‫• اهم شي بيه البوسترير يورثر فالف والهايبوسبيدس‬

Disorders of Seminal Vesicles,

Penis, &Urethra
Seminal Vesicles A strictly male organ (no
female homologue), develops as a dorsolateral
bulbous swelling of the distal mesonephric duct
at approximately 12 fetal weeks The normal
adult seminal vesicle is 5 to 10 cm in length and
3 to 5 cm in diameter The major canal of the
seminal vesicle empties into the ejaculatory
duct (average length of 2.2 cm) at the terminal
.portion of the vas deferens within the prostate
 PHYSIOLOGY
The secretions from the seminal vesicle contribute
approximately 50% to 80% of the ejaculate
volume, with an average volume of 2.5 mL and a
pH in the neutral to alkaline range
DIAGNOSISThe diagnosis of seminal vesicle
neoplasms can be difficult because they often do
not cause symptoms until late in their course.
General symptoms that may occur include urinary
retention, dysuria, hematuria, or hematospermia.
A mass is often palpable above the prostate and is
usually not tender. Transrectal ultrasound (TRUS)
 Congenital Lesions
Agenesis of the Seminal Vesicles
Unilateral agenesis. It may be associated with
unilateral absence of the vas deferens, as well as
ipsilateral renal anomalies
Bilateral absence of the seminal vesicles is
frequently found in association with congenital
bilateral absence of the vas deferens (CBAVD)
Obstruction of the Seminal Vesicles entrance of
an ectopic ureter leading to infection of the
obstructed organ due to local invasion of bladder or
prostate cancer
Hematospermia: bloody ejaculation middle age may
be due to hyperplasia of mucosa of SV
 Infection
Vesiculitis Bacterial infections are commonly due to colonic
flora and are thought to be secondary to bacterial prostatitis.
Occasionally, chronic bacterial seminal vesiculitis may require
surgical removal to eliminate symptoms and to prevent
recurrent septicemia
Abscess Abscesses of the seminal vesicles usually have an
unknown etiology, although predisposing factors include
diabetes mellitus, chronic indwelling catheter, and endoscopic
manipulation
Calculi are usually related to obstruction, infection, or both

Masses most masses within the seminal vesicles are not

neoplastic. Tumors the seminal vesicles are extremely rare.
Benign primary tumors are the most common, simple cysts of
the seminal vesicle due to obstruction of the ejaculatory duct

of
 Disorders of Penis
Apenia: congenital absence of penis, extremely
rare; urethra opens on perineum or inside
rectum
Megalopenis: enlarged rapidly during childhood
due to abnormalities that increase the
production of testosterone (interstitial cell tu. of
testis, hyperplasia, tu, of adrenal cortex)
Micropenis: more common, testosterone
deficiency, a penis smaller than 2 standard
deviations from norms .ass. With small
undescended testicles, small scrotum, D.T
decreased ability of hypothalamus to secrete
LHRH
 Congenital anomalies of the Urethra
:Urethral stricture
Congenital is uncommon, fossa navicularis &
membranous U. are the most 2 common sites.
.If sever leads to BOO
Diagnosis by EU&VCU&even retrograde
urethrography. Cystoscopy &urethroscopy are
mandatory whenever suspected
Treatment: surgical, cystoscopy dilatation, direct
vision internal urethrotomy
Single stage –open surgical repair by
anastomotic urethroplasty, buccal mucosa graft
& penile flap
 :Posterior Urethral Valves

most common obstructive urethral lesions in

infants &newborn, only in male, at distal
prostatic urethra; these are mucosal folds
that look like thin membranes they may
cause varying degrees of obstruction
when child attempts to void
:Clinical Findings

