![]() ![]() Middle spermatic nerves arise from the superior hypogastric plexus, pass to the mid-ureter and travel alongside the vas deferens to the internal ring, where they join the spermatic cord. This association between the intestinal (intermesenteric) and testicular nerves may explain the “kick in the stomach” feeling accompanying testicular injury. Superior spermatic nerves, composed of fibers from the renal and intermesenteric plexuses follow the testicular artery to the testis. Three groups of autonomic nerves travel with the gonadal vessels and vas deferens to the epididymis and testis-superior spermatic nerves, middle spermatic nerves, and inferior spermatic nerves ( Figure 5). Therefore, they share a common level of autonomic innervation, which is 90% sympathetic originating from the T10-L1 segments, and the rest parasympathetic originating from the S2–4 segments. The testes are embryologically derived from the same level as the kidneys. Posterior surface is supplied by posterior scrotal nerves (from perineal nerve, branch of pudendal nerve), and the inferior surface is supplied by the long scrotal branches of posterior femoral cutaneous nerve ( 1). Anterior surface is supplied by the anterior scrotal nerves (branching from ilioinguinal nerve). ![]() The anterolateral surface is supplied by genital branch of the genitofemoral nerve. Somatic innervation to the scrotum varies based on the specific scrotal region. Pain Management, Philadelphia: Elsevier, 2011. © 2017 by Dhairya Patel, based on Reynolds LW, Sills SM. Not shown is pudendal nerve, which arises from S2–4, whose branches provide somatic supply to posterior scrotum. Somatic and autonomic nerves supplying the scrotal contents.
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