- 6000 new cases in men a yr (1% of total)

- peak incidence is 20-35

- after age 50, think malignant lymphoma

Testicular Cancer

- Caucasian

- Undescended testes (Cryptorchidism)

- Hx of mumps orchitis

- Hx of inguinal hernia in childhood

- scrotal lump, hardness, heaviness, pain or swelling

Risk factors for testicular cancer

- most common malignancy in men (20% of total)

- environmental factors play important role

- more commin in African-Americans

Prostate Cancer

- Burning or pain on urination

- decreased stream, increased frequency

- hematuria and back or pelvic pain

- can be asymptomatic

Symptoms of Prostate Cancer

- required for an opposite gender genitalia exam

- permission should be asked of the pt to allow this arrangement

Chaperone

- inability to retract the foreskin

Phimosis

- inability to replace the foreskin following retraction

Paraphimosis

- inflammation of the glans penis

- can be secondary to phimosis and build up of smegma

Balanitis

- congenital abnormality where the urethral meatus opens on the ventral (bottom) surface of the glans or the shaft of the penis

- may indicate other internal urinary malformations

Hypospadias

- congenital abnormality where the urethral meatus opens dorsally (top) on the glans or shaft of the penis

Epispadias

- major role is temperature regulation

- left sac hangs lower because spermatic cord is longer

- tone of dartos m. determines its size

- contains a septal fold separating the two sacs

Scrotum

- occurs because of lymphatic obstruction, CHF, nephrotic syndrome, portal vein obstruction, and torsion of the spermatic cord

Scrotal edema

- should be palpated for size, shape and consistency

- indirect inguinal hernia, hydrocele of tunica vaginalis or spermatic cord, spermatocele, varicocele, orchitis, epididymitis, testicular torsion, and testicular cancer

Scrotal masses

- when hernia extends through inguinal canal to lie in front of spermatic cord and testis

- DOES NOT transilluminate

- peristaltic sounds may be heard in scrotal sac during auscultation of the scrotum

- checked by inserting finger into external inguinal ring and having the pt bear down or cough

Indirect inguinal hernia

- scrotal mass that transilluminates

- results from infection or trauma

- accumulation of serous fluid in the cavity of the tunica vaginalis anterior to the testis and epididymis

Hydrocele of tunica vaginalis

- scrotal mass that may transilluminate

- accumulation of serous fluid high in the scrotum

- difficult to differentiate from tunica vaginalis hydrocele

Hydrocele of the spermatic cord

- cystic collection of fluid in the epididymis that contains sperm

- pea sized (<8-10 cm)

- follows course of epididymis posterior and superior to the testis

- may transilluminate and non-tender

Spermatocele

- varicosities of the pampiniform venous plexus along the spermatic cord

- most visible when pt is standing

- soft, irregular, scrotal mass superior to the testis that feels like "a bag of worms"

- DOES NOT transilluminate

Varicocele

- although most varicoceles usually are found on the left side, this pathology can be a cause of L Renal Vein compression and should be screened for following the varicocele

Renal carcinoma

- varicoceles found on the right require you to rule out the possibility of this pathology

IVC obstruction

- infertility, heaviness of the scrotum or pain

Complications of Varicocele

- acute inflammation of the testis that presents as tender swelling of the scrotal contents

- most common cause is bacterial infection in urinary tract

- scrotum may be red, hot

- DOES NOT transilluminate

- chills, fever, and myalgias may be present

Orchitis

- most common cause for orchitis induced hypogonadism

- risk factor for testicular cancer

Viral orchitis (mumps)

- tender swelling of the epididymis usually due to venereal disease

- swelling/pain localizes to epididymis course (posterior and superior to testicle)

- accompanied by systemic symptoms

- DOES NOT transilluminate

- results from rotation of spermatic cord and its contents

- severe pain and scrotal swelling develop rapidly

- DOES NOT transilluminate

- most cases happen around puberty

- urologic emergency because testicular infarction is a possibile outcome

Testicular torsion

- presents typically as painless testicular nodule adherent to the surface of the testis

- multiple nodules may exist

- DOES NOT transilluminate

Testicular Cancer

- caused by infection (mumps), normal aging, or deficiencies in they hypothalamic-pituitary hormone axis

Testicular atrophy

- weakness of posterior wall of inguinal canal behind external ring

- medial to indirect inguinal hernia

- scrotal involvement is rare

Direct inguinal hernia

- occurs most commonly in women

- produce bulge distal to inguinal ligament, adjacent to the femoral vessels

Femoral hernias

- posterior surface of this gland is in close contact with the anterior rectal wall

- ~20 grams

- consistency of tightly extended thenar eminence

- Grade 1-4 ~ 1-4 cm of protusion into rectum

Prostate gland

- typically begins after age 45

- mean age for symptoms to occur is 65 in Caucasians and 60 in African-Americans

- increased a-adrenergic receptor density contributes to bladder outlet obstruction by increasing muscle tone

- produces firm, smooth, elastic or rubbery enlargement

- nodularity may be present

Benign Prostate Hyperplasia (BPH)

- can occur without prostatic enlargement

- typically nodular, irregular and stone-hard

- may be asymptomatic, have obstructive symptoms, or have bone metastasis (skeletal pain)

- lateral lobes accessible to rectal exam

Cancer of the prostate