PRAKTIKUM

PATOLOGI ANATOMI
TRAKTUS GENITALIA
FAKULTAS KEDOKTERAN
UNIVERSITAS KRISTEN DUTA WACANA
1. HYPOSPADIAS
• Abnormal opening of the urethra onto the
ventral surface of the penis or scrotum.
• This results from failure of fusion of the
urethral folds, i.e., it is a form of
feminization. Occurs 1 in 250 male alive
births.
• In the newborn, the differential diagnosis of
proximal hypospadias associated with an
undescended testis should include forms of a
disorder of sexual differentiation, particularly
female virilization (congenital adrenal
hyperplasia), mixed gonadal dysgenesis, partial
androgen insensitivity, and true hermaphroditism
• A karyotype should be obtained in patients with
midpenile or proximal hypospadias and
cryptorchidism
• Right now there is a pop claim that
hypospadias has doubled in frequency in the
past twenty years, and the cause is chemical
pollutants acting as "endocrine disruptors".
• The urethral meatus may open on the ventral
surface of the penis, at the base of the penis
or the perineum.
• This infant with ambiguous genitalia was a
genetic male. The arrow points to the
urethral orifice that opens unto the
perineum.
2. EPISPADIA
 EPISPADIAS
• Abnormal opening of the urethra on the dorsal
surface of the penis.
• Epispadias is a form of extrophy of the urinary
bladder.
• There is usually an associated separation of the
pubic bones and inadequacy of the urinary
sphincters.
• Incontinence and bladder infections are usual.
• Epispadias is fortunately less common than
hypospadias and more difficult to correct surgically.
3. BENIGN PROSTATIC
HYPERTROPHY dan
PROSTATITIS
 4. PROSTATIC
ADENOCARCINOM
A
5. EPIDIDYMITIS and
ORCHITIS
• Non-specific infections of the contents of the scrotum are
usually complications of urinary tract infection,
instrumentation or prostate surgery.
• Gonorrhea: the infection often spreads to the epididymis,
less often the testis.
• Mumps: orchitis is common in adolescents and adults. It
usually follows the onset of parotitis by a week or so, and
may cause atrophy of the germinal epithelium and
infertility. The Leydig cells are spared.
• Tuberculosis: granulomas involving the epididymis; may
spread to the testis.
• Syphilis: gummas involving the testis; may spread to the
epididymis.
 Figure 5.12 (A) Acute vasculitis. Under the tunica albuginea, muscular arteries show
fibrinoid necrosis  and an inflammatory infiltrate. (B) Acute vasculitis. Fibrinoid necrosis
causes segmental infarcts  causing sudden pain.
Acute orchitis. Segmental involvement of tubules is common.
Figure 5.15 (A) Syphilitic orchitis. The interstitium shows a granuloma. (B) Syphilitic
orchitis. A  medium-sized vessel shows marked subintimal fibrosis. (C) Syphilitic gumma.
The circular firm tan  nodule with a broad fibrotic rim suggests a gumma. (D) Syphilitic
gumma. The center of the lesion  shows an ischemic coagulation necrosis with abrupt
transition to a fibrotic zone with an inflammatory  infiltrate.
6. TORSION OF
SPERMATIC CORD
("torsion of the testis")
• Twisting of the spermatic cord is likely to result in
venous infarction and gangrene in a few hours.
• This is quite common, especially in children and
adolescents.
• The involved testis is painful and elevated; the cord
is typically twisted.
• There may or may not be a history of trauma (often
minor, as in baseball or break dancing.
• The underlying problem may be abnormal fixation
of the testis or cryptorchidism.
 7. Hydrocele, Hematocele,
Spermatocele dan Varicocele
 HYDROCELE
• Fluid in the tunica vaginalis.
• Usually idiopathic
• A hydrocele may contain 100 cc or more of
serous fluid.
• If ascites is present and the patient has a
patent processus vaginalis, a hydrocele will
appear and disappear as the patient changes
position.
• One can distinguish a hydrocele from a tumor
mass by trans-illuminating it with a bright
flashlight in a dark room.  
• Hematocele
• Blood in the tunica vaginalis.
• May follow trauma, or a sing of an underlying testicular
cancer.
• Chylocele
• Accumulation of lymphatic fluid in the tunica.
• Spermatocele
• A cystic lesion up to 1 cm or so in the area of the rete
testis, filled with fluid and dead sperms.
VARICOCELE
• Varicosities of the pampiniform plexus,
• Usually on the left side.
• This is common in young men, may cause fertility problems by
warming the testes.
• A new varicocele in an old man often indicates occlusion of
the vein by renal cell carcinoma.
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