
▪ Cancer of the testes could eventually reach the lungs
(via the mediastinal and supraclavicular lymph nodes)

Hard
mass
Note: Metastatic spread can also be via the vascular system

▪ Cancer of the testes could eventually reach the liver and spine
Testis
▪ The valveless veins that form the internal vertebral venous plexus can provide
a pathway for the cancer cells to spread to the brain 30
 Carcinoma: Skin of the Scrotum
▪ Metastatic spread is most likely via the lymphatic system:
▪ Superficial inguinal lymph nodes first!

▪ These lymph nodes lie in the subcutaneous tissue Dr Pott’s identified the increased
risk that chimney sweeps had for
▪ Inferior to the inguinal ligament developing scrotal cancer
(1775)

▪ Symptoms:
▪ Slow growing skin lesion
▪ Often ulcerated
▪ Lump on the skin of the scrotum
▪ May be painful or painless
▪ Microscopic examination of biopsy can confirm if cancerous
31
 Preview: Carcinoma - Uterus, Ovaries & Labium majus
▪ Endometrial cancer begins in the uterus
Possible symptoms:
▪ Uterine cancer cells can spread to the labium majus via the
lymphatic vessels travelling with the
▪ Uterine - Abnormal vaginal bleeding
Pelvic or abdominal pain round ligament of the uterus

▪ Ovarian cancer begins in the ovary

▪ Ovarian - Fatigue
Menstrual changes ▪ Lumbar lymph nodes first
Pelvic or abdominal pain
▪ Lymphatic vessels drain by following the ovarian veins

▪ Labium majus - Gradual change ▪ Cancer of the vulva can begin in the external sex organs
Lasting itch (e.g. labium majus)
Pain or soreness
Lump or swelling ▪ Superficial inguinal lymph nodes first
▪ Lymphatic vessels drain the skin of the perineum
32
 Herniation
A hernia is when part of an organ is displaced and protrudes through
the wall of the cavity containing it, often involving the intestine at a
weak point in the abdominal wall.

▪ Umbilical hernia

▪ Femoral hernia - more common in females

▪ Direct inguinal hernia

▪ Indirect inguinal hernia

▪ Incisional hernia

If the cause is “acquired” → pushes through the posterior wall of the inguinal canal
If the cause is “congenital” → moves through a patent (open) processus vaginalis 33
 Indirect Inguinal
Hernia
Inferior
epigastric a.
• LATERAL to the inferior epigastric artery
• Originates from the deep inguinal ring
➢ Technically there is no defect as this opening is already transmitting
the ductus deferens or round ligament of the uterus!
• Travels through all of the inguinal canal
• Emerges from superficial inguinal ring
• Herniated content is covered by all 3 layers of spermatic cord
➢ Easier to fully enter the scrotum
More common in young males
Direct Inguinal
Hernia
Inferior
epigastric a.
• MEDIAL to the inferior epigastric artery
• Originates from Hesselbach’s triangle
➢ Takes a dramatic shortcut – pushes through weak area!
• Travels through medial part of the inguinal canal
• Emerges from superficial inguinal ring
• Herniated content is only covered by transversalis fascia,
endoabdominal fascia and parietal peritoneum
➢ Less likely to fully enter the scrotum
More common in older males
34

Mnemonic:
Direct inguinal hernia’s
through the triangle
Hesselbach’s Triangle
Hesselbach’s inguinal triangle is located between the
R I P medial and lateral peritoneal (umbilical) folds and is a
weak area in the posterior wall of the inguinal canal

• Three boundaries of Hesselbach’s triangle:

① Medial border:
Lateral border of Rectus abdominis m.

