Keywords: Chapter 17, Urinary Tract and Male GU

5-alpha reductase

The enzyme responsible for conversion of testosterone to DHT in the prostate. Finasteride (Proscar) is an anti-androgen that blocks this enzyme. In long-term clinical trials, finasteride has been shown to decrease prostatic size and improve urine flow rates and symptoms of BPH.
acute epididymitis
Painful swelling of one or both epididymides with fever and a variable incidence of dysuria and pyuria. In young men, usually associated with sexually transmitted urethritis (N. gonorrhoeae or C. trachomatis), in older men, most often associated with prostatitis (infections with coliform bacilli).
acute orchitis
Inflammation of the testis may occur as a result of hematogenous spread of various systemic infectious diseases. It is thought that orchitis without epididymitis originates in this way. Granulomatous orchitis, a nonspecific inflammatory process in the testis, occurs occasionally in middle-aged and older men. It apparently is of noninfectious origin. Evidence suggests that it is an autoimmune disease that represents a granulomatous response to spermatozoa.
acute prostatitis
Chills and fever accompanied by variable degrees of irritative and obstructive voiding dysfunction; characterized by a tender, swollen, and indurated prostate. Purulent prostatic secretions, usually caused by infection with coliform bacilli. Often accompanied by bacteriuria; sometimes associated with bacteremia.
acute urethritis (men)
Dysuria accompanied by urethral discharge without concomitant infection of the bladder. Most often represents a sexually transmitted disease caused by Neisseria gonorrhoeae (yellow discharge) or by nongonococcal agents, e.g., C trachomatis or U. urealyticum (white discharge). A single episode of intercourse with an infected female partner carries a transmission risk of 17-20% for the male. The urethra is the most common site of infection in all men. In heterosexual men, the pharynx is infected in 7%, and in homosexual men, the pharynx is infected in 40% and the rectum in 25%
alpha-fetoprotein
Alpha fetoprotein is a glycoprotein with a molecular weight of 70,000 Daltons and a half-life of 4-6 days. Although present in fetal serum in high levels, beyond the age of I year it is present only in trace amounts. This is a useful marker for yolk sac tumors and hepatomas.
benign prostatic hyperplasia (BPH)
Nodular enlargement of the prostate due to hyperplasia of prostatic glands and stroma. It is a very common disease of older males. It is more common in blacks than whites and other races. The pathogenesis of BPH is not understood, but it is apparently related to hormonal changes that occur with advancing age. The human prostate is composed of 3 zones. Transition, central and peripheral zone. Typically BPH occurs in the transition zone which is around the posterior urethra, whereas carcinoma occurs in the peripheral zone. The nodules in the periurethral part of the prostate may enlarge, protrude into the urinary bladder and act as a valve, occluding the internal orifice of the urethra. BPH causes urinary retention and predisposes to urinary tract infections. BPH is not a preneoplastic condition. The stromal to epithelial tissue ratio in normal prostates is 2:1 and in BPH is 5:1. Stromal tissue is therefore a significant component of BPH.
blood group antigens
Blood group antigens are commonly lost in human bladder tumors, and their loss correlates with tumor stage, grade, and, perhaps, progression rates. Invasive and in situ carcinomas generally show deletion of ABH antigens, as do superficial cancers that eventually progress to a higher stage.
Bowen disease
Squamous cell carcinoma in situ of the genital skin, presenting as an erythematous plaque, usually on the shaft of the penis. May progress to invasive cancer, but such progression occurs in only 10% of cases
Bowenoid papulosis
Multiple dysplastic lesions of the shaft of the penis caused by human papilloma virus, usually of the type 16. Histologically, the lesions show less cytologic atypia than other forms of carcinoma in situ. These lesions respond well to treatment and are readily cured with topical antiviral ointments.
