Male Genital Tract
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Testis •
3.5- 4 cm in length and 2-3 cm in width
•
Covered by fibrinous tunica albuginea
•
The spermatic cord enters the testis along the posterosuperior margin, known as the mediastinum testes
•
Divided into lobules arrayed radially around the mediastinum testes; each lobule being composed of branching seminiferous tubules
•
20-30 ducts form the prostate gland
•
NOTES: testes
not
visualized-
•
The central zone (CZ)
•
The transitional zone (TZ)
undescended
:view- transsagittal, transverse :white echogenecities- calcification
Prostate -has 3 zones: •
The peripheral zone (PZ)
Epididymis •
6-7 cm in length
•
7-8 mm diameter at the globus major (head of epididymis at mediastinum testis) and
•
1-2 mm at the tail where it continues as the vAS deferens
•
The vas deferens courses through the spermatic cord and exits via the deep inguinal ring
•
At the base of the prostate, it joins the seminal vesicle to form the ejaculatory duct
•
To evaluate the upper urinary tract for ureteral obstruction and obstructive nephropathy
•
To evaluate bladder size and estimate post-void residual urine volume, bladder wall thickness, presence of trabeculation, and formation of diverticula
•
The prostate gland should be evaluated for gross evidence of adenocarcinoma
•
CT SCAN:
COMMON DISEASES
1. Benign Prostate Hypertrophy (BPH) •
affects 50-75% of men over age 60 years
•
a result of uninhibited contractioins of a hypertrophied detrusor muscle due to obstructon of the prostatic urethra by enlargement of glandular tissue of the prostate
•
NOTES: central zone- mostly affected
2. Prostate Cancer •
70% occur in the peripheral zone (PZ)
•
20% are found in the transition zone (TZ)
•
Trans-rectal biopsy is the gold standard for diagnosis
•
Direct extentsion into the seminal vesicles, bladder base, and perivesical fat
•
Extracapsular spread is evaluated with transrectal prostate ultarasonography with biopsy or endorectal coil MR imaging +/MR spectroscopy
•
Nodal metastases may be evaluated with CT or MRI, and biopsy is performed if nodes are greater than 10 mm
•
If nodal disease is present, 80% have bone mets within 5 years. The obturator and internal/external iliac nodal chains are most commonly involved. Bone metastases are evaluated by checking the PSA level, then performing a bone scan.
demonstrated in the right peripheral zone
•
Ill-defined bladder mass at the bladder base (arrows)
•
The mass is well seen because it is outlined by the excreted contrast (M)
•
This mass is seen to arise from the prostate gland (P)
•
Prostate normal size: <4 x 4 (3.7 x 3.7 x 3.7; <20 grams)
3. Torsion •
Due to abnormal configuration of the testicle on its pedicle (“bell clapper deformity”), leading to abnormal twisting of the spermatic cord that causes testicular ischemia. It is most common in adolescents and infants less than 12 months old.
•
Torsion is classified incomplete.
•
Complete torsion: >360 degree twist. Adult males 80% testicular salvage rate when reversed within 5 hours
•
Incomplete torsion: <360 degrees. Relatively longer period before testicle is unsalvageable
•
HIGH RESOLUTION ULTRASOUND
Bulge in the scapular line
Signal intensity
complete
or
•
Enlarged and diffusely hypoechoic testicle
•
Contains areas
•
Epididymis may be enlarged and hypoechoic
•
Scrotal thickening
is
•
as
multifocal
DOPPLER ULTRASOUND
hypoechoic
•
If there is no blood flow to testis (evaluated by Doppler ultrasound) after 1 minute of scanning time
•
If there is a single small vessel in the symptomatic testis, when contralateral normal testis shows readily detectable diffuse flow
Enlarged & predominantly hypoechoic epididymis with a reactive hydrocele
•
4. Epididymitis •
Is the most common acute scrotal process in postpubertal age group
•
9x more differential torsion
•
ULTRASOUND
common than consideration,
•
Enlarged epididymis
•
Hydrocele or pyocele
•
Scrotal skin thickening
•
Associated orchitis
and
COLOR DOPPLER ULTRASOUND •
Enlarged, hypoechoic epididymis
•
Increased color surrounding epididymis
hyperemic
flow/blood flow symptomatic
the main testicular
hypoechoic
5. Orchitis •
Is a parenchymal infection of the testicle
•
Often seen as a complication of mumps infection (25% of postpubertal male patients with mumps)
•
Other frequent causes include echovirus, group B arboviruses, and lymphocytic choriomeningitis virus
•
Unilateral in 2/3, usually developing within 7-10 days of parotiditis associated with mumps
•
The testicle may be secondarily involved by epididymitis
*enlarged left testicle NOTES: hydrocele, enlarged epididymal head, testicle with thickened scrotal sac
6. Varicocele •
Distention of the pampiniform venous plexus due to incompetent valves of the spermatic vein
•
Standing or valsalva may provoke the distention
•
95% are left-sided, and are the most common manageable cause of male infertility