② Lateral border:

2
Inferior epigastric vessels
Deep inguinal
ring location ③ Inferior border:
1
3
Inguinal ligament of Poupart
Superficial inguinal ring location 35
 Treatment: Herniorrhaphy
Hernia’s can be treated by many different surgical techniques that act to repair and
reconstruct the posterior aspect of the anterior abdominal wall and this procedure is known as
hernioplasty or herniorrhaphy

Causes of groin herniation:

▪ Obesity
▪ Pregnancy
▪ Heavy lifting
▪ Chronic obstructive pulmonary disease
▪ Straining (e.g. constipation)
▪ Congenital connective tissue disorders
▪ Defective collagen synthesis
▪ Cigarette smoking
▪ Ascites

Chance of reoccurrence after repair is 10-15% 36

 Hydro-, Hemato- and Varico- celes
Hydrocele of
Normal Non-communicating Communicating the cord
May indicate
inflammation of
epididymis
Collection of
Hydrocele serous fluid May be congenital and
Translucent
result from incomplete
obliteration of Testis
processus vaginalis Scrotum

Collection of May indicate injury and

blood NOT
Hematocele in the tunica
rupture of the
translucent
testicular artery
vaginalis

Spermatic cord

Common on the left Feels like a

Varicocele
bundle of
• 90° drainage angle
worms
Dilated veins into left renal v.
Varicocele pampiniform plexus • Nutcracker
Usually
syndrome disappears
Varicocele
when lying Epididymis
external surface view
down Testis 37
 Canal of Nuck
If there is an incomplete obliteration of the processus vaginalis in
females, this can lead to the formation of a small abnormal pouch
of peritoneum in the inguinal canal.

Hydrocele located along the left ▪ Named after Dutch anatomist Anton Nuck (1691)
round ligament and extending
towards the labium majus
▪ The pouch extends anterior to the round ligament of the
uterus and travels into the labia majora

▪ Analogous to a patent processus vaginalis in males and

can result in either:
▪ Indirect inguinal hernia
Labium
majus ▪ Hydrocele
▪ Cyst 38
Case courtesy of Dr Erik Ranschaert, Radiopaedia.org, rID: 11073
Transillumination
Transillumination is a simple method to detect abnormalities by
passing a light through a part of the body.

▪ Requires a dark room

▪ Bright light is applied to the side of the scrotal enlargement

▪ If the light transmits as a red glow → indicates there is only

serous fluid in the scrotum
→ Can diagnose a hydrocele
→ Possible to tap and safely
drain the hydrocele

▪ If the light is NOT transmitted

→ indicates a more serious problem! 39
 Rupture of the Male Urethra
If the male urethra tears (ruptures), urine can leak
Scarpa’s fascia: out into the loose connective tissue around the
• Membranous layer
of subcutaneous scrotum, penis and anterior abdominal wall
tissue in abdomen
▪ Fluid may extravasate (escape) into the perineal
area where it can accumulate deep to Colles’ fascia
Dartos fascia: and spread under Dartos and Scarpa’s fasciae
• Superficial fascia of
the penis Line of fusion:
• Dartos fascia of No fluid will leak Straddle injury:
the scrotum into the thigh Trauma of the perineal area (in males this is between the scrotum & anus)
caused by a forceful blow with a hard object
Fascia
lata
Colles’ fascia:
• Superficial fascia of
the perineum

40
 Spermatic Cord Torsion
Testicular torsion or “twisting of the spermatic cord” can occur at
any age although is most common during adolescence
(particularly between 12-16 years of age)

Surgical EMERGENCY!

Neonatal Testicular Torsion

Driver & Losty (1998) British Journal of Urology
▪ The venous drainage of the testis becomes
Potential Symptoms: obstructed and consequently results in arterial
▪ Sudden, severe onset of pain in the scrotum
▪ Swelling/Redness of the scrotum
ischemia, edema & hemorrhage
▪ Lower quadrant pain in the abdomen ▪ Advised to undergo surgery 4-6 hours after the onset of pain to prevent
▪ Nausea
infertility or necrosis of the testis
▪ Vomiting (a.k.a. emesis)
▪ Torsion usually occurs above the upper pole of the testis
▪ Fever
▪ Surgery involves fixing the testes to the scrotal septum in order to
Can be tested using the cremasteric reflex! prevent reoccurrence 41
 Cremasteric Muscle Reflex
The cremasteric muscle reflex causes rapid elevation of the testis when
the skin on the ipsilateral thigh is gently stroked

