Testes and epididymis

The testes are a pair of oval, slightly flattened bodies measuring about 4 cm in length and 2.5 cm in diameter. Together with the epididymides, they lie in the scrotum, an extra-abdominal sac just below the penis. The walls of the cavity in which the testes and epididymis reside are known as the tunica vaginalis. The tunica vaginalis forms from intra-abdominal peritoneum that migrates into the primitive scrotum during development of the male internal genitalia. After migration of the testis into the scrotum, the channel down which the testis has moved (processus vaginalis) is obliterated.

The epididymis is a comma-shaped structure that clasps the posterolateral margin of the testis. It is formed from the duct of the epididymis, an irregularly twisted tube. The epididymal duct is about 600 cm long. It begins at the top of the testis as the head of the epididymis. After an extraordinarily tortuous course it ends as the tail of the epididymis, then becomes the vas deferens (Fig. 7.1).

The testicular arteries supply blood to the testes and epididymides. These arteries arise from the aorta just below the renal arteries. The testicular arteries end in a dense vascular plexus, the pampiniform plexus, which courses just under the tunica vaginalis surrounding the testes. The plexus drains into the testicular veins. The pampiniform plexus dissipates heat out of the scrotum by vasodilatation and thereby has an important role in temperature regulation of the testes. Like the ovarian veins, the right testicular vein empties into the inferior vena cava, and the left testicular vein into the left renal vein. Lymphatic drainage of the testes is to the para-aortic nodes.

All the blood and lymph vessels to the testis and epididymis are bundled in a structure known as the spermatic cord. This structure also contains the vas deferens and any remnants of the processus vaginalis. The spermatic cord enters the scrotum from the abdomen through the inguinal canal.

The testis is the site of spermatogenesis and sex steroid production in the male. The epididymis is the site of final sperm maturation. The scrotum is basically a specialized dermal pouch that protects the testis and epididymis from physical injury and aids in heat regulation of the testes. Spermatozoa are very heat sensitive. Because the testes and epididymides are outside the body cavity, intratesticular temperature is typically lower than in the abdomen. Disorders of urogenital development that result in testicular retention within the abdominal cavity or inguinal canal can have dramatic effects on future fertility and increase the risk for testicular tumors (relative risk 3–8). Most of these are seminomas (Chapter 40).

Vas (ductus) deferens and seminal vesicles

The vas deferens is a direct continuation of the epididymis. It is a 45-cm-long structure that begins at the lower end of the epididymis and ascends along the posterior aspect of the testis in loose coils. After leaving the back of the testis, the vas deferens traverses the spermatic cord into the abdomen. The vas deferens may be felt as a firm hard cord on the posterior aspect of the spermatic cord as it traverses the scrotum toward the superficial inguinal ring. After crossing into the abdomen, the vas deferens curves medially across the external iliac artery toward the pelvis. From there, it crosses the obturator nerve and vessels and the vesicular vessels. The vas deferens then crosses over the ureter to meet the duct of the seminal vesicle. Together, the vas deferens and the duct of the seminal vesicle form the ejaculatory duct that opens into the prostatic portion of the urethra. The ejaculatory duct is short (2.5 cm) and lies very close to its companion contralateral duct as they pass forward through the prostate.

The seminal vesicles are a pair of hollow, sacculated structures located at the base of the bladder in front of the rectum. Each vesicle is about 5 cm long and more intimately connected to the bladder than to the rectum. During embryonic development, the seminal vesicles form as diverticula of the vas deferens. The structures share common blood and lymphatic supplies.

Blood supply to the vas deferens and seminal vesicles is mainly from the inferior vesicular artery. The artery accompanies the vas deferens into the scrotum where it anastomoses with the testicular artery. Lymphatic drainage is to the internal and external iliac nodes.

The vas deferens functions in sperm transport. The seminal vesicles produce approximately 50–60% of the volume of the seminal fluid. Important seminal vesicle-derived semen components include fructose and prostaglandins.