Male Genital System

EPIDIDYMIS
•Male genital system includes the testes, vas deferens, seminal vesicles
and ejaculatory ducts.
•The testes are suspended into the scrotum by the spermatic cords.
•The prostate and bulbo-urethral glands act as accessory sex-glands which
exhibit prominent growth in post-pubertal life.
•Male external genitalia comprise the scrotum and the penis.
 Epididymis
• It is a coma-shaped body, situated along the lateral part of the posterior border of testis
• consists of head, body and tail.
• The head : formed by the coiling of the efferent ductules ; each coiled mass is conical in
shape and forms lobule of epididymis.
• Sometimes the head gives attachment to a sessile or pedunculated body, the appendix of
epididymis, which is a remnant of the degenerated cephalic part of the mesonephros.
• The body and tail of epididymis are formed by the coiling of a single duct, the canal of
epididymis.
• From the tail vas deferens begins as a continuation of canal of epididymis.
 Macroscopic Structure of testis
• Each lobule of testis contains one to three seminiferous tubules and
interstitial cells of Leydig.
• The seminiferous tubule consists of convoluted part in front, and straight part
behind ; when uncoiled the length of each tubule is about 2 feet (70-80 cm).
• Total number of tubules in each testis is about 400 to 600.
•The straight parts of seminiferous tubules ascend in the mediastinum, join
with the adjacent tubules and form a plexiform network of tubules known as the
rete testis.
•About 12 to 20 efferent ductules arise from the upper end of the rete testis and
enter in the head of epididymis.
Sagittal section of testis and epididymis
•Each ductule forms a cone-shaped coiled mass, the lobule of epididymis ;
length of the ductule is about 6 to 8 inches (15- 20 cm).
•The efferent ductules unite to form a single duct, the canal of epididymis,
which by convolutions forms body and tail of epididymis.
•the length of the canal is about 20 feet (6 meters).
•Sometimes superior and inferior aberrant ductules are connected to the
canal of epididymis respectively at the head and tail of the organ.
•The aberrant ductules are the remnant of some proximal and distal
mesonephric tubules.
Transverse section of testis and epididymis
 Microscopic Structure of testis
Seminiferous tubules
•Each seminiferous tubule is covered by basement membrane which
supports internally two varieties of cells—a generation of spermatogenic
cells, and supporting cells of Sertoli.
•During sexual maturity the spermatogenic cells proliferate cyclically until
the mature spermatozoa are set free in the lumen of seminiferous tubules.
•The sex cells are arranged into three ill-defined zones—
1. Outer
2. intermediate and
3. inner
Cross-section of seminiferous tubules
• The outer zone consists of a population of sperma­togonia which are the
direct descendants of primitive male sex cells or gonocytes.
• The intermediate zone consists of outer layers of primary
spermatocytes and inner layers of secondary spermatocytes
• The inner zone consists of two or more rows of spermatids and some
residual bodies between them..
• Two varieties of spermatids are seen, new and old.
• New spermatids are spherical in shape the older ones are elongated and
plunge into the cytoplasm of the Sertoli cells until the mature
spermatozoa are released into the lumen of the seminiferous tubules.
 Sertoli cells
•These are elongated polyhedral cells and extend from the basement membrane to
the lumen of seminiferous tubules.
Functions of Sertoli cells
•The interconnected network of spermatogenic cells by cytoplasmic bridges is
physically suppor­ted by extensive cytoplasmic ramifications of the Sertoli cells.
•Since the spermatogenic cells are isolated from the blood supply by the blood-
testis barrier, they depend on the Sertoli cells for exchange of nutrients and
metabolites.
•The Sertoli cell barrier also protects the developing sperm cells from
immunologic attack.
 Rete Testis
•These are lined by the flattened epithelium.

Efferent Ductules

•The ductules are lined by ciliated columnar epithelium, and are

surrounded by circularly disposed smooth muscles.
 Canal of Epididymis
•The canal is lined by ciliated pseudostratified columnar epithelium
•The cilia are non-motile and are known as stercocilla.
•The seminiferous tubules contain mature spermato­zoa floating in a
fluid medium, and initially the sperms are non-motile.
•The fluid materials of the tubules are continuously absorbed by the
mucous membrane of the efferent ductules and the proximal part of the
canal of epididymis.
•The suction action thus formed within the efferent ductules helps in the
transport of sperma­tozoa to the head and body of the epididymis where
they are stored before ejaculation.
 THE VAS DEFERENS

• The vas deferens (ductus deferens) is a thick cord­like tubular structure

and is about 45 cm (18 inches) long.

