Spermatic cord

Where is the spermatic cord located and what is its course?

The cord begins at the epididymis and ends at the deep (internal) inguinal ring. In adult males, its length is 15–20 cm (it gradually increases during the descent of the testis).

Within the inguinal canal, the spermatic cord lies between the lower free margins of the internal oblique and transversus abdominis muscles and the inguinal ligament.

The topography of the cord is closely related to the shape of the inguinal triangle:

• In the slit-oval shape, the internal oblique muscle adequately covers the deep ring and functions as a valve—upon contraction, it arcuately compresses the spermatic cord, providing good protection against hernias.
• In the triangular shape, the muscle runs horizontally, valve function is absent, and the posterior wall of the canal is largely uncovered by muscles, creating favorable conditions for the development of inguinal hernias.

What structures are contained within the spermatic cord?

The cord is a complex of structures including vessels, nerves, and ducts. Its contents include:

• Ductus deferens (ductus deferens).
• Arteries: testicular artery (a. testicularis), artery of the ductus deferens (a. ductus deferentis, branching from the umbilical artery), and cremasteric artery (a. cremasterica).
• Veins: pampiniform venous plexus (plexus pampiniformis), testicular veins, veins of the ductus deferens, and cremasteric vein (v. cremasterica).
• Nerves: testicular plexus, ductus deferens plexus, genital branch of the genitofemoral nerve (ramus genitalis n. genitofemoralis), as well as sympathetic and parasympathetic fibers. The ilioinguinal nerve (n. ilioinguinalis) also lies on the surface of the cord.
• Lymphatic vessels.
• Remnant of the processus vaginalis of the peritoneum.
• Loose connective tissue and the cremaster muscle (m. cremaster).

What sheaths cover the cord?

From superficial to deep, the spermatic cord is surrounded by three layers formed from the structures of the anterior abdominal wall:

1. External spermatic fascia (fascia spermatica externa) — originates from the aponeurosis of the external oblique muscle of the abdomen in the region of the superficial inguinal ring.
2. Cremaster muscle (m. cremaster) with its fascia (fascia cremasterica) — formed from the lower fascicles of the internal oblique muscle of the abdomen.
3. Internal spermatic fascia (fascia spermatica interna) — is a direct continuation of the extraperitoneal transversalis fascia (fascia transversalis), which forms a funnel-shaped depression in the area of the deep inguinal ring.

Clinical significance in surgery and oncology

• Herniorrhaphy: In congenital inguinal hernia, the hernia sac represents a patent processus vaginalis of the peritoneum and is firmly fixed externally to the sac wall by the elements of the spermatic cord. During surgery, the neck of the sac is bluntly separated from the cord elements. If the adhesion is very dense, a purse-string suture is placed from the inside, "stepping over" the cord and leaving it outside the suture. In the Postempski repair of the posterior wall of the canal, the spermatic cord is relocated into the subcutaneous tissue, and the inguinal canal is completely obliterated.
• Oncology: Testicular germ cell tumors, including embryonal carcinoma, are capable of invading the spermatic cord. According to the TNM classification, tumor invasion into the cord corresponds to stage T3 or pT3.
• Infections: In acute chlamydial epididymo-orchitis, pain from the epididymis can radiate to the spermatic cord, inguinal canal, lower back, and sacrum.

Class and exam questions

What else to study on this topic

• Inguinal canal (canalis inguinalis)
• Ductus deferens
• Testis and epididymis
• Testicular germ cell tumors
• Surgical treatment of inguinal hernias

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