Brunn nests
Solid nests of transitional epithelium formed by invagination of the surface epithelium into the submucosa of the urinary bladder or ureters. If these nests contain slits or central lumen they are referred to as cystitis cystica. If the nests show signs of glandular metaplasia, the lesion is called cystitis glandularis
calculus
A simple stone. Urinary calculi can occur in the renal collecting system, ureters or urinary bladder. These stones are composed of calcium oxalate, calcium phosphate, ammonium magnesium sulfate, urate crystals or cysteine.
carcinoma of the penis
A malignant neoplasm of the shaft or glans of the penis or the urethral meatus. It is rare in the US (less than 0.5% of all cancers in males) but common in South America, Africa and Asia. In areas such as Africa and regions of South America, penile carcinoma may comprise 10 20% of all malignant lesions. Penile carcinoma occurs most commonly in the sixth decade of life. Almost all tumors are histologically squamous cell carcinomas. The tumors may be exophytic or endophytic with superficial ulceration. The disease is virtually unheard of in males circumcised near birth. One theory postulates that smegma accumulation under the phimotic foreskin results in chronic inflammation leading to carcinoma.
carcinoma of the prostate
A malignant tumor of the prostate, histologically classified as adenocarcinoma. It usually originates in the peripheral lobe of the prostate and therefore can be palpated on digital rectal examination (DRE) as an induration of the prostate. Prostate cancer is a disease of old age. It is the most prevalent malignant tumor of males but in most instances it is asymptomatic and localized to the prostate (latent carcinoma). The highest incidence has been reported among American blacks. Tumors spread locally, metastasize to pelvic Iymph nodes and distant sites, most notably vertebral bones.
carcinoma of the ureter
A malignant tumor of the urinary epithelium. Histologically classified in most instances as transitional cell carcinoma. It can be papillary endophytic or invasive exophytic. Histologically, it can be graded on a scale from I to III, like urinary bladder tumors.
carcinoma of the urinary bladder
A malignant tumor of the bladder epithelium. Most are histologically transitional cell carcinomas, which can be further classified (graded) as low grade (I), intermediate grade (II) and high grade (III) malignancies. The World Health Organization has proposed that transitional cell carcinomas be divided into 3 grades on the basis of urothelial architecture; cell size, pleomorphism, nuclear polarization, and hyperchromatism; and the number of mitoses present . Invasive carcinoma is often preceded by carcinoma in situ. Carcinoma in situ (CIS) is recognizable as flat, non-papillary anaplastic epithelium. The urothelium lacks the normal cellular polarity, and cells are large and have prominent nucleoli. In addition, exophytic lesions occurring with CIS are more likely to recur and invade. Tumors, especially those that are grade I and II, may be papillary and endophytic. Grade III tumors are usually exophytic and highly invasive. Squamous cell carcinomas account for 10% of tumors. These tumors are preceded by squamous metaplasia of the bladder epithelium and are an especially common complication of chronic inflammation in schistosomiasis. Adenocarcinomas are rare, and usually found in the dome of the bladder presumably arising from the remnants of the urachus
chancroid
Chancroid is a sexually transmitted disease caused by Haemophilus ducreyi. It is a well-established cofactor for HIV transmission, and 10% of patients with chancroid may also have syphilis or herpesvirus infection . One or more painful, dirty-appearing chancroid ulcers appear after the first few days of infection.
choriocarcinoma
A rare, highly malignant tumor of germ cell origin, composed of neoplastic cytotrophoblastic and syncytiotrophoblastic cells. These cells, like their placental equivalents are highly invasive causing hemorrhage and necrosis of tissues into which they have spread. Choriocarcinoma elements are common components of teratocarcinomas. Choriocarcinoma cells secrete human chorionic gonadotropin, which serves as a marker for these tumors.
chronic prostatitis
An imprecise term that encompasses a variety of syndromes of variable cause and clinical sequelae: chronic bacterial prostatitis, chronic non-bacterial prostatitis, and prostatodynia.
chyluria
The passage of lymphatic fluid or chyle is noted by the patient as passage of milky white urine. This represents a Iymphatic-urinary fistula.
