Scrotum

Question 1

The 2 most common causes of this?

Answer 1

Fournier’s gangrene

• DM, by far!!! 40-60% of pts are diabetic.
• Alcoholism

Question 2

What is the salvage rate if surgery is performed after 12 hours post-torsion onset?

Answer 2

20%

Question 3

Both testicles look like this & the man has been receiving steroid supplementation for his entire life.

• Dx?
• Tx?

Answer 3

• Dx: adrenal rests from congenital adrenal hyperplasia:
  
  • Results in enzyme deficiency involved in production of cortisol & aldosterone.
  • This leads to elevated ACTH which causes adrenal hyperplasia.
  • These are adrenal rests & can be found all over the place in neonates & regress.
  • These can enlarge if exogenous hormone therapy is inadequate.
• Increase the steroids.
  
  • These will regress as steroids increase.

Question 4

If a male presents w/an empty scrotal sac, where is the most common location of the testis in this condition?

Answer 4

• Undescended testicle: they can occur anywhere in the retroperitoneum from the lower pole of the kidney to the inguinal region.
• 80% are located in the inguinal region, just caudal to the external inguinal ring.

Question 5

Most common malignancy found in an undescended testis?

Answer 5

• Seminoma

Question 6

What is the gold standard for identification of a malpositioned testis or to prove the absence of a testis in boys?

Answer 6

Surgical exploration.

• According to the American Urological Assoc guidelines, they recommend against the use of imaging in the eval of boys w/cryptorchidism.
• ~70% of cryptorchid testes are palpable & require no imaging.
• Pts w/nonpalpable cryptorchid testes should undergo a diagnostic laparoscopy to ID & treat the malpositioned testes. The operation can end if the testicle is truly absent & confirmed at surgery.

Question 7

What is a potential complication of this if left untreated?

Answer 7

Dx: epididymis-orchitis.

• Can lead to testicular infarction.
• Other complications: pyocele, testicular abscess.

Question 8

On normal scrotal US, what is the blood flow w/in the epididymis relative to testis?

Answer 8

LESS! Often epididymal flow may not be detected.

Question 9

Difference in appearance of a testicular mixed germ cell tumour vs. seminoma?

Answer 9

GCT: heterogeneous, cystic, solid, & calcified components.

Seminoma: uniformly hypoechoic.

Question 10

RFs for testicular cancer?

Answer 10

• personal Hx of GCT
• family Hx of GCT
• cryptorchidism
• infertility
• testicular dysgenesis

Question 11

Typical appearance of testicular infarction & reason?

Answer 11

• Heterogeneous testicular parenchyma.
• Wedge-shaped area of hypoechogenicity or heterogeneity w/vertex directed towards the mediastinum testis w/lack of colour or power Doppler flow.
• Upper pole is more prone to infarction b/c of dual supply to the lower pole from the posterior epididymal artery.

Question 12

This male has a palpable lump on his penile shaft. Dx?

• In which anatomic structure is the abnormality present?

Answer 12

Dx: Peyronie disease

• Tunica albuginea of the corpora cavernosa.
• This can results in penile deformity & curvature.
• Usually on the dorsal surface of the penis, but can also occur on ventral/lateral surfaces.

Question 13

Where do spermatoceles occur?

Answer 13

In the epididymal head.