Contents

Structural Lesions of the Urethral Wall

Congenital Scrotal Disorders Extra testicular Scrotal Disorders

Urethral Diverticulum
Urethral diverticulum may be defined as a localized

out pouching of tissue from the urethra into the potential space surrounding the urethra. The cause is uncertain. Symptoms are variable, the most common being frequency, urgency, and dysuria. Congenital or Acquired Female > Male

Urethral Fistulas
Urethral fistulas develop if there is failure of closure

after urethral rupture or laceration. They may be caused by; - Rectal or Gynecological surgery. -Obstetric injury. -Radiotherapy. -Inflammatory lesions. -Strictures or Carcinomas.

 Urethrorectal, urethroperineal, urethrovaginal,

urethrovesical and urethrocutaneous. IMAGING Cystourethroscopy VCUG Retrograde urethrography MRI CT scan

1 month old girl

Ambiguous Genitalia And Intersex

(Disorders of Sex Development)
Atypical appearance of the external genitalia making

sex determination difficult

Occur when Genetic sex, Gonadal sex, or Genital sex

of an individual are discordant.

Complex situation with a wide variety of phenotypes.

Types
1.True Hermaphrodite (ovotesticular DSD) 2.Pseudohermaphrodite a. Male Pseudo hermaphrodite (46 XY with two testes) b. Female Pseudo hermaphrodite (46 XX with two ovaries) 3.Gonadal Dysgenesis a. Pure (bilateral streak gonads) b. Mixed(testis and a streak gonad)

Teenage girl presented with primary amenorrhea and prominent labioscrotal folds

A child with ambiguous genitalia

Ambiguous genitalia in a newborn with congenital adrenal hyperplasia

A newborn with Ambiguous genitalia

Undescended Testes (Cryptorchidism)

Cryptorchidism is defined as failure of the testis to descend

from its intra-abdominal location into the scrotum.

Preterm infants 28-32 wks Unilateral or bilateral 20-48 times more likely to undergo malignant

degeneration

 Cryptorchid: testis neither resides nor can be manipulated

into the scrotum

Ectopic: aberrant course Retractile: can be manipulated into scrotum where it

remains without tension

Gliding: can be manipulated into upper scrotum but

retracts when released

Imaging
Ultrasound
CT scan MRI Angiography

34 years old male with infertility

28-year-old man with history of left cryptorchidism after

orchiopexy at age 6 years

34 years old male with severe pain in the RIF along with fever and chills.

1 year old boy with non palpable testes

9 year old boy

Hydrocele
A hydrocele is filling of serous fluid between the

visceral and parietal layers of tunica vaginalis.

Congenital or Acquired. Is most often idiopathic. Can be secondary to infection or lymphatic blockage

by tumor.

 Chronic infective hydrocele (especially tuberculous)

may be associated with considerable calcification of the tunica.

Hydrocele may demonstrate internal echoes.

Hematocele
It is an accumulation of blood distending the tunica

vaginalis.
Acute or Chronic Is most often caused by trauma. Is occasionally due to tumor.

 Complex appearance with echogenic debris and

septations.

Pyocele
A scrotal abscess, or pyocele, is most often a

complication of epididymo-orchitis, which has crossed the mesothelial lining of the tunica vaginalis.
On US scans, an abscess appears as a complex,

heterogeneous fluid collection.

Gas may be present, causing bright specular reflectors

and shadowing

Spermatocele
The most common scrotal mass is spermatocele.
Cystic lesions in the head of epididymis. Filled with spermatozoa containing fluid. Low level echoes can be seen in some cases. Septations --- with large spermatoceles.

Epididymal Cysts
Epididymal cysts form in the head as well as in the

body and tail of the epididymis. Are anechoic. Contains serous fluid. Indistinguishable from spermatoceles.

Epididymitis
Inflammation of the epididymis, usually due to

ascending infection with gram negative bacilli or Chlamydia.

Young adult males, late middle age and elderly.

Imaging of epididymitis
The preferred imaging examination is ultrasonography. Enlarged (>17 mm) epididymis . Hypoechoic, hyperechoic, or heterogeneous echotexture. Increased blood flow. Associated reactive hydrocele . Scrotal wall thickening.

Patient with severe pain in the scrotum.

Varicocele
Varicoceles are dilated peritesticular veins that form as

the result of incompetent valves in the spermatic veins. Extremely common(8-16% of male population) 15-25 years of age. 85% Left sided 15% Bilateral. If only right sided-Malignancy should be suspected. If presenting in old age(>40 yrs) for the first timeMalignancy should be suspected. Pain ,discomfort and Infertility.

 Gray scale sonography depicts Varicoceles as

numerous, dilated(>2mm), tortuous, tubular channels in the peritesticular tissues. Located lateral, posterior and/or superior to the testis. Visible flow may be seen within larger varicoceles on conventional ultrasound, but it is usually too slow to be detected with color Doppler imaging. Their prominence is increased in the upright position and with valsalva maneuver, and this is detectable on color Doppler imaging.