Testis • The central zone (CZ)

• 3.5- 4 cm in length and 2-3 cm in width

• The transitional zone (TZ)
• Covered by fibrinous tunica albuginea

• The spermatic cord enters the testis along

the posterosuperior margin, known as the
mediastinum testes

• Divided into lobules arrayed radially

around the mediastinum testes; each
lobule being composed of branching
seminiferous tubules

• 20-30 ducts form the prostate gland

• NOTES: not visualized- undescended

testes

:view- transsagittal, transverse

:white echogenecities- calcification

Epididymis
• 6-7 cm in length

• 7-8 mm diameter at the globus major

(head of epididymis at mediastinum testis)
and

• 1-2 mm at the tail where it continues as

the vAS deferens

• The vas deferens courses through the

spermatic cord and exits via the deep
inguinal ring

• At the base of the prostate, it joins the

seminal vesicle to form the ejaculatory
duct

Prostate

-has 3 zones:

• The peripheral zone (PZ)

 • To evaluate the upper urinary tract for
ureteral obstruction and obstructive
nephropathy

• To evaluate bladder size and estimate

post-void residual urine volume, bladder
wall thickness, presence of trabeculation,
and formation of diverticula

• The prostate gland should be evaluated

for gross evidence of adenocarcinoma

COMMON DISEASES

1. Benign Prostate Hypertrophy (BPH)

• affects 50-75% of men over age 60 years

• a result of uninhibited contractioins of a

hypertrophied detrusor muscle due to
obstructon of the prostatic urethra by
enlargement of glandular tissue of the
prostate

• NOTES: central zone- mostly affected

• CT SCAN:
2. Prostate Cancer

• 70% occur in the peripheral zone (PZ)

• 20% are found in the transition zone (TZ)

• Trans-rectal biopsy is the gold standard for

diagnosis

• Direct extentsion into the seminal

vesicles, bladder base, and perivesical fat

• Extracapsular spread is evaluated with

transrectal prostate ultarasonography with
biopsy or endorectal coil MR imaging +/-
MR spectroscopy

• Nodal metastases may be evaluated with

CT or MRI, and biopsy is performed if
nodes are greater than 10 mm

• If nodal disease is present, 80% have bone

mets within 5 years. The obturator and
internal/external iliac nodal chains are
most commonly involved. Bone
metastases are evaluated by checking the
PSA level, then performing a bone scan.

• Ill-defined bladder mass at the
bladder base (arrows) 3. Torsion
• The mass is well seen because it is
outlined by the excreted contrast
(M)
• This mass is seen to arise from the
prostate gland (P)
• Prostate normal size: <4 x 4 (3.7 x
3.7 x 3.7; <20 grams)
Bulge in the scapular line
Signal
intensity is
demonstrated in the right peripheral
zone
• Due to abnormal configuration of the
testicle on its pedicle (“bell clapper
deformity”), leading to abnormal twisting
of the spermatic cord that causes
testicular ischemia. It is most common in
adolescents and infants less than 12
months old.
• Torsion is classified as complete or
incomplete.
• Complete torsion: >360 degree twist.
Adult males 80% testicular salvage rate
when reversed within 5 hours
• Incomplete torsion: <360 degrees.
Relatively longer period before testicle is
unsalvageable
• HIGH RESOLUTION ULTRASOUND
• Enlarged and diffusely hypoechoic
testicle
• Contains multifocal hypoechoic
areas
• Epididymis may be enlarged and
hypoechoic
• Scrotal thickening
• DOPPLER ULTRASOUND
 • If there is no blood flow to testis Enlarged & predominantly hypoechoic epididymis
(evaluated by Doppler ultrasound) with a reactive hydrocele
after 1 minute of scanning time

• If there is a single small vessel in

the symptomatic testis, when
contralateral normal testis shows
readily detectable diffuse flow

• COLOR DOPPLER ULTRASOUND

• Enlarged, hypoechoic hyperemic

epididymis

4. Epididymitis • Increased color flow/blood flow

surrounding symptomatic
• Is the most common acute scrotal process epididymis
in postpubertal age group

• 9x more common than the main

differential consideration, testicular
torsion

• ULTRASOUND

• Enlarged and hypoechoic

epididymis

• Hydrocele or pyocele

• Scrotal skin thickening

• Associated orchitis

5. Orchitis

• Is a parenchymal infection of the testicle

• Often seen as a complication of mumps

infection (25% of postpubertal male
patients with mumps)
 • Other frequent causes include echovirus, NOTES: massive upper and lower
group B arboviruses, and lymphocytic peritesticular areas
choriomeningitis virus

• Unilateral in 2/3, usually developing within

7-10 days of parotiditis associated with
mumps

• The testicle may be secondarily involved

by epididymitis

7. Hydrocele
*enlarged left testicle
• Is the accumulation of fluid between
NOTES: hydrocele, enlarged epididymal head,
the visceral and parietal tunica
testicle with thickened scrotal sac
vaginalis

• It may occur in isolation or in

6. Varicocele association with epididymitis, orchitis,
torsion, trauma, or tumor
• Distention of the pampiniform venous
plexus due to incompetent valves of the
spermatic vein

• Standing or valsalva may provoke the

distention

• 95% are left-sided, and are the most

common manageable cause of male
infertility

• COLOR DOPPLER

• The compressible, tortuous vessels

measure more than 2 mm diameter
8. Scrotal Trauma
• Ultrasound demonstrates multiple • presents with pain, nausea, vomiting
serpiginous anechoic spaces of and extreme tenderness with scrotal
similar size, and Doppler shows ecchymosis and swelling
venous flow within these spaces • surgical exploration and debridement
is needed if the tunica albuginea has
been violated and devitalized
 TUMORS

semineferous tubules have extruded

or if there is a large scrotal hematoma
• ULTRASOUND
• irregular testicular contour
(rupture)
• multifocal linear hypoechoic
areas (contusion)
• comlex hydrocele, or
• extratesticular mass caused by
hematoma
• areas of uniformly decreased echogenicity
• usually focal but may be diffuse
• may cause bulging of the tunica albuginea

Staging is performed by CT
I tumor confined to testis
II extratesticular spread
IIA minimal nodal metastases, limited to
infradiaphragmatic stations
IIB bulky retroperitoneal nodal metastases
III lymphatic involvement above diaphragm
IV extranodal metastases (pulmonary,
hepatic, osseous, CNS

a focal hypoechoic structure within this

testicle
this is most consistent with hematoma

Seminoma
• the most common malignancy of males
age 15-30
• usually presenting as a painless scrotal
mass
• risk factors include
• cryptorchidism
• maternal diethylstilbestrol (DES)
use
• testicular atrophy
• germ cell tumors comprise
• 95% of testicular cancer *NOTES:
• 40% of these are seminomas Male pelvis- Ultrasound is done first
• 40% showed mixed histologic - mass: transrectal ultrasound
pattern - with malignancy: CT scan or
MRI
-testicle: HRUTZ

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Maraming salamat kay ate cands para sa
additional notes. ☺