• It resembles a whip cord because the musculature is thicker than the

size of the lumen.
Vas deferens
 Course and Relations
•begins from the tail of epididymis as- continuation of the canal of epididymis, and
passes somewhat tortuously upwards behind the testis and medial to the epididymis.
•Enters as the principal constituent of the spermatic cord and traverses the inguinal
canal.
•In the spermatic cord it lies in the posterior part accompanied by a pair of
testicular veins and artery to the vas.
•At the deep inguinal ring - leaves the other constituents of the cord and winds
round the lateral side of the inferior epigastric artery.
 Course and Relations

•It ascends for about 2.5 cm in front of the external iliac artery, and then
passes sub-peritoneally backwards and downwards along the lateral
pelvic wall crossing successively the medial side of the external iliac
vessels, obliterated umbilical artery, obturator nerve and vessels.
•Thereafter the vas crosses above and medial to the terminal part of
ureter, and makes an angular bend downwards and medially.
 •It passes behind the base of the urinary bladder, in front of rectal
ampulla and on the medial side of the seminal vesicle.
•This part of the vas presents a dilatation known as the ampulla.
•Finally it approaches the base of prostate and joins with the duct of
seminal vesicle to form the ejaculatory duct.
 Structure
•On cross section, the vas presents three coats from outside inwards —
areolar, muscular and mucous.
•The muscular coat consists of ill-defined outer longitudinal and
inner circular layers of smooth muscles. Sometimes an inner
longitudinal layer is found close to the commencement of the duct.
•The mucous membrane is lined by nonciliated simple columnar
secretory epithelium.
•Close to the termination of the duct the mucous membrane may be two-
celled thick.
•Ampulla of the vas probably acts as a storage of semen.
 Blood supply

• It is supplied by the artery to the vas which is a branch of superior or

inferior vesical artery.
 Development
• It is developed from the mesonephric duct.
 Applied anatomy
• Bilateral ligation of the vas deferens (vasectomy) is applied as one of the
methods of family planning.
• Immediately after vasectomy the spermatogenesis ceases, and reappears
after a few weeks.
• The growth of the interstitial cells is not affected.
• Therefore, psychological fear as regards potency in vasectomized
individuals does not have any anatomical basis.
• Vasectomy is easily and painlessly performed under local anaesthetic.
• The vasa are delivered through tiny bilateral scrotal incisions
• or through a single midline scrotal incision. For
• medico-legal reasons it is wise to remove a segment of each vas to
• prove that it has been successfully divided. Burying the cut ends
• or turning them back on themselves probably helps to prevent
• them rejoining.
 THE SEMINAL VESICLES
•These are a pair of compressed somewhat pyramidal organs, sandwiched
between the base of the bladder and ampulla of rectum.
•The base of each vesicle is directed upwards and laterally, and comes
in contact with the terminal part of ureter;
•the apex of the vesicle converges towards the base of prostate and joins
with the vas deferens to form the ejaculatory duct.
• Each vesicle is formed by the coiling of a single duct which presents
numerous lateral diverticula; these are held together by connective
tissue.
• It measures about 5 cm in length and 2 to 3 cm in width. When uncoiled,
the length of the vesicle is about 10 to 15 cm.
• Fluid is viscous and
Contains fructose,proteins
And prostaglandins
 Relations

• In front — Base of the bladder.

•Behind — Ampulla of rectum separated by the recto­vesical fascia.
•Medially — Ampulla of the vas deferens.
•Laterally — Posterior true ligament of the bladder containing vesical
plexus of veins.
 Structure
•from outside inwards of three coats — areolar, muscular and
mucous.
•The muscular coat consists of outer longitudinal and inner circular
layers of unstriped muscles.
•The mucous membrane is thrown into numerous folds
lined by simple columnar epithelium with occasional goblet cells
in the diverticula.
• The secretion of the vesicle- viscid, yellowish white alkaline fluid.
[Link] the bulk of the semen.
[Link] secretion is rich in fructose, prostaglandin and a coagulating
enzyme known as vesiculase.
[Link] height of the mucous membrane is regulated by the secretion
of androgen.
 Blood Supply

• Each vesicle is supplied by the inferior vesical and middle rectal

arteries.
 Nerve Supply

• Sympathetic fibres are derived from the superior hypogastric plexus

and parasympathetic fibres from the pelvic splanchnic nerves.
 Development

• Each vesicle is developed as a diverticulum which arises from the

caudal part of the mesonephric duct.
 Function

• Contrary to the previous belief, the seminal vesicle does not act as
reservoir of semen.

