male GU path Flashcards
hypospadias
urethral opening on the inferior
epispadias
(dorsal [superior] urethral opening)
• Less common, but ↑assoc. with other GU anomalies
• Both associated with constriction…UTIs
• almost ALWAYS occurs with extrophy of the bladder!!
phimosis
inability to retract the foreskin
• Congenital (normal during infancy, for prepuce and glans to be adherent)
• acquired (recurrent infection in uncircumcised adults males), secondary changes microbiome-type infection
• May lead to paraphimosis (strangulation of venous flow)
o foreskin has become retracted back, and can not longer be pulled back over
Patent Urachus
- Failure of urachus to obliterate, giving vesico -umbilical fistula or urachal cyst
Extrophy of bladder
- Failure of cloacal membrane development
- occurs at the same time as lower abdominal
- wall formation → bladder connects to surface
- Associated with epispadias of penis
- Requires surgical repair
testicular descent
testes appear on urogenital ridge
coelomic cavity evaginates into the scrotal swelling forming the processus vaginalis
testes begin descent into the scrotum through the processes and guided by the gubernaculum
testical mvmt down processus creates the inguinal canal
processus obliterates shortly after birth
Hydrocele:
- Communicating hydrocele: the sac that is down in the scrotum continues to communicate w/ the abdomen and fills w/ peritoneal fluid – this communication can be narrow or wide
o as a clinician you can usually reduce the sac created in the scrotum through pushing fluid back into the abdominal cavity through the patent processus vaginalis
o these are common and normal in first 6-12 months of infancy
o present as bulging scrotal enlargement – esp. w/ increased intra-abdominal pressure (w/ valsalva maneuver) → pushes fluid through patent processus vaginalis
o this is usually seen on right hand side – d/t descent of right testicle occurring later - Noncommunicating hydrocele: Processus vaginalis partially obliterates, but not completely in the middle
o cysts can occur in inguinal canal but don’t communicate w/ abdominal cavity - A hydrocele must be distinguished from a true testicular mass, and transillumination may help, because the hydrocele will transilluminate but a testicular mass will be opaque.
spermatocele
: “Epididymal cyst”
- masses in testes that DO contain sperm
- cyst is painless and filled with fluid – usually doesn’t cause sx, unless there is extravasation of sperm into the surrounding tissues
- no effect on fertility
varicocele
- collection of dilated and tortuous veins
- clinically may present w/ sense of heaviness on one side of scrotum
- when palpated fells like “bag of worms”
- presence of varicocele on one side may reduce the fertility of the individual
** note: increases with valsalva maneuver
indirect inguinal hernia
occurs more laterally
o majority are indirect
o herniation through internal ring : formed through internal oblique and transversus abdominis
o results from patent processus vaginalis
- clinical features: increased intraabdominal pressure results in increased scrotal size. If there is no vascular compromise there are usually no clinical sx
- when the intestine becomes compromised and not enough O2 is getting to the intestine, can result in reddened scrotum, painful to the touch, and intestine cannot be reduced and pushed back up through inguinal canal d/t being swollen
direct inguinal hernia
- Direct hernia: more medial to major vessels
o herniation through external ring: formed by external oblique aponeurosis - clinical features: increased intraabdominal pressure results in increased scrotal size. If there is no vascular compromise there are usually no clinical sx
- when the intestine becomes compromised and not enough O2 is getting to the intestine, can result in reddened scrotum, painful to the touch, and intestine cannot be reduced and pushed back up through inguinal canal d/t being swollen
Balanoposthitis
(balanitis-glans; posthitis- prepuce)
• foreskin (prepuce) AND glans are inflamed together
• Inflammation from poor hygiene in the uncircumcised
• Caused by multiple organisms
• Smegma: accumulation of desquamated epithelial cells, sweat and inflammatory debris
• May lead to phimosis, etc.
Condyloma Accuminata:
- Benign sexually transmitted disease of HPV types 6 and 11
- Most often in coronal sulcus and inner surface of prepuce (check under foreskin)
- 2/3 of partners will develop infection
• Condylomata of the meatus and glans tend to have cauliflower morphology (left)
• Condylomata of the shaft tend to be flat (right)
• if remove the lesion – need to know you’re not removing the virus and partner has also been infected
Morphology: papillary architecture w/ koilocytic atypia
bowen disease
red or gray plaque on the shaft = CIS of the penis
o must be excised completely w/ clean margins and w/ careful follow up
- pre cancerous CIS of HPV (type 16)
- on exam see erythroplakia and leukoplakia
bowenoid papulosis
multiple reddish-tan papules in young adults. Do not go onto invasive SCC
o These NEVER invade – though looks like CIS
o looks like SCC in situ – though dermatologist will recognize the gross pattern of distribution and conclude that it will not be invasive, regress on its own
- DOES NOT EVER INVADE
- CIS lesion of HPV 16
- on exam see multiple papules that regress on their own
Invasive Squamous Cell Carcinoma of the penis:
• Rare Tumor in US: < 1% of tumors in males
– 10-20% tumors of males in parts of 3rd world
• Risk factors
– lack of circumcision
– Association with HPV 16 & 18, etc. (About 50% associated with HPV)
– Occurs between ages 40 & 70
– Association with smoking
• Slow-growing, painless tumor that presents late
• Prognosis depends on spread to regional lymph nodes
– Inguinal lymph nodes (-): 66% 5 year survival
– Inguinal lymph nodes (+): 27% 5 year survival
morphology: see squamous pearls!
Pearly Penile Papules:
• not HPV/genital wart • normal variant - cause is unknown • not sexually transmitted • appears in 2nd/3rd decade • no tx necessary • relatively common – no viral changes
Cryptorchidism:
• The failure of the testicle to descend into the scrotum
– sertoli cells produce MIS (AMH) → causes initial descent of testicle
– most likely d/t imbalance of androgen and improper guidance of testicle
• Two embryologic phases
– Transabdominal: at 6 weeks, Sertoli cells → MIS (Mullerian inhibition substance) → regression female organs. At 9 weeks, Leydig cells produce testosterone → Wolffian duct develops into male genitalia, testis up in lower abdomen. “Differential Growth”
– Inguinal-scrotal (Androgen driven): craniosuspensory ligament dissolves and gubernaculum guides testis into scrotum
• Present in 1% at 1 year; 25% are bilateral
– Associated with Klinefelter syndrome, premature birth and family history
• At risk for: testicular cancer, trauma, torsion and infertility
• Surgical correction is necessary (orchiopexy)
– when identified it has to be corrected: bringing into scrotum or removal
Prune Belly Syndrome:
- Abdominal muscle deficiency
- Severe urinary tract abnormalities
- Bilateral cryptorchidism in males