condyloma acuminatum
A genital wart caused by human papilloma virus most often of the types 6 and 11. Histologically, condylomata resemble other warts and show acanthosis, papillomatosis, prominence of the granular layer, parakeratosis and keratosis. HPV can be demonstrated in the nuclei of the keratinocytes by immunofluorescence microscopy or electron microscopy.
cryptorchidism
An abnormal location of the testis, related to its incomplete descensus during fetal life. The cryptorchid testis may be located in the inguinal canal, inside the abdominal cavity or high in the upper scrotum. The testis may be repositioned into the scrotum surgically (orchidoplexy). Bilateral cryptorchidism results in infertility. Such testes are at increased risk for developing germ cell tumors, which is the primary reason for orchidoplexy, so that surveillance can be done.
cystitis
Acute bacterial cystitis is an infection of the urinary bladder caused mainly by coliform bacteria (usually strains of E. coli and other members of the Enterobacteriaciae) and less often by Gram-positive aerobic bacteria (especially Staphylococcus saprophyticus and the enterococci). The infection usually ascends to the bladder from the urethra. The incidence of acute cystitis is much greater in girls and women than in boys and men because the female urethra is shorter and allows easier ascending infection. Adenovirus infection may lead to hemorrhagic cystitis in children; however, viral cystitis rarely is found in adults.

Predisposing factors include pregnancy, diabetes, urinary calculi, prior instrumentation (e.g., cystoscopy), chemotherapy or radiation therapy. Cystitis may be classified as acute or chronic. Histologically such lesions show nonspecific signs of acute or chronic inflammation. Malakoplakia is a unique form of chronic cystitis in which the infiltrate consists of macrophages that contain cytoplasmic inclusions known as Michaelis-Gutmann bodies. Chronic interstitial cystitis is a persistent form of chronic cystitis of unknown etiology, that does not respond to conventional antibacterial therapy and is often associated with mucosal ulceration (Hunner ulcer).

diverticula of the bladder
Outpouchings of the bladder wall, secondary to chronic obstruction.
dysuria
Painful urination is usually related to acute inflammation of the bladder, urethra, or prostate. At times, the pain is described as "burning" on urination and is usually located in the distal urethra in men.
Eagle-Barrett (prune belly) syndrome
The Eagle-Barrett syndrome is a relatively rare condition in which there is failure of normal development of the abdominal muscles and the smooth muscle of the ureters and bladder. Bilateral cryptorchidism is the rule. At times, talipes equinovarus and hip dislocation are also noted. Because the smooth muscle of the ureterotrigonal complex is deficient, reflux is to be expected; advanced hydroureteronephrosis is present.
embryonal carcinoma
Malignant germ cell tumors composed of undifferentiated cells resembling early embryonic cells. The tumor has a peak incidence in the 25-35 year age group. Pure embryonal carcinomas are rare accounting for about 10-15% of all germ cell tumors. Embryonal carcinoma cells can also act as stem cell of teratocarcinomas, histologically pleomorphic tumors composed of developmentally pluripotent stem cells, and their somatic and extraembryonic derivatives.
enuresis
Bed wetting. It is physiologic during the first 2 or 3 years of life. It may be functional or secondary to delayed neuromuscular maturation of the ureterovesical component, but it may present as a symptom of organic disease (e.g., infection, distal urethral stenosis in girls, posterior urethral valves in boys, neurogenic bladder).
Epididymitis
Inflammation of the epididymis, usually secondary to lower urinary tract infections or sexually transmitted diseases. Often spreads to the testis (epididymo-orchitis). It may cause local pain, swelling and induration. Bilateral epididymitis may cause infertility.
epispadia
Congenital anomaly of the penis and the urethral meatus in which the urethra opens on the dorsal side of the penis. May be associated with other anomalies of the urogenital tract especially extrophy of the bladder.