•
COLOR DOPPLER •
•
The compressible, tortuous vessels measure more than 2 mm diameter Ultrasound demonstrates multiple serpiginous anechoic spaces of similar size, and Doppler shows venous flow within these spaces
NOTES: massive peritesticular areas
upper
and
lower
7. Hydrocele •
Is the accumulation of fluid between the visceral and parietal tunica vaginalis
•
It may occur in isolation or in association with epididymitis, orchitis, torsion, trauma, or tumor
8. Scrotal Trauma • presents with pain, nausea, vomiting and extreme tenderness with scrotal ecchymosis and swelling • surgical exploration and debridement is needed if the tunica albuginea has been violated and devitalized
TUMORS
•
semineferous tubules have extruded or if there is a large scrotal hematoma ULTRASOUND • irregular testicular contour (rupture) • multifocal linear hypoechoic areas (contusion) • comlex hydrocele, or • extratesticular mass caused by hematoma • • •
areas of uniformly decreased echogenicity usually focal but may be diffuse may cause bulging of the tunica albuginea
Staging is performed by CT I tumor confined to testis II extratesticular spread IIA minimal nodal metastases, limited to infradiaphragmatic stations IIB bulky retroperitoneal nodal metastases III lymphatic involvement above diaphragm IV extranodal metastases (pulmonary, hepatic, osseous, CNS
a focal hypoechoic structure within this testicle this is most consistent with hematoma
Seminoma • the most common malignancy of males age 15-30 • usually presenting as a painless scrotal mass • risk factors include • cryptorchidism • maternal diethylstilbestrol (DES) use • testicular atrophy • germ cell tumors comprise • 95% of testicular cancer • 40% of these are seminomas • 40% showed mixed histologic pattern
*NOTES: Male pelvis- Ultrasound is done first - mass: transrectal ultrasound - with malignancy: CT scan or MRI -testicle: HRUTZ
*********************END****************** ***
Maraming salamat additional notes. ☺
kay
ate
cands
para
sa
3.5- 4 cm in length and 2-3 cm in width
•
Covered by fibrinous tunica albuginea
•
The spermatic cord enters the testis along the posterosuperior margin, known as the mediastinum testes
•
Divided into lobules arrayed radially around the mediastinum testes; each lobule being composed of branching seminiferous tubules
•
20-30 ducts form the prostate gland
•
NOTES: testes
not
visualized-
•
The central zone (CZ)
•
The transitional zone (TZ)
undescended
:view- transsagittal, transverse :white echogenecities- calcification
Prostate -has 3 zones: •
The peripheral zone (PZ)
Epididymis •
6-7 cm in length
•
7-8 mm diameter at the globus major (head of epididymis at mediastinum testis) and
•
1-2 mm at the tail where it continues as the vAS deferens
•
The vas deferens courses through the spermatic cord and exits via the deep inguinal ring
•
At the base of the prostate, it joins the seminal vesicle to form the ejaculatory duct
•
To evaluate the upper urinary tract for ureteral obstruction and obstructive nephropathy
•
To evaluate bladder size and estimate post-void residual urine volume, bladder wall thickness, presence of trabeculation, and formation of diverticula
•
The prostate gland should be evaluated for gross evidence of adenocarcinoma
•
CT SCAN:
COMMON DISEASES
1. Benign Prostate Hypertrophy (BPH) •
affects 50-75% of men over age 60 years
•
a result of uninhibited contractioins of a hypertrophied detrusor muscle due to obstructon of the prostatic urethra by enlargement of glandular tissue of the prostate
•
NOTES: central zone- mostly affected
2. Prostate Cancer •
70% occur in the peripheral zone (PZ)
•
20% are found in the transition zone (TZ)
•
Trans-rectal biopsy is the gold standard for diagnosis
•
Direct extentsion into the seminal vesicles, bladder base, and perivesical fat
•
Extracapsular spread is evaluated with transrectal prostate ultarasonography with biopsy or endorectal coil MR imaging +/MR spectroscopy
•
Nodal metastases may be evaluated with CT or MRI, and biopsy is performed if nodes are greater than 10 mm
•
If nodal disease is present, 80% have bone mets within 5 years. The obturator and internal/external iliac nodal chains are most commonly involved. Bone metastases are evaluated by checking the PSA level, then performing a bone scan.
demonstrated in the right peripheral zone
•
Ill-defined bladder mass at the bladder base (arrows)
•
The mass is well seen because it is outlined by the excreted contrast (M)
•
This mass is seen to arise from the prostate gland (P)
•
Prostate normal size: <4 x 4 (3.7 x 3.7 x 3.7; <20 grams)
3. Torsion •
Due to abnormal configuration of the testicle on its pedicle (“bell clapper deformity”), leading to abnormal twisting of the spermatic cord that causes testicular ischemia. It is most common in adolescents and infants less than 12 months old.