① Elicited by stroking the skin on the medial aspect of the proximal,

superior part of the thigh:

 General Somatic Afferent (GSA / Sensory)

➢ Femoral branch of genitofemoral nerve
➢ Ilioinguinal nerve

② Contraction of the cremaster muscle within the loops of cremasteric

fascia raise the testis to “safety”:

 General Somatic Efferent (GSE / Motor)

➢ Genital branch of genitofemoral nerve 42
 Cryptorchid (Undescended) Testis
Due to the testes relocating from the lumbar region down into the scrotum,
it is common for this process to encounter anomalies:
▪ Four degrees of incomplete (arrested) descent:
• Typically unilateral:
➢ Approx. 95%
1. In abdominal cavity close to deep inguinal ring

2. In inguinal canal • Incidence in male births:

➢ 30% in premature
3. At superficial inguinal ring ➢ 1% in full-term

4. In the upper part of the scrotum • Increased risk of developing

a malignancy

▪ Four types of ectopic maldescent:

1. In the superficial fascia (Scarpa’s fascia) of the anterior

abdominal wall, above the superficial inguinal ring

2. At the root of the penis

3. In the perineum
Crypt: Orchis:
4. In the thigh Meaning hidden Greek word for testis 43
 Vasectomy
A vasectomy is a surgical procedure performed on males to
produce infertility and act as a contraceptive measure

➢ Has to occur bilaterally

➢ Performed under local anesthetic

➢ Small incision is made in the upper region of the scrotal wall

and the two ductus (vas) deferens are ligated

▪ Spermatozoa may still be present in the first few post-

operative ejaculations

▪ After the procedure, ejaculatory fluid will only contain

secretions from the seminal vesicles and the prostate
44
Reference: Summary of Layers

45
Reference: Inguinal Canal – Internal Aspect

Deep inguinal ring

Superficial inguinal ring

46
 Reference: Female vs. Male
Round Ilioinguinal n.
ligament
of the uterus

Genital branch
of genitofemoral n.
Testicular a.
Pampiniform plexus of vv.
Ductus (vas) deferens

Ilioinguinal Internal spermatic fascia

n. Cremasteric fascia
Artery and vein interspersed with muscle
of the round ligament
Genital branch
of genitofemoral n. External spermatic fascia

Female Male
47
 Reference: Overview

Superficial inguinal ring

Testicular a.
Ductus deferens & artery to ductus deferens
Cremaster fascia and muscle Pampiniform plexus

External spermatic fascia Head of

Epididymis
Dartos fascia and muscle

Skin
48
 Reference: Inguinal Canal and Spermatic Cord

Internal
spermatic fascia
Pampiniform
plexus of veins Cremasteric
muscle and fascia

External spermatic fascia

will be “picked up” after the External oblique
contents emerge from the aponeurosis
superficial inguinal ring! (reflected)
49
Reference: Epididymis and the Pathway of Spermatozoa

50
 Reference: Course of Ductus (vas) Deferens
Ampulla of ductus deferens Ampulla of ductus deferens
Urinary bladder
Ureter
Ureter

Seminal
vesicle

Ductus (vas)
deferens
(traveling in spermatic cord)

Seminal
vesicle

Prostate
gland
Left testis Right testis Epididymis
Testis
from posterior view from posterior view 51
 Reference: Extravasation of Urine

Camper’s fascia

Scarpa’s
fascia Flow of
extravasated Urinary bladder
urine
Prostate gland
Dartos Corpus
cavernosum
fascia
Corpus
Colles’ spongiosum
Rupture of urethra
at bulb of the penis
fascia
52