Erythroplasia of Queyrat
Squamous carcinoma in situ of the glans penis. May progress to invasive cancer, but this occurs only in about 10% of cases.
extrophy of the bladder
A congenital anomaly of the urinary bladder characterized by incomplete closure of the anterior wall of the bladder and the abdominal cavity, allowing the bladder to communicate freely with the external world.
filariasis
An infection with Wuchereria bancrofti a threadlike nematode about 0.5 cm or more in length that lives in the human lymphatics. The patient suffers recurrent lymphadenitis and lymphangitis with fever and malaise. Not infrequently, inflammation of the epididymis, testis, scrotum, and spermatic cord occurs. Varying degrees of painless elephantiasis of the scrotum and extremities develop as obstruction to Iymphatics progresses
frequency
The normal capacity of the bladder is about 400 ml. Frequency may be caused by residual urine, which decreases the functional capacity of the organ.
genital herpes infections
Herpes simplex virus is a double-stranded DNA virus that may cause persistent or latent infections. Most genital herpes infections are due to type 2 virus, although infection due to type I herpes virus, which is commonly associated with oral infections, has been reported in 10-25% of cases of genital herpes. Vesicles grouped on an erythematous base, not following a neural distribution, and associated with a previous history of such eruptions are pathognomonic for genital herpes.
germ cell tumors
Tumors originating from germ cell of the testis, ovary or in extragonadal sites. Irrespective of their origin, these tumors show histologic homology.
Gleason grading system
Grading system for prostate carcinoma. which assigns two grades to each area of prostate cancer based on a major and minor pattern of glandular differentiation in the area. According to this system, Gleason numbers 2-4 represent well-differentiated; 5-7, moderately differentiated, and 8-10, poorly differentiated cancer
gonadoblastomas
Gonadoblastomas comprise 0.5% of all testicular tumors and are almost exclusively seen in patients with some form of gonadal dysgenesis. The majority of these tumors occur in patients under 30 years of age. Four-fifths of patients with gonadoblastomas are phenotypic females. Males typically have cryptorchidism or hypospadias.
granuloma inguinale
Granuloma inguinale, a sexually transmitted chronic infection of the skin and subcutaneous tissue of the genitalia, perineum, and inguinal area, has an incubation period of 2-3 months. The infective agent, Calymmatobacterium granulomatis. A painful papule is the first sign of granuloma inguinale.
Human chorionic gonadotropin (HCG)
HCG is a glycoprotein with a molecular weight of 38,000 Daltons and a half-life of 24 hours. It is composed of 2 subunits: alpha and beta. It is a useful marker for germ cell tumors that contain syncytiotrophoblastic elements.
hydrocele
collection of clear, serous fluid in the scrotum. The fluid typically fills the space between the layers of the tunica vaginalis testis.
Hydronephrosis
Dilation of the ureter, renal pelvis, and calices is usually observed in association with reflux, sometimes to an extreme degree. In males, because they have a relatively long segment of sterile urethra, such changes are often seen in the absence of infection. Sterile reflux is less damaging than infected. Secondary back pressure resulting from reflux or obstruction leading to dilation of the ureter and renal pelvis. With progression this leads to hydronephrotic atrophy of the renal papilla and parenchyma.
hypospadia
A congenital anomaly of the penis and the urethral meatus in which the urethra opens on the ventral side of the penis. It is the most common congenital meatal anomaly.
incontinence
The patient may lose urine without warning; this may be a constant or periodic symptom. The more obvious causes exstrophy of the bladder, epispadias, vesicovaginal fistula, and ectopic ureteral orifice. Injury to the urethral smooth muscle sphincters may occur during prostatectomy or childbirth.
lactic acid dehydrogenase (LDH)
LDH is a cellular enzyme with a molecular weight of 134,000 Daltons that has 5 isoenzymes; it is normally found in muscle (smooth, cardiac, skeletal), liver, kidney, and brain. Elevation of total serum LDH and in particular isoenzyme-I was shown to correlate with tumor burden in NSGCTs. LDH may also be elevated in seminoma.