•
Torsion is classified incomplete.
•
Complete torsion: >360 degree twist. Adult males 80% testicular salvage rate when reversed within 5 hours
•
Incomplete torsion: <360 degrees. Relatively longer period before testicle is unsalvageable
•
HIGH RESOLUTION ULTRASOUND
Bulge in the scapular line
Signal intensity
complete
or
•
Enlarged and diffusely hypoechoic testicle
•
Contains areas
•
Epididymis may be enlarged and hypoechoic
•
Scrotal thickening
is
•
as
multifocal
DOPPLER ULTRASOUND
hypoechoic
•
If there is no blood flow to testis (evaluated by Doppler ultrasound) after 1 minute of scanning time
•
If there is a single small vessel in the symptomatic testis, when contralateral normal testis shows readily detectable diffuse flow
Enlarged & predominantly hypoechoic epididymis with a reactive hydrocele
•
4. Epididymitis •
Is the most common acute scrotal process in postpubertal age group
•
9x more differential torsion
•
ULTRASOUND
common than consideration,
•
Enlarged epididymis
•
Hydrocele or pyocele
•
Scrotal skin thickening
•
Associated orchitis
and
COLOR DOPPLER ULTRASOUND •
Enlarged, hypoechoic epididymis
•
Increased color surrounding epididymis
hyperemic
flow/blood flow symptomatic
the main testicular
hypoechoic
5. Orchitis •
Is a parenchymal infection of the testicle
•
Often seen as a complication of mumps infection (25% of postpubertal male patients with mumps)
•
Other frequent causes include echovirus, group B arboviruses, and lymphocytic choriomeningitis virus
•
Unilateral in 2/3, usually developing within 7-10 days of parotiditis associated with mumps
•
The testicle may be secondarily involved by epididymitis
*enlarged left testicle NOTES: hydrocele, enlarged epididymal head, testicle with thickened scrotal sac
6. Varicocele •
Distention of the pampiniform venous plexus due to incompetent valves of the spermatic vein
•
Standing or valsalva may provoke the distention
•
95% are left-sided, and are the most common manageable cause of male infertility
•
COLOR DOPPLER •
•
The compressible, tortuous vessels measure more than 2 mm diameter Ultrasound demonstrates multiple serpiginous anechoic spaces of similar size, and Doppler shows venous flow within these spaces
NOTES: massive peritesticular areas
upper
and
lower
7. Hydrocele •
Is the accumulation of fluid between the visceral and parietal tunica vaginalis
•
It may occur in isolation or in association with epididymitis, orchitis, torsion, trauma, or tumor
8. Scrotal Trauma • presents with pain, nausea, vomiting and extreme tenderness with scrotal ecchymosis and swelling • surgical exploration and debridement is needed if the tunica albuginea has been violated and devitalized
TUMORS
•
semineferous tubules have extruded or if there is a large scrotal hematoma ULTRASOUND • irregular testicular contour (rupture) • multifocal linear hypoechoic areas (contusion) • comlex hydrocele, or • extratesticular mass caused by hematoma • • •
areas of uniformly decreased echogenicity usually focal but may be diffuse may cause bulging of the tunica albuginea
Staging is performed by CT I tumor confined to testis II extratesticular spread IIA minimal nodal metastases, limited to infradiaphragmatic stations IIB bulky retroperitoneal nodal metastases III lymphatic involvement above diaphragm IV extranodal metastases (pulmonary, hepatic, osseous, CNS
a focal hypoechoic structure within this testicle this is most consistent with hematoma
Seminoma • the most common malignancy of males age 15-30 • usually presenting as a painless scrotal mass • risk factors include • cryptorchidism • maternal diethylstilbestrol (DES) use • testicular atrophy • germ cell tumors comprise • 95% of testicular cancer • 40% of these are seminomas • 40% showed mixed histologic pattern
*NOTES: Male pelvis- Ultrasound is done first - mass: transrectal ultrasound - with malignancy: CT scan or MRI -testicle: HRUTZ
*********************END****************** ***
Maraming salamat additional notes. ☺
kay
ate
cands
para
sa
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