• It expels the contents only during ejaculation.

 THE EJACULATORY DUCTS
•Each duct, about 2 cm long, is formed by the
union of vas deferens and the duct of seminal
vesicle.
•It passes downwards and medially, postero-
lateral to the median lobe of prostate and
opens at the colliculus seminalis, one on each
side of the prostatic utricle.
•The duct consists of outer circular and
inner longitudinal layers of smooth muscle,
and is lined by columnar epithelium which
may be two-celled thick.
PROSTATE GLAND
 Epididymal cysts
• These are filled with a crystal-clear fluid. They are very common,usually multiple
and vary in size at presentation.
• They represent cystic degeneration of the epididymis.
Clinical features
• usually found in middle age.
• often bilateral.
• The clusters of tense cysts feel like a tiny bunches of grapes
They should be brilliantly transilluminable.
Treatment
• Aspiration is useless because the cysts are multilocular.
• If they are causing discomfort they should be excised.
• Excision -interfere with export of sperm from testis on that side.
 Spermatocele
• unilocular retention cyst derived from some portion of the sperm-conducting mechanism
of the epididymis.
• Clinical features:
• It typically lies in the epididymal head above and behind the upper pole of the testis.
• It is usually softer and laxer.
• it transilluminates.
• The fluid contains spermatozoa and resembles barley water in appearance.
• Spermatoceles are usually small and unobtrusive.
• Treatment:
• Smaller ones can be ignored.
• Larger ones should be aspirated or excised through a scrotal incision.
EPIDIDYMO-ORCHITIS

• Inflammation confined to the epididymis is epididymitis

• Infection spreading to the testis is epididymo-orchitis.
• Two types- acute and chronic
ACUTE TYPE:
causes/etiology-a.) Infection reaches the epididymis via vas from
a primary infection of the urethra, prostate or seminal vesicles
b.) In men with outflow obstruction, epididymitis
may result from a secondary urinary infection
c.) STDs like gonococcal epididymis, chlamydia..
d.) blood borne infections like streptococcal, staphylococcal and proteus
e.) Is a complication of catheterisation or instrumentation of
the urinary tract
Clinical features:
• initial symptoms are those of urinary infection.
• Later, an ache in the groin and a fever herald the onset of epididymitis.
• The epididymis and testis swell and become painful.
• The scrotal wall, at first red, oedematous and shiny, may become
adherent to the epididymis.
• Occasionally, an abscess may form and discharge of pus may occur
through the scrotal skin.
• Acute tuberculous epididymitis- should be considered when the vas is
thickened and there is little response to the usual antibiotics.
TREATMENT:
May need aggressive treatment with parenteral antibiotics.
Chronic disease:
• Chronic tuberculous epididymo-orchitis usually begins insidiously.
Aetiology-
• The frequency with which the lower pole is attacked first indicates that
the infection is retrograde from a tuberculous focus in the seminal
vesicles.
Clinical features-
• Typically, there is a firm discrete swelling of the lower pole of the
epididymis, which aches a little.
• The disease progresses until the whole epididymis is firm and craggy behind a
normal-feeling testis.
• characteristic beading of the vas may be apparent as a result of subepithelial
tubercles.
• The seminal vesicle feels indurated and swollen.
• In neglected cases, a tuberculous ‘cold’ abscess forms, which may discharge.
• The body of the testis may be uninvolved for years but the contralateral
epididymis often becomes diseased.
• Investigations:
1.)urine and semen should be examined repeatedly for tubercle bacilli in
all patients with chronic epididymo-orchitis.
2.)An intravenous urogram and a chest radiograph should be performed.
Treatment-
• Secondary tuberculous epididymitis may resolve when the primary focus
is treated.
• Treatment with anti-tuberculous drugs is less effective in genital
tuberculosis than in urinary tuberculosis.
• If resolution does not occur within 2 months, epididymectomy or
orchidectomy is advisable.