Leydig cell tumors
Leydig cell tumors are the most common non-germ cell tumors of the testis and account for 1-3% of all testicular tumors. The cause of these tumors is unknown; unlike germ cell tumors, there is no association with cryptorchidism. Ten percent of tumors in adults are malignant.
lymphogranuloma venereum
Chlamydia trachomatis, immunotypes Ll, L2, and L3 cause lymphogranuloma venereum. A papule or pustule appears 5-21 days after sexual exposure. The disease is characterized by a transient genital lesion followed by lymphadenitis and, possibly, rectal strictures.
malakoplakia
A chronic inflammation characterized histologically by infiltrates of macrophages that contain calcific, targetoid, round cytoplasmic inclusions (Michaelis-Gutmann bodies). It occurs most often in the urinary bladder, but may affect testes, kidneys or any other organ in the body. In the urinary bladder, malakoplakia presents as yellow plaques and induration of the bladder wall.
meatal stenosis
Stricture or narrowing of meatus leading to urinary obstruction (congential obstruction)
megaureter
A congenital acquired dilatation of the ureter associated with hydronephrosis.
neurogenic bladder
An abnormally functioning bladder that has lost its autonomic innervation usually following spinal cord injury.
nocturia
Urination at night. Nocturia may be a symptom of renal disease related to a decrease in the functioning renal parenchyma with loss of concentrating power. Nocturia can occur in the absence of disease in persons who drink excessive amounts of fluid in the late evening. Coffee and alcoholic beverages, because of their specific diuretic effect, often produce nocturia if consumed just before bedtime.
non-bacterial prostatitis
Non-bacterial prostatitis clearly is the most common of the prostatitis syndromes; its cause is unknown. Men with non-bacterial prostatitis have abnormal numbers of inflammatory cells in their prostatic expressates, but no causative infectious agent can be found by culture or other means. Some researchers believe that non-bacterial prostatitis is an autoimmune disease of the prostate. The diagnosis of non-bacterial prostatitis is confirmed only by exclusion of other specific forms of prostatitis.
non-gonococcal urethritis
Non-gonococcal urethritis is a syndrome with several microbial causes. The most important and potentially dangerous is Chlamydia trachomatis. Within the last 2 decades, C trachomatis has been recognized as being responsible for an increasing number of genital syndromes.
non-specific granulomatous prostatit
Non-specific granulomatous prostatitis is seen occasionally; it may be eosinophilic or noneosinophilic. The eosinophilic variety typically occurs in men who are asthmatic or prone to allergies. The apparent underlying cause is a type of vasculitis. The non-eosinophilic variety probably results from a granulomatous reaction within the prostate that is caused by extravasation of prostatic secretions from the ducts and acini into the stroma.
obstruction
Blockade of a hollow viscus or blood vessel. Urinary obstruction can occur at the level of renal pelvis, ureter, ureterovesical junction, urinary bladder or the urethra. Such an obstruction may cause hydronephrosis, hydroureter and predispose to urinary infections. Obstructions can be congenital, due to developmental anomalies or acquired; bilateral or unilateral. Acquired obstruction of the ureters may be classified as extrinsic, if the ureter is compressed from outside or intrinsic if the lesion obstructs the lumen from inside. Typical extrinsic causes of obstruction are pelvic tumors, pregnant uterus, retroperitoneal fibrosis. Intrinsic causes include ureteric tumors, urinary stones, blood clots, detached renal papillae separated from the rest of the kidney by papillary necrosis. Obstruction of the bladder is most often caused by prostatic hyperplasia or urinary stones. Urethral strictures secondary to venereal inflammation or tumors are less common causes of urinary obstruction.
orchitis
Inflammation of the testis, resulting from ascending lower urinary tract, or sexually transmitted infection or hematogenous dissertation of pathogens. Ascending orchitis is usually caused by coliform pathogens, N. Gonorrhoeae, Chlamidia, or T. Pallidum. Hematogenous orchitis is caused by pyogenic bacteria that reach testes during sepsis, or viruses, such as mumps virus. Tuberculous orchitis secondary to pulmonary or renal infection is rare in the US.
