• Opening of urethra on the inferior surface of the penis
• Due to failure of the urethral folds to close  

• Opening of urethra on superior surface of peis
• Due to abnormal positioning of the genital tubercle
• Associated with bladder exstrophy 

• Benign warty growth on genital skin
• Due to HPV type 6 or 11
• Characteized by koilocytic change 

• Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
• Sexually transmitted disease caused by Chlamydia trachomatis serotypes L1-L3
• Eventually heals with fibrosis
• Perianal involvement may result in rectal stricture

• Malignant proliferation of squamous cells of penile skine
• Risk Factors:
• Lack of circumcision- freskin acts as a nidus for inflammation and irritation if not properly maintained
• HPV: 2/3 of cases 
• Precursos in situ lesions:
• Bowen disease: In situ carcinoma on the glans that presents as leukoplakia
• Erythroplasia of Queyrat: In situ carcinoma on the glans that presents as erythroplakia
• Bowenoid Papulosis: It situ carcinomas that presents as multiple reddish papules
• Seen in younger patients (40s)
• Does not progress to invasive carcinoma

• Failure of testicle to descend into the scrotal sac
• Testicles normally develop in the abdomen and then descend into the scrotal sac as the fetus grows
• Most common congenital male reproductive abnormality (seen in 1% of male infants)
•  Most cases resolve spontaneously otherwise orchiopexy is performed before 2 yrs of age
• Complications include testicular atrophy with infertility and increased risk for seminoma

• Inflammation of the testicle
• Causes:
• Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae
• Increased risk of sterility but libido is not affected because of Leydig cells are spared
• E coli and Pseadomonas: seen in older adults.  UTI pathogens spread into the reproductive tract  
• Mumps virus (teenage males)-increased risk for infertility: testicular inflammation is usually not seen in children < 10 yrs old
• Autoimmne orchitis: characterized by granulomas involving the seminiferous tubules

• Twisting of the spermatic cord
• Thin-walled veins become obstructed leading to congestion and hemorrhagic infarction
• Usually due to congenital failure of testes to attach to the inner lining of the scrotum 
• Presents in adolescents with sudden testicular pain and absent cremasteric reflex  

• Dilation of the spermatic vein due to impaired drainage
• Presents as scrotal swelling with a "bag of worms" appearance
• Usually left sided
• The left testicular vein drains into the left renal vein while the right testicular vein drains directly into the IVC
• Associated with left sided renal cell carcinoma, renal cell carcinoma often invades the renal vein
• Seen in a large percentage of infertile males  

• Fluid collection within the tunica vaginalis
• Tunica Vaginalis is a serous membrane that covers the testicle as well as the internal surface of the scrotum
• Associated with incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)
• Presents as scrotal swelling that can be transilluminated   

• Arise from germ cells or sex cord stroma
• Presents as a firm, painless testicular mass that cannot not be transilluminated
• Usually not biopsied due to risk of seeding the scrotum
• Removed via radical orchiectomy
• Most testicular tumors are malignany germ cell tumors  

• Malignant tumor comprised of large cells with clear cytoplasm and central nuclei
• Resembles spermatogonia
• Forms a homogenous mass with no hemorrhage or necrosis
• MC testicular tumor
• Resembles ovarian dysgerminoma
• Rare cases may produce HCG
• Good prognosis  
• Responds to radiotherapy

• Malignant tumor comprised of immature, primitive cells that may produce glands
• Forms a hemorrhagic mass with necrosis
• Aggressive with early hematogenous spread  
• Chemotherapy may result in differentiation into another type of germ cell tumor (e.g. teratoma)
• Increased AFP or HCG may be present

• Malignant tumor that resembles yolk sac elements
• Most common testicular tumor in children
• Schiller-Duval bodies- glomerulus like structures are seen on histology
• Elevated AFP

• Malignant tmor of syncytiotrophoblast and cytotrophoblast (placenta-like tissue but villi are absent)
• Spreads early via blood
• HCG is elevated
• May lead to hyperthyroidism or gynecomastia
• β-HCG is similar to that of FSH, LH, and TSH 