A- S&S: mild, moderate to sever symptoms of obstruction, poor

intermittent dribbling urinary stream, urinary infection &sepsis,
hydronephrosis, failure to thrive
B – Laboratory findings: uremia, poor concentrating ability, urine
infection, anemia, (B urea& creatinine clearance are the best
indicators of extent of renal failure)
C – X-Ray finding: voiding cystorethrography, large residual urine,
VUR, sever trabeculation, elongation of posterior urethra with
.prominent bladder neck, EU hydronephrosis &hydroureter
D – U.S: hydronephrosis, hydroureter, bladder distention, fetal
hydronephrosis typical at 28w
:E – Instrumental Examination
Urethroscopy &cystoscopy, under G.A
trabeculation&cellues occasionally, vesical
.diverticula, visual identification
Treatment; distraction of the valves, in mild
to moderate cases TU fulguration, in sever
cases catheter AB &correction of fluid
&electrolyte imbalance, Vesicostomy if
.reflux .percutaneous loop ureterostomies
 ;Anterior urethral valves
rare congenital anomaly .urethral dilatation
or diverticula proximal to the lesion, boo,
post voiding incontinence, &infection,
.enuresis
.Diagnosis; urethroscopy &VCUG
.Treatment; electro fulguration
:Urethrorectal &Vesicorectal Fistulas
Are rare &almost always associated with
imperforated anus
 :Hypospadias
the urethral meatus opens on the ventral
side of the penis proximal to the tip of the
glans penis
Sexual differentiation &urethral development
8-15w
Fusion of urethral folds along the ventral
.surface of the penis
Familial? No specific genetic, estrogen
.&progesterone increase the incidence
 Classification: in male evidence of
feminization

Glandular -1
Coronal -2
Penile -3
Penoscrotal -4
Perineal -5
Clinical Findings:
S&S
Difficulty in directing the urinary stream &stream
spraying
Chrdee can prevent sexual intercourse, infertility
Abnormal hooded appearance, meatal
stenosis,association with undescended testis
:Laberotary,X-ray &indoscopic finding
Buccal smear &karyotyping
Treatment: surgery
For psychological reasons before school age
 :Chordee without Hypospadias
Short urethra, fibrous tissues surrounding
the corpus spongiosum, both
Epispadias: urethra displaced dorsally
More in male classification glandular,
penile, penopubic
In female; bifid clitoris, separation of labia,
.most are incontinent
Treatment ; surgical ,continence
 Acquired Diseases &Disorders of
the penis &male urethra
Priapism: prolonged painful erection with no
sexual desire or excitement
idiopathic 60%
associated with (leukemia, sickle cell disease, 40%
pelvic tumor, and pelvic infection), penile
.trauma, spinal cord trauma, use of medication
:Classification
High flow non ischemic; perineal trauma, central -1
penile artery lead to loss of penile blood flow
regulation
;Low flow ischemic -2
 :Peyronies disease
Plastic induration of the penis affecting
middle age &older men complaining of
painful erection, curvature &poor erection
distal to the affected area
Examination of the penile shaft reveals
palpable dense fibrous plaque of varying
.size involving tunica alboginea
spontaneous remission 50%
Phimosis: the contracted foreskin cannot be
retracted over the glans.
Paraphymosis:the foreskin ,once retracted over
the glans, cannot be replaced in its normal position
Circumcision:higher incidence of penile
.carcinoma in uncircumcised males

Urethral stricture :acquired is common in

men but rare in women
Infection, trauma ,long term catheter,
.instrumentation
Clinical Findings:
S&S
Decrease in urinary stream, spraying or double &post voiding dribbling
.Chronic urethral discharge (C.prostatitis)
.Acute cystitis
Induration, periurethral abscess, urethrocutaneous fistulas, if chronic
retention; palpable bladder
:Laboratory findings
Urofometry if less than 10ml/sec (normal>20ml/sec)
Urine for c/s
:X-ray findings
Urethrogram or VCUG
Instrumental Examination
.Urethroscopy
:DD
.Prostatic condition, bladder neck contracture urethral CA
 :Complications
Chr.prostatitis, cystitis, chr.urinary infection,
diverticula, periurethral abscess,VUR,
urethral CA.vesical calculi
:Treatment
.dilatation: not curative -1
:Urethrotomy under direct vision -2
:Surgical reconstruction -3
:Treatment of complications -4
 Urethral Condylomata Acuminata
(urethral warts)
Wart like papillomas caused by papilloma virus
usually transmitted sexually
Complain from bloody spotting,
.u.discharge&dysuria
:Treatment
Resection; direct, transurethral fulguration by
.resectoscope, CO2-Laser
Multiple lesions; 5% fluorouracil solution 20min-
.2/w-5w
:Stenosis of Urethral Meatus
:Penile Phlebothrombosis &Lymphatic Occlusion
 PENILE PHLEBOTHROMBOSIS &
LYMPHATIC OCCLUSION

