Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

26. Chronic Orchialgia: Workup and Management
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Fig. 26.2. Layers of the scrotal wall.
Anatomy
The testicle is egg shaped with an average length of 5 cm. Testicular
function is tightly regulated with signaling from the hypothalamus and
anterior pituitary gland. The main function of the testicle is to produce
sperm from germ cells and testosterone from Leydig cells . There is
another cell type (called Sertoli cells ) that is important for support.
Sperm travels through the testicle (lobules, seminiferous tubules, rete
testis, epididymis) and vas deferens until it mixes with fluid from the
seminal vesicles and prostate to form semen. This combined fluid is
eventually expelled into the urethra during ejaculation.
The spermatic cord houses the testicular artery, testicular veins
(pampiniform plexus), vas deferens, artery of vas deferens, lymphatic
vessels, and nerves. Neural innervation to the testicle is via a complex
neural network with significant crossover. Afferent innervation of the
scrotum originates via somatic nerves in the genital branch of the genitofemoral
nerve, ilioinguinal nerves, and autonomic branches from T10- L1
parasympathetic ganglia [ 11 ]. The genitofemoral and ilioinguinal nerves
provide anterior scrotal wall and thigh innervation. The posterior scrotal
wall is innervated via the perineal branch of the pudendal nerve. There
is an alternate autonomic pathway between the pelvic plexus and testis
via the vas deferens, which explains the positive response to anesthetic
injections to the pelvic ganglia [ 12 ]. On average, there are 31 small
diameter (less than 1 mm) nerve fibers in the spermatic cord. The three