Male Genital B90 Diseases of the penis, scrotom, and funiculus spermaticus

Question 1

What are the 2 most common malformations of the penis?

What complications can they have?

Answer 1

Hypospadias: Abnormal urethral opening somewhere along the ventral side

Epispadias: Abnormal opening on the dorsal side

The openings are often constricted –> prone to obstruction and UTIs

Often present with other congenital anomalies like inguinal hernia and undescended testis

Question 2

What is the term for local infection of the glans alone or glans an prepuce

What causes them and what are the common infecting microbes?

Answer 2

Balanitis - glans inflammation

Balanoposthitis - glans and prepuce

poor local hygeine in uncircumcised males and accumulation of smegma.

• Candida albicans,*
• Gardnerella,*

pyogenic bacteria

anaerobic bacteria

Question 4

What does the term phimosis mean?

Answer 4

That the prepuce cannot be easily retracted off of the glans.

Occurs usually from repeated balanoposthitis and scarring, but also occurs congenitally

Question 5

Define paraphimosis

Answer 5

When the foreskin is basically stenotic tightly retracted over the glans and restricting circulation.

Causes pain and congestive swelling

Question 6

Fungal infection

Answer 6

Almost always Candidiasis

Red, raised, painful, pruritic lesion can occur anywhere in the genital region

Question 7

Penile Neoplasms

general features, and the 3 main types

Answer 7

95% are squamous carcinomas

In the US penile neoplasms are rare, only 0.4% of all male cancer

In developing countries they are much higher, occuring usually in uncircumcised males over 40 yrs.

Risk factors:

• HPV 16 and 18
• smoking
• poor hygeine of uncircumcised males

Types:

1. Squamous Cell Carcinoma in situ: Arises in the epidermal strat squamous keratinized epithelium. In older males. A solitary plaque on the shaft. 10% chance to become Invasive.
2. Invasive squamous cc: Is usually preceded by SCCiS Gray, crusted, papular (pimple like) lesion usually on the glans or prepuce. The papules rupture, aking ulcerated, indurated (hardened) lesion. Metastasizes to inguinal lymph nodes. 5yrS is 2/3rds with no metastases, drops to 25% once inguinal metastases occur. Inguinal metastases are in about 25% of patients at diagnosis.
3. Verrucous Carcinoma of the penis. Squamous cell carcinoma that forms papillary lesions with almost no atypical cells and deep margins. They are locally invasive but never metastasize.

Question 8

Non-dermatological and non-neoplastic disorders of scrotum

Answer 8

Hydrocele: Serous fluid accumulation in the tunica vaginalis. Is the most common cause of Scrotal swelling. Tunica vaginalis is the embryonic extension of the parietal peritoneum.

• May be due to nearby infections or tumors, or can be idiopathic

Hematocele: Blood within the tunica vaginalis

Chylocele: Lymphatic fluid accumulation, due to lymphatic obstruction. Filariasis infection can cause this, elephantiasis of the scrotum due to chylocele.

Epidermoid cyst: swollen hair follicles or blocked sebaceous glands. Usually innocuous, but may become infected (like the one on my back did).

Question 9

What is the funiculus spermaticus?

What are the two major diseases associated with it?

Answer 9

The spermatic cord

Spermatic cord torsion and varicocele

Spermatic cord torsion: Torsion of the testes within the tunica sac.

• Initially venous ischemia, causing veinous swelling of the testis
• then Arterial ischemia
• Sudden onset of severe testis pain, requires rapid treatment.
• Is a medical emergency, as it can lead to hemorrhagic infarction and severe bleeding.
• Occurs in adults b/c of congenital “bell clapper” defect where the tunica vaginalis fuses too high on teh spermatic cord, leaving too much room for the testis to rotate.

Neonatal spermatic cord torsion

• occurs in utero or right after birth and is idiopathic, ie occuring without the bell clapper anomaly seen in adults.

Varicocele

• Abnormal dilation of veins in the pampiniform plexus in spermatic cord, from lack of venous valves. ie varicose veins within the cord.
• Causes infertility in ~50% of patients.
• Occurs mostly on the left side (90%) for some reason and 10% are bilateral
• There is concurrent decreased spermatogenesis and germ cell degeneration in the sperminiferous tubules. Increased Leydig cells.