Epididymis

The vas deferens descends to the lower end of the testicle and becoming much convoluted forms the globus minor or tail, thence ascends, forming the body, and finally at the top, receiving the efferent ducts, forms the globus major or head. Between the body of the epididymis and testis is a pocket or depression called the digital fossa. Attached to the upper end of the testis is a small flat body in front of the globus major and attached to the globus major itself is a small cystic pedunculated growth. Both are known as the hydatids of Morgagni, and the former is the remains of the duct of Muller, while the latter is derived from the Wolffian body.

Practical Application

Inflammation of the testis proper is called orchitis; of the epididymis, epididymitis. When the testicle as a whole is enlarged, if it is due to syphilis or new growth, the testis itself is mainly affected and it is then called sarcocele. Inflammations, the result of injury, may produce a true orchitis, but when arising from infections they involve the vas deferens and epididymis and produce an epididymitis. This is the case in gonorrhoea and tubercle, and to a less extent in mumps. An enlarged epididymis can be outlined by careful palpation as being distinct from the testis proper. Advanced tubercle may invade the testis subsequently.

Cystic disease is fairly frequent; it involves the epididymis, especially the globus major. The cysts may be very numerous and may spring either from the ducts of the globus major or from the hydatids of Morgagni.

Coverings Of The Testicle

The tunica vaginalis comes from the peritoneum, the tunica albuginea is the continuation of the transversalis fascia (infundibuliform fascia); it is strong, dense, and inelastic. Over this are a few cremasteric fibres from the internal oblique and the intercolumnar fascia from the external oblique. The dartos is continuous with the fascia of Scarpa of the abdomen.

Application

The tunica vaginalis being a closed sac may become distended with serum, forming a hydrocele. The precautions to be taken in tapping it have been alluded to above. It is treated radically by excising the parietal layer and leaving the visceral layer covering the testicle and epididymis. The questions of hemorrhage and skin inversion have also been discussed. Inflammation causes intense pain on account of the unyielding character of the tunica albuginea. To relieve it multiple fine punctures are sometimes made. Abscess (tuberculous) of the testicle opens the tunica albuginea and the testicular tissue protrudes, forming a hernia testis. Such testicles are often excised, but if not the hernia eventually shrinks and reduces itself (Holden).

Spermatic Cord

The left spermatic cord is longer than the right, hence the left testicle hangs lower. The cord is composed of the vas deferens with its artery, a branch of the superior vesical, and veins; the spermatic artery with its veins; the cremasteric artery; and the layers derived from the abdominal wall (the same as possessed by the testicle). It also possesses nerves, the genital branch of the genitocrural, and branches of the sympathetic, and lymphatics. The vas deferens is a small, round, hard cord lying posteriorly. It can be seen when the elements of the cord are separated and can be distinctly felt even through the scrotum. The deferential artery accompanies and lies on the cord. The deferential veins go with the artery. They unite and form three or four trunks (pampiniform plexus) which pass through the inguinal canal to join and form at the internal ring one large vein, the spermatic, which accompanies the spermatic artery; the right empties into the vena cava, while the left empties into the left renal vein. They possess but few valves, which are imperfect.

The spermatic artery, from the aorta, descends in front of the vas deferens and is accompanied by the pampiniform plexus of veins. It lies in the plexus with most of the veins in front of it. These vessels lie in loose, fatty connective tissue derived from the subperitoneal tissue along with the atrophied remains of the peritoneum (ligament of Cloquet).

These structures are covered by the sheath of the cord, composed (1) of the transversalis fascia (infundibuliform fascia), (2) cremasteric fibres and fascia from the internal oblique, and (3) intercolumnar fascia from the external oblique.