Disorders of Male External Genitalia

Lukáš Bittner

Urologická klinika 3. LF UK a FNKV

What is it?

What is it?

What is it?

What is it?

What is it?

What is it?

What is it?

What is it?

Tumors of the testis- Symptoms

Painless enlargement of the testisTypical delay 3-6 months10% od patients with metastatic diseases

Back painCough or dyspnoeBone pain

Signs

Testicular mass or diffuse enlargementPalpation of

AbdomenSupraclavicularScalene nodes

Gynecomastia by 30-50% Sertoli and Leydig cc.tu.

Epidemiology, risk factors

Most common solid tu in males under 30

90-95% germ cell tu (seminomas, nonseminomas)

Rest nongerminal (Leyding cell, Sertolli cell)

1-2% bilateral7-10% history of cryptorchidism

Intraabdominal testis risk 1/20Inquinal 1/80

Lab. findings

Tu. markersAFP (Alfa-fetoprotein) produced by yolk sac

(never found in pure seminomas)hCG (human Chorionic Gonadotropin) produced

by choriocarcinomaLDH (Lactic acid dehydrogenase), tu burden

AnemiaLiver function tests

Imaging

Scrotal US

Imaging

CT of adomen

Imaging

Chest X-ray

Pathology

Tumors of the testis

Germinal

Seminoma

Nonseminoma

Embryonall Cell CArcinoma

Teratoma

Choriocarcinoma

Nongerminal

Leydig cell tu

Sertolli cell tu

Gonadoblastoma

Pathology

Seminoma 35%most common in 4. decadeNever AFPhCG 7%

Embrional Cell Carcinoma 20%Yolk sac tu most common among Childs

Pathology

Teratoma 5%Children and adultsMaturre may have elements derived from

• Ectoderm• Mesoderm• Endoderm

Choriocarcinoma ‹1%Small lesion with central hemorhageAggresiveHematogenous spread

Metastatic Spread

Except choriocarcinoma stepwise lymphatic fashion

Lymph nodes Th1- L4, paracaval, paraaortalWith concetration at level of renal hilum

Scrotal violation may result in inquinal metastases

Visceral metastasesLung, liver, brain, bone

Treatment

Radical orchiectomyInguinal expolation with cross clamping of

spermatic cord and delivery+

Low stage seminoma Retroperitoneal irradiation

High stage seminomaPlatinum based CHT• 4 cycles of PEB (cisplatin, etoposide, bleomycin)

Treatment

Nonseminomatous germ cell tumorsPlatinum based CHTRPLND• Radical• Modified

Prognosis

Hydrocele

collection of watery fluid around the testicle

Ethilology

PostraumaticPostinflammatoryInbornIdiopatic

Hydrocele

Therapy

Aspiration- often returnsOpen Hydrocelectomy

Varicocele

Dilatated veins within the pampiniform plexus

Incidence in subfertile men 40%Associated with testicular athrophy

USG findings/thermography

Symptoms

More frequent on left side

Mostly asymptomatic

Dull painShould be subfertilityShould be

hypogonadism

Treatment

Microsurgery inguinal/sctotal

Treatment

Radiologic obliteration

Treatment

Laparoscopic ligation

Phimosis

Condition in which the contracted foreskin cannot bet retracted over the glans

Phimosis

Calculi or sqaumous cell ca may develop

Malhygiene, chronic infection, DM common cause

Newborn boys cannot retract prepucium, no correction needed under 2 y.

Circumcision

Paraphimosis

Conditon in which forskin, once retracted over the glans, cannot be replaced in its normal position

Therapy

Squeezing the edema and retraction of foreskin

Dorsal slit

Than circumcision