corpus cavernosum

spinal cord segments S2 - S4.

cavernous, pudendal, and dorsal nerves of the penis. (2 at least)

Suspensory ligament

Fundiform ligament

Hypospadias

prostatic arteries

prostatic venous plexus

inferior hypogastric plexus

prostate

testes and the epididymis.

calcification of the prostatic secretion forming corpora amylacea.

Seminoma

U/S:

• seminomas usually appear as a homogeneous intratesticular mass of low echogenicity compared to normal testicular tissue

• the mass is usually oval and well-defined in the absence of local invasion

  • usually confined within the tunica albuginea, rarely extending to para-testicular structures 

• internal blood flow is seen on colour Doppler imaging

• cystic regions and calcifications are less common than in non-seminomatous germ cell tumours

• larger seminomas can have a heterogeneous appearance

Hydrocele

Aetiology

Congenital

There are two main subtypes of congenital hydrocele:

• communicating hydrocele

• spermatic cord hydrocele
  

In the communicating type, fluid collects around a patent processus vaginalis which failed to successfully obliterate.

The spermatic cord hydrocele is further subdivided into:

• encysted type (spermatic cord cyst): no communication with the peritoneum or tunica vaginalis

• funicular type (funiculocele)

  • communicates with the peritoneum at the internal ring and does not surround the testis

  • more common in children and premature infants 
    

Acquired

• trauma

• epididymitis

• testicular torsion

• testicular neoplasm

• testicular infarction 

central zone

Seminal Vesicles

Polyorchidism / triorchidism

triorchidism, there are three testes with the supernumerary being situated on the left in 65% of the cases.

if you didn't steal gain 40 points and a hint for final question. void if chosen as first question.

Cryptorchidism 

Ultrasound of the bladder and prostate demonstrates and enlarged prostate (consistent with benign prostatic hypertrophy)

midline cystic lesions/cyst-like lesions

• Mullerian duct cyst
• prostatic utricle cyst
• ejaculatory duct cyst (tends to be more paramedian 6)
• cystadenoma of prostate
• ductus deferens cyst
• TURP defect

lateral cystic lesions

• cystic degeneration of benign prostatic hyperplasia
• prostatic retention cyst
• seminal vesicle cyst
• diverticular prostatitis
• prostatic abscess
• cavitatory prostatitis from chronic prostatitis
• parasitic prostatic cyst
• cystic prostatic carcinoma

Primary varicocele 

Most varicoceles are primary and result from incompetent or congenitally absent valves in the testicular vein (internal spermatic vein).

Secondary varicocele

Secondary varicoceles are much less common and result from increased pressure in the testicular vein due to compression (e.g. extrinsic mass such as retroperitoneal lymphadenopathy or renal mass, or renal vein compression in nutcracker syndrome), obstruction (e.g. renal vein thrombus), or splenorenal shunting (portal hypertension). 

The left testis is affected much more commonly affected (≈85%) than the right.

This may be due to the shorter course of the right testicular vein and its oblique insertion into the IVC which creates less backpressure. In contrast, the left testicular vein has a longer course and inserts into the left renal vein at a right angle. 

Bilateral varicoceles are not uncommon (≈15%).

Normal adult testes measure approximately 3 cm (AP) x 2-4 cm (TR) x 3-5 cm (length), with a volume of 12.5-19 mL

At birth, testes measure approximately 1.5 cm (length) x 1 cm (width), reaching ~4 mL volume at puberty

Prostatic abscess

U/S:

It usually demonstrates ill-defined hypoechoic areas within an enlarged and/or distorted prostate gland. There may be inhomogeneous echoes within these ill-defined areas.

CT:

The prostate is replaced by a large collection of peripherally enhancing, low-attenuation fluid which extends into the left ischioanal fossa. Thickening of the bladder base, likely due to reactive inflammation.

PI-RADS (Prostate Imaging–Reporting and Data System)

1971

first full study published 1982

• grade III
  • no major dilatation in supine position
  • dilated veins up to lower pole of testis seen only in standing position
  • reflux at lower pole veins during Valsalva manoeuvre

• grade IV
  • dilated veins even in supine position
  • reflux during Valsalva manoeuvre

2

• 1st decade: yolk sac tumour and testicular teratoma

• 2nd decade: choriocarcinoma

• 3rd decade: embryonal cell carcinoma

• 4th decade: seminoma

• ≥7th decade: lymphoma (usually non-Hodgkin lymphoma) and spermatocytic seminoma