Ihe testes usually lie in an upright position with the superior portion tipped slightly forward and outward. Ihe average size is between 4 and 5 cm in length, and approximately 3 cm in width and depth. Ihe overall volume is about 25 mL. Each testis is encased in a thick fibrous tunica albuginea except posterolaterally, where it is in tight apposition with the epididymis. Ihe enveloping tunica vaginalis anchors each testis and epididymis to the posterior scrotal wall. Inferiorly, the testis is anchored to the scrotum by the scrotal ligament (gubernaculum). A lack of firm posterior fixation leaves both the testes and epididymis at risk for torsion. Ihe posterior (visceral) leaf of tunica vaginalis is contiguous with the tunica albuginea testis. A potential space exists between this visceral leaf and the anterior (parietal) tunica vaginalis. Any traumatic or inflammatory event will impede the normal parietal tunica vaginalis from absorbing viscerally secreted fluid, resulting in a hydrocele ( Fig.

FIG. 91-3. Embryonic retroperitoneal testis descends into the scrotum and invaginates into the tunica vaginalis, which anchors it to the posterior scrotal wall. Note the potential space in the tunica vaginalis for development of a hydrocele.

The blood supply is by the internal spermatic and external spermatic arteries, which travel together in the spermatic cord. Venous return is primarily by the internal spermatic, epigastric, internal circumflex, and scrotal veins. The lymphatics drain toward the external, common iliac, and periaortic nodes.

The epididymis is a single, fine, tubular structure approximately 4 to 5 m long compressed into an area of about 5 cm. The function the epididymis is to promote sperm maturation and motility. Vestigial embryonic structures, the appendix epididymis and the appendix testis, which have no known physiologic function, are often associated with the testes and epididymis. The appendix epididymis, a remnant of the epigenitales, is found attached to the head of the epididymis, or globus major. The appendix testis, a pear-shaped structure of mullerian duct origin, is usually situated on the uppermost portion of the testis at the junction of the testis and the globus major of the epididymis.

The vas deferens, a prominent part of the adnexa of the scrotal contents, is a distinct muscular tube that is easily palpable within the scrotal sac. It extends cephalad in the spermatic cord from the tail of the epididymis (globus minor) traversing the inguinal canal and crossing medially behind the bladder over the ureters to form the ampullae of the vas, where it joins with the seminal vesicles to form the paired ejaculatory ducts in the prostatic urethra.

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