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Testis • The central zone (CZ)

• 3.5- 4 cm in length and 2-3 cm in width


• The transitional zone (TZ)
• Covered by fibrinous tunica albuginea

• The spermatic cord enters the testis along


the posterosuperior margin, known as the
mediastinum testes

• Divided into lobules arrayed radially


around the mediastinum testes; each
lobule being composed of branching
seminiferous tubules

• 20-30 ducts form the prostate gland

• NOTES: not visualized- undescended


testes

:view- transsagittal, transverse

:white echogenecities- calcification


Epididymis
• 6-7 cm in length

• 7-8 mm diameter at the globus major


(head of epididymis at mediastinum testis)
and

• 1-2 mm at the tail where it continues as


the vAS deferens

• The vas deferens courses through the


spermatic cord and exits via the deep
inguinal ring

• At the base of the prostate, it joins the


seminal vesicle to form the ejaculatory
duct

Prostate

-has 3 zones:

• The peripheral zone (PZ)


• To evaluate the upper urinary tract for
ureteral obstruction and obstructive
nephropathy

• To evaluate bladder size and estimate


post-void residual urine volume, bladder
wall thickness, presence of trabeculation,
and formation of diverticula

• The prostate gland should be evaluated


for gross evidence of adenocarcinoma

COMMON DISEASES

1. Benign Prostate Hypertrophy (BPH)

• affects 50-75% of men over age 60 years

• a result of uninhibited contractioins of a


hypertrophied detrusor muscle due to
obstructon of the prostatic urethra by
enlargement of glandular tissue of the
prostate

• NOTES: central zone- mostly affected

• CT SCAN:
2. Prostate Cancer

• 70% occur in the peripheral zone (PZ)

• 20% are found in the transition zone (TZ)

• Trans-rectal biopsy is the gold standard for


diagnosis

• Direct extentsion into the seminal


vesicles, bladder base, and perivesical fat

• Extracapsular spread is evaluated with


transrectal prostate ultarasonography with
biopsy or endorectal coil MR imaging +/-
MR spectroscopy

• Nodal metastases may be evaluated with


CT or MRI, and biopsy is performed if
nodes are greater than 10 mm

• If nodal disease is present, 80% have bone


mets within 5 years. The obturator and
internal/external iliac nodal chains are
most commonly involved. Bone
metastases are evaluated by checking the
PSA level, then performing a bone scan.
demonstrated in the right peripheral
zone

• Ill-defined bladder mass at the


bladder base (arrows) 3. Torsion

• The mass is well seen because it is • Due to abnormal configuration of the


outlined by the excreted contrast testicle on its pedicle (“bell clapper
(M) deformity”), leading to abnormal twisting
of the spermatic cord that causes
• This mass is seen to arise from the testicular ischemia. It is most common in
prostate gland (P) adolescents and infants less than 12
months old.
• Prostate normal size: <4 x 4 (3.7 x
3.7 x 3.7; <20 grams) • Torsion is classified as complete or
incomplete.

• Complete torsion: >360 degree twist.


Adult males 80% testicular salvage rate
when reversed within 5 hours
Bulge in the scapular line
• Incomplete torsion: <360 degrees.
Relatively longer period before testicle is
unsalvageable

• HIGH RESOLUTION ULTRASOUND

• Enlarged and diffusely hypoechoic


testicle

• Contains multifocal hypoechoic


Signal
areas
intensity is
• Epididymis may be enlarged and
hypoechoic

• Scrotal thickening

• DOPPLER ULTRASOUND
• If there is no blood flow to testis Enlarged & predominantly hypoechoic epididymis
(evaluated by Doppler ultrasound) with a reactive hydrocele
after 1 minute of scanning time

• If there is a single small vessel in


the symptomatic testis, when
contralateral normal testis shows
readily detectable diffuse flow

• COLOR DOPPLER ULTRASOUND

• Enlarged, hypoechoic hyperemic


epididymis

4. Epididymitis • Increased color flow/blood flow


surrounding symptomatic
• Is the most common acute scrotal process epididymis
in postpubertal age group

• 9x more common than the main


differential consideration, testicular
torsion

• ULTRASOUND

• Enlarged and hypoechoic


epididymis

• Hydrocele or pyocele

• Scrotal skin thickening

• Associated orchitis

5. Orchitis

• Is a parenchymal infection of the testicle

• Often seen as a complication of mumps


infection (25% of postpubertal male
patients with mumps)
• Other frequent causes include echovirus, NOTES: massive upper and lower
group B arboviruses, and lymphocytic peritesticular areas
choriomeningitis virus

• Unilateral in 2/3, usually developing within


7-10 days of parotiditis associated with
mumps

• The testicle may be secondarily involved


by epididymitis

7. Hydrocele
*enlarged left testicle
• Is the accumulation of fluid between
NOTES: hydrocele, enlarged epididymal head,
the visceral and parietal tunica
testicle with thickened scrotal sac
vaginalis

• It may occur in isolation or in


6. Varicocele association with epididymitis, orchitis,
torsion, trauma, or tumor
• Distention of the pampiniform venous
plexus due to incompetent valves of the
spermatic vein

• Standing or valsalva may provoke the


distention

• 95% are left-sided, and are the most


common manageable cause of male
infertility

• COLOR DOPPLER

• The compressible, tortuous vessels


measure more than 2 mm diameter
8. Scrotal Trauma
• Ultrasound demonstrates multiple • presents with pain, nausea, vomiting
serpiginous anechoic spaces of and extreme tenderness with scrotal
similar size, and Doppler shows ecchymosis and swelling
venous flow within these spaces • surgical exploration and debridement
is needed if the tunica albuginea has
been violated and devitalized
TUMORS

semineferous tubules have extruded


or if there is a large scrotal hematoma
• ULTRASOUND
• irregular testicular contour
(rupture)
• multifocal linear hypoechoic
areas (contusion)
• comlex hydrocele, or
• extratesticular mass caused by
hematoma
• areas of uniformly decreased echogenicity
• usually focal but may be diffuse
• may cause bulging of the tunica albuginea

Staging is performed by CT
I tumor confined to testis
II extratesticular spread
IIA minimal nodal metastases, limited to
infradiaphragmatic stations
IIB bulky retroperitoneal nodal metastases
III lymphatic involvement above diaphragm
IV extranodal metastases (pulmonary,
hepatic, osseous, CNS

a focal hypoechoic structure within this


testicle
this is most consistent with hematoma

Seminoma
• the most common malignancy of males
age 15-30
• usually presenting as a painless scrotal
mass
• risk factors include
• cryptorchidism
• maternal diethylstilbestrol (DES)
use
• testicular atrophy
• germ cell tumors comprise
• 95% of testicular cancer *NOTES:
• 40% of these are seminomas Male pelvis- Ultrasound is done first
• 40% showed mixed histologic - mass: transrectal ultrasound
pattern - with malignancy: CT scan or
MRI
-testicle: HRUTZ

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Maraming salamat kay ate cands para sa
additional notes. ☺