disorders of male external genitalia lukáš bittner urologická klinika 3. lf uk a fnkv
TRANSCRIPT
Disorders of Male External Genitalia
Lukáš Bittner
Urologická klinika 3. LF UK a FNKV
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 testisTypical delay 3-6 months10% od patients with metastatic diseases
Back painCough or dyspnoeBone pain
Signs
Testicular mass or diffuse enlargementPalpation of
AbdomenSupraclavicularScalene 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% bilateral7-10% history of cryptorchidism
Intraabdominal testis risk 1/20Inquinal 1/80
Lab. findings
Tu. markersAFP (Alfa-fetoprotein) produced by yolk sac
(never found in pure seminomas)hCG (human Chorionic Gonadotropin) produced
by choriocarcinomaLDH (Lactic acid dehydrogenase), tu burden
AnemiaLiver function tests
Imaging
Scrotal US
Imaging
CT of adomen
Imaging
Chest X-ray
Pathology
Tumors of the testis
Germinal
Seminoma
Nonseminoma
Embryonall Cell CArcinoma
Teratoma
Choriocarcinoma
Nongerminal
Leydig cell tu
Sertolli cell tu
Gonadoblastoma
Pathology
Seminoma 35%most common in 4. decadeNever AFPhCG 7%
Embrional Cell Carcinoma 20%Yolk sac tu most common among Childs
Pathology
Teratoma 5%Children and adultsMaturre may have elements derived from
• Ectoderm• Mesoderm• Endoderm
Choriocarcinoma ‹1%Small lesion with central hemorhageAggresiveHematogenous spread
Metastatic Spread
Except choriocarcinoma stepwise lymphatic fashion
Lymph nodes Th1- L4, paracaval, paraaortalWith concetration at level of renal hilum
Scrotal violation may result in inquinal metastases
Visceral metastasesLung, liver, brain, bone
Treatment
Radical orchiectomyInguinal expolation with cross clamping of
spermatic cord and delivery+
Low stage seminoma Retroperitoneal irradiation
High stage seminomaPlatinum based CHT• 4 cycles of PEB (cisplatin, etoposide, bleomycin)
Treatment
Nonseminomatous germ cell tumorsPlatinum based CHTRPLND• Radical• Modified
Prognosis
Hydrocele
collection of watery fluid around the testicle
Ethilology
PostraumaticPostinflammatoryInbornIdiopatic
Hydrocele
Therapy
Aspiration- often returnsOpen 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 painShould be subfertilityShould 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