Papilloma
The World Health Organization recognizes a papilloma as a papillary tumor with a fine fibrovascular stalk supporting an epithelial layer of normal transitional cells maintaining polarity. Papillomas are uncommon, accounting for approximately 2% of all transitional cell tumors.
pneumaturia
The passage of gas in the urine strongly suggests a fistula between the urinary tract and the bowel. This occurs most commonly in the bladder or urethra but may be seen also in the ureter or renal pelvis. Carcinoma of the sigmoid colon, diverticulitis with abscess formation, regional enteritis, and trauma cause most vesical fistulas. Congenital anomalies account for most urethroenteric fistulas. Certain bacteria, by the process of fermentation, may liberate gas .
posterior urethral valves
Most common obstructive urethral lesion in infants and newborns. Occurs only in males. The valves consist of mucosal folds that cause varing degrees of obstruction (congenital obstruction).
primary syphilis
Syphilis is caused by Treponema pallidum, a spirochete, which gains access through the intact or abraded skin or mucous membranes. The patient usually presents with a painless penile sore (chancre) 2 4 weeks after sexual exposure.
prostate specific antigen (PSA)
PSA is a glycoprotein (mol wt 33,000) that is secreted in the cytoplasm of prostatic cells. It is a serine protease and functions normally in aiding liquefaction of semen. It is a good serologic marker of prostate carcinoma. Normal values of PSA in young adults are between 0 and 4 ng/mL. In addition PSA levels are age specific. The upper limits of normal PSA for a 40-49 year-old is 2.5 ng/mL, 50-59-year-old is 3.5 ng/mL, 60-69-year-old is 4.5 ng/mL, and for a 70-79->year-old is 6.5 ng/mL. Recent studies have also shown that two types of serum PSA exist: complexed PSA, which is associated with cancer, and free PSA, which is associated with BPH. Future availability of assays to differentiate the two types of PSA will increase utility of PSA in detecting cancer and estimating BPH. Tumors metastatic to the bone produce osteoblastic metastases which appear dense on x-rays. Such metastases are associated with an elevated serum level of alkaline phosphatase, released from the osteoblasts.
prostatitis
Inflammation of the prostate. Infectious prostatitis is caused by coliform bacteria. No bacterial pathogens are found in a large number of cases which are presumably caused by either viruses or Chlamydia spp. or Mycoplasma spp. or some other unidentified pathogens.
PSA density (serum PSA/prostate volu
PSA density is a laboratory tool proposed as being useful to determine which patients need biopsy. PSA density has been found to be useful in: (a) patients where prostate size is large, whose elevated PSA may be due to BPH; (b) patients where initial biopsy is negative and follow-up PSA reveals a rising trend. Studies have shown that a PSA density above 0.1->0.15 is associated with a 15% incidence of cancer, while a density above 0.15 is associated with 60% cancer.
Reiter syndrome
A syndrome of unknown etiology typically presenting as a triad: urethritis, arthritis and conjunctivitis. The urethral discharge is typical, but it does not contain bacteria.
schistosomiasis (Bilharziasis)
Schistosomiasis, caused by a blood fluke. Schistosoma japonicum is found in the Far East; and Schistosoma haematobium (Bilharzia haematobia) is limited to Africa (especially along its northern coast), Saudi Arabia, Israel, Jordan, Lebanon, and Syria. This disease principally affects the urogenital system, especially the bladder, ureters, seminal vesicles, and, to a lesser extent, the male urethra and prostate gland. Because of emigration of people from endemic areas, the disease is being seen with increasing frequency in both Europe and the USA.
seminoma
A malignant germ cell tumor composed of polygonal neoplastic cells that have clear cytoplasm, contain glycogen and resemble fetal gonocytes. The tumor cells are arranged into solid nests surrounded by fibrous septa that are infiltrated with Iymphocytes. Seminoma accounts for 40% of all testicular tumors. It has a peak incidence in the 35-45 years age group. The tumor is radiosensitive and can be cured in over 90% of cases.
