Male Genitalia

Question 1

Testicular cancer

Answer 1

Germ cells (most, young males 15-30): seminomas and nonseminomas
Non-germ cells: supportive, hormone-producing tissue
Painless mass in testicle
Scrotal enlargement or swelling
Dull ache in lower abdomen, back, groin
Irregular, contender mass fixed on testis
May also have hydrocele (transilluminates)
May have associated inguinal lymphadenopathy

Question 2

Hernia

Answer 2

Protrusion of peritoneal-lined sac through defect in abdominal wall
3 regions: indirect inguinal, direct inguinal, femoral

Question 3

Varicocele

Answer 3

Abnormal totuosity and dilation of veins of the pampiniform plexus within the spermatic cord
More commonly left testicle
Asymptomatic or scrotal pain/heaviness
"Bag of worms"
Small - palp with Valsalva
Moderate - palp without Valsalva
Large - visible bulging

Question 4

Hypospadias

Answer 4

Congenital defect, urethral meatus located on ventral surface of the glans penile shaft or base of penis
8-20 weeks gestation
Genetic, endocrine, environmental factors
Dorsal hood of foreskin and granular groove are evident, prepuce is incomplete ventrally

Question 5

Spermatocele

Answer 5

Benign cystic accumulation of sperm occurring on the epididymis
Asymptomatic
Smooth, spherical contender mass at epididymis < 1 cm

Question 6

Klinefelter syndrome

Answer 6

XXY
Becomes apparent in puberty
Hypogonadism, diminished public/axillary/facial hair
Enlarged breast tissue
Tall stature, long legs, short trunk
Infertile

Question 7

Paraphimosis

Answer 7

Inability to replace foreskin to its usual position after it has been retracted behind the glans
Inadvertently induced condition
Foreskin becomes trapped behind corona for a prolonged period, constricting band of tissue forms around the penis and impairs blood and lymphatic flow to the glans penis and prepuce
If untreated, may present with necrosis, gangrene

Question 8

Strangulated hernia

Answer 8

Occur when blood supply to the protruded tissue is compromised

Question 9

Penile cancer

Answer 9

Squamous cell carcinoma originating in the glans, foreskin
HPV
Superficial neoplasms of prepuce, glans and progress to corpora cavernosa and urethra

Question 10

Lymphogranuloma venereum

Answer 10

STI of the lymphatics
Caused by chlamydia trachoma’s
Lesion at site of entry (at or near coronal sulcus)
Travels via lymphatics to regional lymph nodes
Painless lesion on penis
Fever, malaise

Question 11

Genital herpes

Answer 11

STI from HSV
Painful lesions on penis, genital area, perineum
Burning, painful urination
Inguinal lymphadenopathy, fever

Question 12

Testicular torsion

Answer 12

Twisting of testis on spermatic cord, surgical emergency
Cuts off blood supply to the testicle
R/f: trauma, strenuous activity
Age: newborn-adolescents
Acute onset of pain
Commonly vomiting, anorexia
Uncommon fever or dysuria
Absence of cremasteric reflex on side of acute swelling
Scrotal discoloration

Question 13

Direct hernia

Answer 13

Bulge in area of Hesselbach triangle
Easily reduced
Hernia bulges anteriorly, pushes against side of finger on examination
More common in those older than 40

Question 14

Orchitis

Answer 14

Acute inflammation of the testis secondary to infection
Complication of mumps
Generally unilateral, results in testicular atrophy (50%)
Older adults, may result from bacterial migration from prostatic infection
Pain, fatigue, malaise, myalgia, fever
Mumps orchitis follows parotitis by 4-7 days

Question 15

Femoral hernia

Answer 15

Occur at the fossa ovalis, where femoral artery exits the abdomen
Inguinal canal empty on examination
More commonly right sided
Least common
More in females

Question 16

Peyronie disease

Answer 16

Fibrous band in the corpus cavernosum
Dense, fibrous scar tissue forms in the tunica albuginea (wall of the corpus cavernosum during erection)
May be from trauma
Bending or indentation of erection, pain
History of duputren contracture (finger joint flexion contractures)

Question 17

Hydrocele

Answer 17

Fluid accumulation in the scrotum as a result of defect in tunica vaginalis
Generally disappears spontaneously in first 6 months
Nontender, smooth, firm mass superior and anterior to the testes
Transilluminates

Question 18

Indirect hernia

Answer 18

Pain on straining
Soft swelling in area of internal ring
Hernia comes down canal and touches fingertip on examination
Most common; children, young males

Question 19

Epididymitis

Answer 19

Inflammation of the epididymis - major consideration in differential dx of testicular torsion (emergency)
Result of STI or UTI; may occur following tuberculosis
Painful scrotum, urethral discharge, fever, pyuria
Firm, lumpy, tender
Beaded vas deferens
Age: adolescence-adulthood
Gradual pain onset
Uncommon vomiting, anorexia
Possible fever, dysuria
Urethral discharge, sexual activity, fever, pyuria, thickened or nodular epididymis

Question 20

Syphilitic chancre

Answer 20

STI
Skin lesion, associated with primary syphilis
Bacterium Treponema pallidum
2 weeks after exposure
Painless, firm, round, small, commonly on the glans

Question 21

Molluscum contagiosum

Answer 21

STI viral infection of skin and mucous membranes
Poxvirus
Pearly gray, umbilicate, smooth painless lesions on penis

Question 22

Condyloma acuminata

Answer 22

STI
Genital warts caused by HPV
Invades the basal layer of epidermis; causes mucosal microabrasions
Latent phase -> active
Soft, painless, wart-like lesions on penis
Pearly, filiform, fumigating (ulcerating, necrotic)