Photo: Anete Lusina

What is the most important organ of the male?

The testes The testes are the primary male reproductive organ and are responsible for testosterone and sperm production. Each testis is 4-5-cm long, 2-3-cm wide, weighs 10-14 g and is suspended in the scrotum by the dartos muscle and spermatic cord.

emedicine.medscape.com - Male Reproductive Organ Anatomy - Medscape Reference

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Scrotum

The scrotum is a fibromuscular pouch divided by a median septum (raphe) forming 2 compartments, each of which contains a testis, epididymis and part of the spermatic cord. Layers of the scrotum consist of skin, dartos muscle, external spermatic fascia, cremasteric fascia and internal spermatic fascia, which is in close contact with the parietal layer of the tunica vaginalis. [1] The skin and dartos layers of the scrotum are supplied by the perineal branch of the internal pudendal artery in addition to the external pudendal branches of the femoral artery. The layers deep to the dartos muscle are supplied by the cremasteric branch of the inferior epigastric artery. The veins of the scrotum accompany the arteries, eventually draining into the external pudendal vein and subsequently the greater saphenous vein. Lymphatic drainage of the skin of the scrotum is by the external pudendal vessels to the medial superficial inguinal lymph nodes. The scrotum has a rich sensory nerve supply that includes the genital branch of the genitofemoral nerve (anterior and lateral scrotal surfaces), the ilioinguinal nerve (anterior scrotal surface), posterior scrotal branches of the perineal nerve (posterior scrotal surface), and the perineal branch of the posterior femoral cutaneous nerve (inferior scrotal surface).

Testes

The testes are the primary male reproductive organ and are responsible for testosterone and sperm production. Each testis is 4-5-cm long, 2-3-cm wide, weighs 10-14 g and is suspended in the scrotum by the dartos muscle and spermatic cord. [1] Each testis is covered by the tunica vaginalis testis, tunica albuginea, and tunica vasculosa. The tunica vaginalis testis is the lower portion of the processus vaginalis and is reflected from the testes on the inner surface of the scrotum, thus forming the visceral and parietal layers. Beneath the visceral layer of the tunica vaginalis is the tunica albuginea, which forms a dense covering for the testes. Internal to the tunica albuginea is the tunica vasculosa, containing a plexus of blood vessels and connective tissue. Bilateral testicular arteries originating from the aorta, just inferior to the renal arteries, provide arterial supply to the testes. The testicular arteries enter the scrotum in the spermatic cord via the inguinal canal and split into two branches at the posterosuperior border of the testis. Additionally, the testes receive blood from the cremasteric branch of the inferior epigastric artery and the artery to the ductus deferens. The pampiniform plexus drains both the testis and epididymis before coalescing to form the testicular vein, usually above the spermatic cord formation at the deep inguinal ring. Lymphatic drainage via the testicular vessels passes into the abdomen, ending in the lateral aortic and pre-aortic nodes. The tenth and eleventh thoracic spinal nerves supply the testes via the renal and aortic autonomic plexuses.

Epididymis

The epididymis is a C-shaped structure lying intimately along the posterior border of each testis and includes an enlarged head, a body and a tail. The tunica vaginalis covers the epididymis except at the posterior border. Vasculature and innervation of the epididymis is the same as for the testes (see the image below).

Ductus (vas) deferens

The ductus (vas) deferens is the continuation of the epididymis; it is 30-45-cm long and conveys sperm to the ejaculatory ducts. [1, 2] The convoluted portion of the ductus deferens becomes straighter (diameter, 2-3-mm) as it travels posterior to the testis and medial to the epididymis. Subsequently, the ductus ascends on the posterior aspect of the spermatic cord until it reaches the deep inguinal ring, where it participates in the formation of the spermatic cord and loops over the inferior epigastric artery. At this point, the ductus travels along the lateral pelvic wall, medial to the distal ureter, along the posterior wall of the bladder until it reaches the seminal vesicles dorsal to the prostate. Each ductus deferens has an artery usually derived from the superior vesical artery (artery to the ductus), with venous drainage to the pelvic venous plexus. Lymphatic drainage of the ductus deferens is to the external and internal iliac nodes and innervation is mainly sympathetic from the pelvic plexus.

Spermatic cord

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The spermatic cord extends from the deep inguinal ring, through the inguinal canal to the testis. The layers of the spermatic cord include (from outward to inward): external spermatic fascia (derived from the deep fascia of the external abdominal oblique muscle), cremasteric fascia (derived from the internal oblique muscle), and internal spermatic fascia (derived from the transversalis fascia). The structures that form the spermatic cord include: (i) the ductus deferens and associated vasculature and nerves (posterior wall of the cord), (ii) the testicular artery, (iii) the pampiniform plexus, ultimately forming the testicular vein, and (iv) the genital branch of the genitofemoral nerve.

Ejaculatory ducts

The ejaculatory ducts are 2-cm in length and derived from the union of the seminal vesicle and the ampulla of the vas deferens. Each duct starts at the base of the prostate and terminates at the seminal colliculus (verumontanum). The vasculature, innervation, and lymphatics of the ejaculatory ducts are the same as for the ductus deferens.

