Disorders of Male External Genitalia Urologická klinika 3. LF UK a FNKV Disorders of Male External Genitalia Lukáš Bittner

What is it?

What is it?

What is it?

What is it?

What is it?

What is it?

What is it?

What is it?

Tumors of the testis- Symptoms Painless enlargement of the testis Typical delay 3-6 months 10% od patients with metastatic diseases Back pain Cough or dyspnoe Bone pain

Signs Testicular mass or diffuse enlargement Palpation of Abdomen Supraclavicular Scalene nodes Gynecomastia by 30-50% Sertoli and Leydig cc.tu.

Epidemiology, risk factors Most common solid tu in males under 30 90-95% germ cell tu (seminomas, nonseminomas) Rest nongerminal (Leyding cell, Sertolli cell) 1-2% bilateral 7-10% history of cryptorchidism Intraabdominal testis risk 1/20 Inquinal 1/80

Lab. findings Tu. markers Anemia Liver function tests AFP (Alfa-fetoprotein) produced by yolk sac (never found in pure seminomas) hCG (human Chorionic Gonadotropin) produced by choriocarcinoma LDH (Lactic acid dehydrogenase), tu burden Anemia Liver function tests

Imaging Scrotal US

Imaging CT of adomen

Imaging Chest X-ray

Embryonall Cell CArcinoma Pathology Tumors of the testis Germinal Seminoma Nonseminoma Embryonall Cell CArcinoma Teratoma Choriocarcinoma Nongerminal Leydig cell tu Sertolli cell tu Gonadoblastoma

Pathology Seminoma 35% Embrional Cell Carcinoma 20% most common in 4. decade Never AFP hCG 7% Embrional Cell Carcinoma 20% Yolk sac tu most common among Childs

Pathology Teratoma 5% Choriocarcinoma ‹1% Children and adults Maturre may have elements derived from Ectoderm Mesoderm Endoderm Choriocarcinoma ‹1% Small lesion with central hemorhage Aggresive Hematogenous spread

Metastatic Spread Except choriocarcinoma stepwise lymphatic fashion Lymph nodes Th1- L4, paracaval, paraaortal With concetration at level of renal hilum Scrotal violation may result in inquinal metastases Visceral metastases Lung, liver, brain, bone

Radical orchiectomy Treatment Low stage seminoma High stage seminoma Inguinal expolation with cross clamping of spermatic cord and delivery + Low stage seminoma Retroperitoneal irradiation High stage seminoma Platinum based CHT 4 cycles of PEB (cisplatin, etoposide, bleomycin)

Treatment Nonseminomatous germ cell tumors Platinum based CHT RPLND Radical Modified

Prognosis

Hydrocele collection of watery fluid around the testicle

Ethilology Postraumatic Postinflammatory Inborn Idiopatic

Hydrocele

Therapy Aspiration- often returns Open Hydrocelectomy

Varicocele Dilatated veins within the pampiniform plexus Incidence in subfertile men 40% Associated with testicular athrophy

USG findings/thermography

Symptoms More frequent on left side Mostly asymptomatic Dull pain Should be subfertility Should be hypogonadism

Treatment Microsurgery inguinal/sctotal

Treatment Radiologic obliteration

Treatment Laparoscopic ligation

Phimosis Condition in which the contracted foreskin cannot bet retracted over the glans

Phimosis Calculi or sqaumous cell ca may develop Malhygiene, chronic infection, DM common cause Newborn boys cannot retract prepucium, no correction needed under 2 y.

Circumcision

Paraphimosis Conditon in which forskin, once retracted over the glans, cannot be replaced in its normal position

Therapy Squeezing the edema and retraction of foreskin Dorsal slit Than circumcision