Week 9- DMS 211 Scrotum and Prostate

normal measurement of testes

3-5 x 2-4 x 3 cm

each testis is divided into ___ lobules which contain __________________

250-400, seminiferous tubules

the seminiferous tubules converge at the ________ of each lobule and anastomose to form ________________

apex, rete testis

how does the rete testis drain

into the epi head through efferent ductules

normal length of the epididymis

6 to 7 cm

the epi is divided into the...

head, body, and tail

the largest part of the epi is the ____ measuring ________

head, 6 to 15 mm in width

where is the epi located

superior to upper pole of testis

the epi contains _____ efferent ductules which converge to form the ____________

10 to 15, body and tail

the epi becomes the __________ which then continues into the ______________

vas deferens, spermatic cord

location of the epi body

posterolateral testis from upper to lower pole

location of the epi tail

posterior to lower pole of testis

appendix of the epi

small protuberance from the head

what component of the testis makes them appear as echogenic

seminiferous tubules

what is the main function of the testes

store and produce sperm

why do the testes hang away from the body

body temp is too hot for sperm to survive

what is cut in a vasectomy

vas deferens

mediastinum

where all the tubules join together at rete testes

the testis are covered by the...

tunica albuginea

mediastinum testis

posterior aspect of tunica albuginea that forms vertical septum

function of the mediastinum

support vessels and ducts coursing through testis

what lines the inner surface of the scrotum

tunica vaginalis

what are the layers of tunica vaginalis

parietal- creates the scrotal wall

visceral- surrounds testis and epi

where do hydroceles form

in space between parietal and visceral layers tunica vaginalis

the vas deferens is the continuation of the

ductus epididymis

verumontanum

junction of ejaculatory ducts and urethra

contents of the spermatic cord

vas deferens

testicular arteries

venous pamp plexus

lymphatics, nerves

location of spermatic cord

extends from scrotum to inguinal canal

function of spermatic cord

suspends the testes in the scrotum

blood supply to the testis

testicular arteries from abdominal aorta, cremasteric (EIA) and deferential artery (IIA)

venous pampiniform plexus

where venous drainage of the scrotum occurs

where do varicoceles happen?

at venous pampiniform plexus

the RT testicular vein drains into the ______________

IVC

the left testicular vein drain into the ___________________

left renal vein

2D imaging is important for diagnosing...

cystic and solid masses

hydrocele

undescended testis

hernia

spectral doppler is important for diagnosing...

torsion

when assessing for torsion you must get

both venous and arterial flow

__________________ flow will disappear first in torsion

venous

color doppler is important for diagnosing...

epididymitis and orchitis

if there is inflammation color will show...

hypervascularity

measuring vessels is important for diagnosing...

varicocele

what measurement is abnormal meaning there is a varicocele present?

AP over 3mm

when diagnosing ___________________ and ______________________ the valsalva movement is needed

hernia and varicocele

if a pt presents with scrotal pain what needs to be ruled out?

torsion

if a pt presents with trauma what needs to be ruled out?

hemorrhage

scrotal trauma may cause acute scrotal issues such as

hydrocele, hematocele, rupture

sono findings assoc with scrotal rupture

interruption of tunica albuginea, irregular contour, scrotal wall thickening, hematocele

sono appearance of acute hematocele

echogenic with numerous highly visible echos

with time hematoceles may show

low-level echoes and develop septations

sono appearance of hematoma

large, heterogenous areas within scrotum-- become more complex with time

____________________ and ____________________ are also asssoc with trauma to the testis

epididymitis and torsion

what is epididymo-orchitis

infection of epididymis and testis which usually occurs secondary to epididymitis

epididymo-orchitis is most commonly caused by...

spread of lower urinary tract infection via spermatic cord

what is the most common cause of acute scrotal pain in adults

epididymo-orchitis

sono appearance of epididymo-orchitis

epi is enlarged and hypoechoic

hyperemic flow

secondary hemorrhage may be seen with focal hyperechoic areas

what is the buddy sign?