• Tumor composed of mature fetal tissue derived from two or three embryonic layers
• Malignant in MALES
• AFP or B-HCG may be increased  

• Germ cell tumors are usually mixed
• Prognosis is based on the worst component  

• Tumors that resemble sex-cord stromal tissues of the testicle
• Usually benign
• Leydig cell tumor usually produced androgens causing precocious puberty in children or gynecomastia in adults
• Reinke crystals seen on histology
• Sertoli cell tumor is comprised of tubules and is usually cliniclaly silent  

• MCC of a testicular mass in males > 60 yrs old
• OFten bilateral mass
• Usually of diffuse large B cell types  

• Small round organ that lies at the base of the bladder encircling the uethra
• Sits anterior to the rectum
• Posterior aspect of prostate is palpable by digital rectal exam
• Consists of glands and stroma
• Glands are composed of an inner layer of luminal cells and an outer layer of basal cells
• Secrete alkaline: milky fluid that is added to sperm and semnal vesicle fluid to make semen
• Glands and stroma are maintained by androgens  

• Acute inflammation of the prostate is usually due to bacteria
• C. trachomatis and N. gonorrhoea are common causes in young male adults
• E. coli and Pseudomonas are common causes in older adults
• Presents as pysuria with fever and chills
• Prostate is tender and boggy on digital rectal exam
• Prostatic secretions show WBC but cultures reveal bacteria  

• Chronic inflammation of prostate
• Presents as dysuria with pelvic or lower back pain
• Prostatic secretions show WBCs but cultures are negative

Benign Prostatic Hyperplasia

BPH

• Hyperplasia of prostatic stroma and glands
• Age-related change
• Present in most men by the age of 60 yrs old
• No increased risk for cancer
• Related to dihydrotestosterone (DHT)
• Testosterone is converted to DHT by 5-α-reductase in stromal cells
• DHT acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules
• Occurs in the central periurethral zone of the prostate
• Problems starting and stopping urine stream
• Impaired bladder emptying with increased risk for infection and hydronephrosis
• Urine dribbling
• Hypertrophy of bladder wall smooth muscle
• Increased risk for bladder diverticula
• Microscopic hematuria may be present
• Prostate specific antigen (PSA) is often slightly elevated due to increased number of glands
• PSA is made by prostatic glads and liquifies semen
• Treatment: α1-antagoist (terazosin) to relax smooth muscle
• Also relaxes vascular smooth muscle lowering BP
• α1_A - antagonist (tamsulosin) are used in normotensive individuals to avoid the α1_B- antagonist effects on blood vessels
• 5α-reductase inhibitor can be used as treatment as well
• Blocks conversion of testosterone to DHT
• Takes months to produce results
• Also useful for male pattern baldness
• Side effects are gynecomastia and sexual dysfunction

• Malignant proliferation of prostatic glands
•  Most common cancer in men
• 2nd most common cause of cancer-related death
• Risk factors include age, race (African Americans> Caucasians > Asians) and diet high in saturated fats
• Prostatic carcinoma is most often clinically silent
• Usually arises in the peripheral posterior region of the prostate and hence does not produce urinary symptoms early on
• Screening begins at age of 50 wtih DRE and PSA
• Normal serum PSA increases with age due to BPH
• PSA > 10 ng/dL is highly worrisome at any age
• Decreased % free-PSA is suggestive of cancer (cancer makes bound PSA)
• Prostatic biopsy is required to confirm the presence of carcinoma
• Shows small, invasive glands with prominent nuceoli
• Gleason grading system is based on architecture alone (not nuclear atypia)
• Multiple regions of the tumor are assessed because architecture varies from area to area
• A score (1-5) is assigned for two distinct areas and then added to produce a final score (2-10)
• Higher score suggests worse prognosis
• Spread to lumbar spine or pelvis is common results in osteoblastic metastases that present as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)
• Prostatectomy is performed for localized disease
• Advanced disease is treated with hormone supression to reduce testosteron and DHT
• GnRH analogs (leuprolide) shut down the hypothalamus (LH and FSH are reduced)
• Flutamide acts as a competitive inhibitor at the androgen receptor