Sertoli cell tumors
Sertoli cell tumors are exceedingly rare, comprising less than 1% of all testicular tumors. Approximately 10% of the lesions are malignant. Virilization is often seen in children, and gynecomastia may be present in 30% of adults.
teratocarcinoma
A malignant germ cell tumor composed of embryonal carcinoma cells, which act as stem cells of the tumor, and their differentiated derivatives. The descendants of malignant stem cells may remain malignant or differentiate into mature nonproliferating tissues. Malignant components of teratocarcinomas belong usually to the extra-embryonic lineages: trophoblastic, placenta-like cells, forming choriocarcinoma elements, and cells corresponding to the extraembryonic yolk sac, known as yolk sac carcinoma. Choriocarcinoma cells secrete human chorionic gonadotropin (hCG), whereas yolk sac carcinoma cells secrete alpha fetoprotein (AFP). AFP and hCG are elevated in the blood of teratocarcinoma bearing patients and serve as serologic markers of this testicular malignancy.
teratoma
A benign tumor of germ cell origin, composed of nonproliferating somatic tissues. In the testis, teratomas are rare and usually found in prepubertal children.
torsion of the testis
A rotation of the testis around the spermatic cord resulting in occlusion of blood vessels and a hemorrhagic infarction of the testis. Because the torsion affects the thin walled veins more than the arteries, the infarct resulting from the obstruction of venous outflow is always hemorrhagic.
trabeculation of the bladder wall
In order to balance the increasing urethral resistance, the bladder musculature hypertrophies. With hypertrophy, individual muscle bundles become taut and give a coarsely interwoven appearance to the mucosal surface.
TRUS - Transrectal Ultrasonography
TRUS is useful to diagnose and stage prostate cancer in several ways. (a) It can identify 60% of cancers even if they are nonpalpable, because of hypo-echogenic characteristics of these cancers. This is presumably because the compact, highly cellular nature of malignancy produces a minimal interphase between cells, and this creates minimal internal echoes. Transrectal ultrasound is also more accurate than DRE at detecting extracapsular extension.
tumors of the epididymis
Adenomatoid tumors of the epididymis are the most common and typically occur in the third and fourth decade of life. Leiomyomas are the second most common tumor of the epididymis.
tumors of the scrotum
The most common benign lesion is a sebaceous cyst. Squamous cell carcinoma is the most common malignant tumor of the scrotum. In the past, squamous cell carcinoma of the scrotum most commonly resulted from exposure to environmental carcinogens including chimney soot, tars, paraffin, and some petroleum products.
tumors of the spermatic cord
Spermatic cord tumors are typically benign. Lipomas of the cord account for the majority of these lesions.
urethral caruncle
A painful, polypoid ulcerated mass at the meatus of female urethra. Histologically, it consists of granulation tissue covered with hyperplastic partially ulcerated transitional or squamous cell epithelium.
urethritis
Inflammation of the urethra, most often caused by coliform bacteria, or sexually transmitted pathogens such as Neisseria gonorrhoeae, Chlamydia spp.and Mycoplasma spp.
varicocele
Varicosities of the scrotal veins forming the pampiniform plexus. Most often it produces no symptoms but it may cause infertility.
Verrucous carcinoma of the penis
A low-grade malignancy also known as giant condyloma of Buschke-Lowenstein which presents as a cauliflower-like, exophytic lesion.
Yolk sac tumor
A malignant germ cell tumor of the testis, typically found in children under the age of fIve years. Histologically the tumors appear variegated and show numerous patterns of cell growth, labeled as reticulated, microcystic, papillary myxoid, etc. Schiller-Duval bodies resembling fetal glomeruli are often present. The tumor cells secrete AFP. Surgery is curative. Similar yolk sac tumor elements may be found in teratocarcinomas, accounting for the elevated AFP in the blood of patients harboring these tumors.