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Testicle and Epididymis Anesthesia

Overview

Embryology

Anesthesia of the testicle and epididymis is best understood starting from the embryological origin of the respective structures. The testes are embryologically derived from the same level as the kidneys and, therefore, share a common level of innervation, that being the T10-L1 level for pain conduction and T10-L2 for sympathetic innervation. As the fetus matures, the testes descend into the scrotum. The scrotum is innervated anteriorly by the ilioinguinal and genitofemoral nerves, while the posterior portion of the scrotum is innervated by the perineal branches of the pudendal nerves. Anatomy is shown in the images below.

Anatomy of the urogenital system.

Anatomy of the urogenital system.

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Spermatic cord and adjacent structures.

Spermatic cord and adjacent structures.

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The afferent fibers for the internal contents of the scrotum run in the spermatic cord. It is at this site that an anesthetic nerve blockade is best approached, as the nerves are relatively superficial to the skin as they run through the spermatic cord. With a relatively noninvasive and simple technique, anesthesia of the testicles and epididymis can be achieved.

In the images below, note that the nerves that are involved with the innervation of the scrotal sac include the iliohypogastric and ilioinguinal nerves and the genitofemoral nerves, along with a branch of the pudendal nerve on the posterior surface of the scrotal sac. Therefore, administration of local anesthetic to the spermatic cord itself, while establishing anesthesia of the testicle and epididymis, does not establish anesthesia of the overlying skin.

Innervation of the male urogenital system.

Innervation of the male urogenital system.

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Testis innervation.

Testis innervation.

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