showing both testicles with the same color box and settings

when evaluating epididymo-orchitis the ___________________ sign is very important

buddy sign

assoc findings of epididymo-orchitis

scrotal wall thickening and hydrocele (low level or anechoic echoes) in the anterolateral area of testes

pyocele

pus fills space between layers of tunica vaginalis, occurs when untreated infection or abscess ruptures associated with trauma/surgery/torsion

sono appearance of pyocele

internal septations, loculations, debris

when may infarction occur in the testis

with severe cases of orchitis

sono appearance of infarction

swollen testis within tunica albuginea, obstruction, decreased flow

bell clapper deformity

occurs when tunica vaginalis completely surrounds testis, epi, distal sperm cord, and twisted within scrotum

_______________ testis are 10 times more likely to be torsed

undescended

torsion of the ___________________ is a surgical emergency an d must be salvaged before _____ for 20% chance

spermatic cord, 12 hours

peak incidence of torsion is at _____

14 yo

signs/symptoms of torsion

sudden onset scrotal pain with swelling, nausea, vomiting

epididymal cysts

small clear cysts with serous fluid that are asymptomatic but may be palpable

most scrotal cysts are __________________

extratesticular located in the epi or tunica albuginea

spermatocele

cystic dilation of the efferent ductules of epi and always in epi head

__________________ are seen more often following a vasectomy

spermatoceles

varicocele

abnormal dilation of veins within the pampiniform- primary caused by incompetent venous valve, secondary caused by increased pressure on sperm vein

varicoceles are more common on the _____________ side

left

causes of varicocele

renal hydronephrosis, abdominal mass, liver cirrhosis, and abdominal malignancy in lt renal vein may cause noncompressible veins

sono appearance of varicocele

less than 2 mm diameter, numerous tortuous tubes within sperm cord, tend to increase in response to Valsalva maneuver

scrotal hernia

occurs when bowel (most common), omentum, or other structures herniate into the scrotum

sono appearance of scrotal hernia

peristalsis seen in scrotum

hydroceles are a collection of _____ fluid with painless swelling, and commonly associated with epididymo-orchitis and torsion

serous

sperm granuloma

chronic inflammatory reaction to extravasation of spermatozoa anywhere within epididymis/vas deferens

____________________________ are most common in pt with a hx of vasectomy

sperm granuloma

tubular ectasia of rete testis

uncommon benign condition with cystic dilation and formation of cysts within the rete testis

associated with spermatocele, epididymal, or testicular cyst

microlithiasis

development of small calculi in testis associated with testicular malignancy, cryptorchidism, Klinefelter’s syndrome, infertility, varicoceles, testicular atrophy, and male pseudohermaphroditism

microlithiasis is usually

bilateral and less than 3 mm

germ cell tumors trends

testicular cancer is uncommon

most common malignancy in 15-35yo

most curable form of cancer

undescended tests are 2.5-8 times more likely to be cancer

types of germ cell tumors of the testis

seminoma, choriocarcinoma, embryonal cell tumors

signs/symptoms of germ cell tumors of the testis

painless lump, enlarged testis, vague discomfort

sono appearance of germ cell tumors

focal hypoechoic masses with no calcs

extratesticular masses are usually _________________ while intratesticular masses are more likely to be ___________________

benign, malignant

______________________ are more aggressive than ___________

embryonal cell tumors, seminomas

embryonal cell carcinoma

heterogenous and less circumscribed

areas of increased echogenicity from calcs, hemorrhage, fibrosis

what is the most common germ cell tumor

seminoma

main indicator for choriocarcinoma

elevated hCG

most common metstasis to testis

prostate or kidneys

metastasis to testis is ___________

bilateral and rare occurring later in life

sono appearance of metastasis

solid hypoechoic mass with mutliple lesions

_______________ makes pt more susceptible to seminoma

undescended testis

cryptorchidism (undescended)

testes do not descend

where may undescended testis be located?

inguinal canal, abdomen, other locations

most common place for testicular ectopia

superficial inguinal canal

anorchia

born without testis