phimosis - inability to retract foreskin; can result in balantis - glans penis inflammation due to build up of smegma (sloughed epithelial cells and mucus)

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paraphimosis - inability to replace foreskin

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hypospadias - condition where urethral meatus opens on the ventral surface on the glans or shaft -> external marker for other internal urinal malformations

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epispadias - condition where urethral meatus opens dorsally on the glans or shaft of penis

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Scrotum - contains tesis, epididymis, spermatic cord and layer of muscle. Septal fold separates two scrotal sacs.

spermatic cord - composed of vas deferns and ttesticular arteries and veins; leaves scrotum through the inguinal canal.

Left scrotal sac hangs lower than right, since left spermatic cord is longer. Tone of dartos muscle determines the size of the scrotum. The scrotum is contracted in cold environments and more pendulous in warm environments.

Scrotal masses:

indirect inguinal hernia: presents as a scrotal mass, since hernia descends thro inguinal canal coming to lie in front of the spermatic cord and testis. do not transsilluminate. Peristatlic sounds heard on ascultation of scrotum.

hydrocele - accumulation of serous fluid in the cavity of the tunica vaginalis secondary to inf. or trauma. fluid mass rests anterior ot testis and epididymis.

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hydrocele of the spermatic cord; mass lies high in the scrotum. May or may not transillluminate;

spermatocele - cystic collection of sperm in epididymis; pea-sized to 8-10 cm. Follows the course of hte epididymis posterior and superior to testis; may transiluminate; non-tender

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varicocele - varicosities of the pampiniform venous plexus running along the spermatic cord; ask patient to stand; soft, irregular, scrotal mass, superior to testis, "bag of worms feel", DO NOT TRANSILLUMINATE; normally happens on L > R; if it happens on R, think about IVC obstruction; if L, think left renal vein compression due to renal carcinoma; infertility, heaviness in scrotum, or pain

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orchitis - acute inflammation of testis that presents as tender swelling of scrotal contents; warm, diffusely painful, red; secondary to UTI of e. coli; if viral (mumps), then will result in hypogonadism; does not transilluminate; systemic symptoms - chills, fever and myalgias

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epididymitis - tender swelling of epididymis usually due to venereal disease; swelling and tenderness superior and posterior to testicle (along the epididymis); accompanied by systemic symptoms; does not transilluminate

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testicular torsion - rotation of spermatic cord and blood vessels ; rapid severe pain and scrotal swelling; does not transilluminate; around puberty and younger men; MEDICAL EMERGANCY; rule out with US.

testicular cancer - presents as painless testicular nodule; adherent to surface of testis; many nodules may exist; does not trransilluminate; 15-35 y/o

In left scrotal sac - venous drainage to L renal vein

In R scrotal sac - drainage to IVC;

thus there's higher pressure gradient at L side, making the L-sided varicocele more common.

If L-sided, think about renal vein compression secondary to renal carcinoma

If R-sided, think about IVC obstruction

Indirect inguinal hernia - weakness in ther internal inguinal ring that allows bowel to slide down along spermatic cord; hernia may exit external ring and enter scrotal sac, or present as a bulge over the midpoint of inguinal ligament.

on exam: exminer must invaginate scrotal sac with index finger inserted into external inguinal ring; ask pt. to cough or strain, while examiner looks for impulse at end of fingertip

direct inguinal hernia - weakness of the post. wall of the inguinal canal directly behind the external ring; bulge produced through the floor of the inguinal canal close to the pubic tubercle and medial to that of an indirect inguinal hernia; scrotal involvement rare

prostate gland

normal: 4 x 3 x 2 cm; weight 20 gms; posterior surface is in close contact with anterior rectal wall, and is accessible to digital palpation on rectal exam (8-10 cm in);

prostate is convex, with a median sulcus, consistency of tightly extended thenar eminence;

normally protrudes no more than 1 cm into rectum

stone-hard consistency is indicative of prostate malignancy

Risk factors for testicular cancer:

Caucasian

Cryptorchisim (undescended testes)

mumps orchitis

inguinal hernia in childhood