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

2. What is it?

3. What is it?

4. What is it?

5. What is it?

6. What is it?

7. What is it?

8. What is it?

9. What is it?

10. 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

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

12. 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

13. 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

14. Imaging
Scrotal US

15. Imaging
CT of adomen

16. Imaging
Chest X-ray

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

18. 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

19. 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

20. 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

21. 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)

22. Treatment Nonseminomatous germ cell tumors Platinum based CHT RPLND
Radical
Modified

23. Prognosis

24. Hydrocele
collection of watery fluid around the testicle

25. Ethilology
Postraumatic
Postinflammatory
Inborn
Idiopatic

26. Hydrocele

27. Therapy
Aspiration- often returns
Open Hydrocelectomy

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

29. USG findings/thermography

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

31. Treatment
Microsurgery inguinal/sctotal

32. Treatment
Radiologic obliteration

33. Treatment
Laparoscopic ligation

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

35. 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.

36. Circumcision

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

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