Seminal vesicles

The 2 seminal vesicles are located between the bladder and the rectum and measure approximately 5 cm in length. The anterior surface is in contact with the posterior wall of the bladder and the posterior surface is in contact with rectovesical (Denonvilliers) fascia. The ampulla of the ductus deferens lies medial to the seminal vesicles and the prostatic venous plexus lies laterally. Arterial blood supply to the seminal vesicles includes branches from the inferior vesical and middle rectal arteries, while venous and lymphatic drainage accompanies these arteries. The inferior division of the hypogastric plexus provides innervation to the seminal vesicles.

Bulbourethral glands

The bilateral bulbourethral glands are 2 cm in diameter and lie lateral to the membranous urethra and are enclosed by the external urethral sphincter. The excretory duct of the gland penetrates the perineal membrane and opens within the bulbar urethra. Vasculature, lymphatic drainage, and innervation are generally the same as for the seminal vesicles.

Prostate

The prostate gland is an ovoid structure encompassing the proximal portion of the urethra and is approximately 2.5-3.0-cm by 4.0-4.5-cm, normally weighing 20-25 g. [2] The base of the prostate is in contact with the bladder, the apex is superior to the perineal membrane, the anterior border is in contact with the vesicoprostatic plexus, the posterior border is separated from the anterior surface of the rectum by the rectovesical (Denonvilliers) fascia and the lateral border is in contact with the levator ani and the prostatic venous plexus. Fibers of the external urethral sphincter surround the prostate (see the image below). The arterial supply to the prostate gland is derived from the inferior vesical artery and branches of the middle rectal artery. Venous drainage of the prostate forms the prostatic plexus, which eventually drains into the internal iliac vein and lymphatic drainage flows to the internal iliac nodes. Innervation is derived from the inferior portion of the hypogastric plexus, primarily to the connective tissue surrounding the gland.

Urethra

The urethra stretches from the bladder to the tip of the glans penis, serving as a passage for urine and semen. The prostatic urethra extends vertically from the bladder neck, through the prostate before becoming the membranous urethra and before penetrating the perineal membrane. Of note, the prostatic urethra contains the orifice of the ejaculatory ducts. As the membranous urethra enters the deep perineal space, the urethra is surrounded by fibers of the external urethral sphincter, eventually entering the bulb of the corpus spongiosum, providing the orifice for the bulbourethral glands and subsequently becoming the penile urethra. When the urethra reaches the glans penis the diameter diminishes to that of the external ostium, the least dilatable portion of the urethral canal. [2]

Penis

The penis is made up of an attached root and a pendulous body. The root consists of two crura and the bulb—3 bodies of erectile tissue attached to the pubic arch (crura) and perineal membrane (bulb). Near the border of the pubic sypmphysis the bilateral crura continue as the corpora cavernosa throughout the body of the penis. The bulb lies between the two crura, narrows anteriorly and continues as the corpus spongiosum. The body of the penis contains the bilateral corpora cavernosa and the median corpus spongiosum. During penile erection, all 3 erectile bodies become engorged with blood. The corpora cavernosa are enveloped in a thick fibrous tunica albuginea, which is comprised of a longitudinal running superficial fibers and a deep layer of circular oriented fibers. The corpus spongiosum is penetrated by the urethra as it traverses the body of the penis (see the images below).

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Corporal bodies of the penis. View Media Gallery

The superficial penile fascia includes loose connective tissue intertwined with dartos muscle fibers. The deep penile fascia, or Buck’s fascia, is a tough fascial layer that encompasses both corpora cavernosa and the corporus spongiosum. The skin of the penis is thin. The corona of the penis is where the skin folds to become the prepuce (foreskin), enveloping the glans penis (see the image below).

Tunica coverage of the penis. View Media Gallery

The vasculature of the penis is extensive. The perineal artery (a branch of the internal pudendal artery) together with the posterior scrotal artery and the inferior rectal artery supply tissues from the bulb of the penis to the anus. The artery of the bulb of the penis, from the internal pudendal, penetrates the penile bulb and subsequently supplies the corpus spongiosum. The deep artery of the penis is one of two terminal branches of the internal pudendal artery; it enters the crus of the penis and continues through the length of the bilateral corpus cavernosum. The other terminal branch of the internal pudendal artery is the dorsal artery of the penis running along the dorsal surface of the penis supplying the penile skin and the glans penis (see the image below).

Arterial supply to the penis. View Media Gallery

The venous drainage of the penis includes the veins draining the corpora cavernosa, which subsequently drains into the circumflex veins. These veins receive venous blood from the corpus spongiosum on the ventral aspect of the penis and wrap around the penis to drain into the deep dorsal vein. The superficial dorsal vein drains the penile skin and prepuce before draining via the superficial external pudendal vein into the external pudendal veins. The deep dorsal vein further drains blood from the glans penis and corpora cavernosa before joining the prostatic venous plexus. The lymphatic drainage of the penis encompasses three locations: the superficial inguinal nodes (penile skin), deep inguinal and external iliac nodes (glans penis), and internal iliac nodes (erectile tissue and urethra; see image below).

Venous drainage of the penis. View Media Gallery

Sensory innervation to the penile skin is through the dorsal nerve of the penis, one of the terminal branches of the pudendal nerve. Autonomic innervation includes both sympathetic and parasympathetic aspects to the corpora cavernosum via the cavernous nerves. The sympathetic fibers originate at the level of T11-T12 and the parasympathetic fibers originate from the pelvic plexus at S2-S4.

emedicine.medscape.com - Male Reproductive Organ Anatomy - Medscape Reference

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