Reproductive: Miscellaneous Male Flashcards
Calcified vas deferens
Note: Common in diabetic pts.
Calcified vas deferens and seminal vesicles
Note: Common in diabetic pts.
Prostatic utricle cyst
Differential for midline pelvic cyst in a male
- Prostatic utricle cyst
- Müllerian duct cyst
- Ejaculatory duct cyst
Differential for off-midline pelvic cyst in a male
- Seminal vesicle cyst
- Diverticulosis of the ampulla of vas deferens
Male
Seminal vesicle cyst
Note: Off-midline pelvic cyst in a male.
Congenital seminal vesicle cysts are associated with…
- Polycystic kidney disease
- Renal agenesis
- Vas deferens agenesis
- Ectopic ureter insertion
Common causes of acquired seminal vesicle cysts
- Prostatic hypertrophy
- Chronic infection/scarring
Note: Classic history is prior prostate surgery.
Seminal vesicle cyst
Prostatic utricle cyst
Cystic dilatation of the prostatic utricle (a midline structure in the prostatic urethra that is a remnant of the Müllerian duct)
Prostatic utricle cysts are associated with…
- Hypospadias
- Unilateral renal agenesis
- Prune belly syndrome
- Downs syndrome
- Imperforate anus
Retrograde cystourethrogram
Prostatic utricle cyst
Note: Focal posterior outpouching of the prostatic urethra.
Which type of male pelvic cyst communicated with the urethra?
Prostatic utricle cyst
Note: This is why these cysts are at an increased risk for superinfection.
What is the most common association with a prostatic utricle cyst?
Hypospadias (urethral opening along the ventral penis)
Male
Müllerian duct cyst
Note: This is due to failed regression of the caudal ends of the Müllerian ducts (in the region of what would be the cervix/vagina).
Does a Müllerian duct cyst communicate with the urethra?
No
Note: The Müllerian duct cyst is basically a vagina/cervix that failed to fully regress in a male.
Müllerian duct cyst
Note: Prostatic utricle cysts do not extend above the base (superior extent) of the prostate.
How can you tell the difference between a prostatic utricle cyst and a Müllerian duct cyst?
Do prostatic utricle or Müllerian duct cysts carry a risk of malignancy?
Yes, but very small (mostly just case reports)
Note: These can be many different types of cancer (e.g. endometrial, clear cell, squamous, etc.)
Think prostate abscess
Note: Thick-walled, separated, heterogenous cystic lesions in the prostate.
What is the most common pathogen in a prostatic abscess?
E. coli
Think prostate abscess
Left scrotal pain
Left testicular torsion
Note: Painful side is hypoechoic (edematous) and hypovascular.
Absent diastolic flow in the left testis, think about torsion
Note: The testes are like the brain, requiring constant bloodflow even in diastole.
Testicular artery spectral doppler findings of testicular torsion
- Decreased or reversed diastolic flow
- Elevated resistive index
Spectral doppler of testicular artery
Normal
Note: There is constant forward flow, even in diastole (velocities are never at or below baseline)
Spectral doppler of testicular artery
Loss of diastolic flow, suspicious for torsion
Spectral doppler of testicular artery
Reversal of diastolic flow, suspicious for torsion
Spectral doppler of testicular artery
Monophasic flow without dicrotic notch, suspicious for torsion
Bell-clapper deformity
An abnormally high attachment of the tunica vaginalis that increases testicular mobility and predisposes to testicular torsion (usually a bilateral deformity)
Note: If a pt with a bell-clapper deformity gets torsion, they will usually perform bilateral orchiopexy (due to increased risk for additional torsions).
How quickly should a pt with testicular torsion get to the OR?
Ideally within 6 hours to have the best chance of preserving testis viability
Differential for testicular hyperemia (e.g. decreased resistive index, increased diastolic flow, etc)
- Epididymo-orchitis (painful)
- Testicular torsion-detorsion (usually pain has resolved)
What is the most common cause of acute onset scrotal pain?
Epididymitis
Common pathogens in epididymitis
- Gonorrhea/chlamydia (sexually active)
- E. coli (not sexually active, from urinary source)
What is the most common location for epididymitis?
Epididymal tail
Note: This is where infection starts, later spreading to the body then head and possible testis.
Isolated orchitis (without epididymitis)…
Think mumps or tuberculosis
Note: Scrotal tuberculosis usually starts as epididymitis, but can also cause orchitis first, then epididymitis.
Think miliary tuberculosis
Note: Multiple hypoechoic nodules in an enlarged/hyperemic testis.
Testicular artery spectral Doppler in a pt with worsening pain in the setting of known orchitis
Impending infarction (due to vascular compromise from severe testicular edema, think of as a compartment syndrome)
Note: Loss/reversal of diastolic flow in the testicular artery should make you think torsion or “impending infarction” if there is known orchitis.
Treatment for testicular rupture
Surgery
Treatment for testicular fracture
Medical management (no surgery)
Testicular fracture vs rupture
Testicular fracture is a linear break in the testis within the tunica albuginea (which is intact)
Testicular rupture is when the tunica albuginea is disrupted
Scrotal trauma
Think testicular fracture/hematoma (no evidence of tunica albuginea disruption)
Scrotal trauma
Testicular rupture
Note: Disruption of the tunica albuginea.
Arrow (curvilinear echogenicity)
Tunica albuginea
Arrowheads
Tunica vaginalis (parietal and visceral)