Superficial veins and lymphatic vessels of the dorsal penile •

shaft just proximal to the corona may become irritated and •
.inflamed
,Examination reveals a tender, indurated
cord-like structure on the distal penile shaft. Slight erythema
.may be present
both penile phlebothrombosis
.and lymphatic occlusion will resolve spontaneously
.The patient must be reassured
 Disorders of the female urethra.
:Cogenital
Distal urethral stenosis in infancy
&childhood (Spasm of the External Urinary
:Sphincter)
:Labial fusion (synechia vulvae)
 :Acquired
,Chronic Urethritis: one of most common
:Senile Urethritis
Symptoms; vesical irritability stress incontinence
.veginal &vulval itching &discharge
Signs; veg.ep. dry &pale, mucosa at urethral
orifice red &hypersensitive
.Lab. Findings :urine is microorganism free
Treatment: diethylstilbestrol,Estrogen
crems&suppositories
 :Urethral Caruncle
benign red friable vascular tumor involving the
posterior lip of the external urinary meatus ,rare
.before the menopause
Prolapse of the Urethra: not common ,children
&paraplegic LMNL
:Urethroveginal fistula
Urethral
.diverticulum:discharge,dysuria,dyspareunia
Urethral stricture: organic not common ,functional
.is more common
 Abnormalities of the Testis and
Scrotum
CRYPTORCHIDISM(UNDESCENDED TESTIS) •
one of the most common disorders encountered •
in pediatric urology •
beginning early in the second month of gestation and •
testicular hormones stimulate development of the •
gubernaculum and testicular descent in the second and
.third trimesters
the gubernaculum develops in both sexes •
Undescended testis is the absence •
of one or both testes in normal scrotal position •
Retractile testes are •
scrotal testes that retract easily out of the scrotum but can be •
manually replaced in a stable scrotal position and remain there
at least temporarily
The pathogenesis •
of isolated cryptorchidism remains largely unknown •
but is most likely multifactorial, involving both genetic •
and environmental risk factors •
Palpable Testes •
may be located along the line of normal •
descent between the abdomen and scrotum or •
in an ectopic
Nonpalpable Testes
Diagnosis
Inguinoscrotal ultrasonography and magnetic resonance
imaging (MRI) are not usually helpful in the diagnosis and
management
of nonpalpable testis
Diagnostic laparoscopy followed by laparoscopic
orchidopexy
Treatment •
Correction of cryptorchidism is indicated to optimize •
testicular function, potentially reduce and/or facilitate •
diagnosis of testicular malignancy, provide cosmetic •
benefits, and prevent complications such as clinical •
.hernia or torsion •
If descent does •
not occur in the postnatal period, present consensus •
supports surgical treatment at 6 months of age •
Medical Therapy •
hCG •
Surgical •
Inguinal Orchidopexy •
Open Transabdominal Orchidopexy •
Laparoscopic Orchidopexy and Fowler-Stephens •
Orchidopexy
Prognosis •
Risk of Malignancy •
Risk of Subfertility •
testicular germ cell tumor (TGCT) •
The relative risk of malignant transformationin an undescended testis is
2.5 to 8 overall and 2 to 3 in boys undergoing prepubertal orchidopexy
Cryptorchidism occurs in 1% to 4% of full-term males; postnatal spontaneous descent and •
.reascent of testes are common
The causes of cryptorchidism are largely unknown, but birth weight, gestational age, 
genetic, and environmental risk
.Yearly testicular examinations are recommended •
.About 80% of undescended testes are palpable, and 60% to 70% are unilateral 
Many boys with nonsyndromic cryptorchidism have epididymal anomalies and a patent 
processus vaginalis, and some have reduced LH and/or testosterone levels during the
.postnatal surge
Orchidopexy is recommended for testes that remain undescended after 6 months of age; 
.hormone therapy is not recommended
Laparoscopy is the procedure of choice, and imaging studies have limited value in the 
diagnosis and treatment of intraabdominal
.cryptorchidism •
Sperm counts are reduced in at least 25% of formerly unilateral and the majority of 
formerly bilateral cryptorchid men, but paternity rates in the unilateral group are similar to
.those of control men
The relative risk of malignancy in cryptorchid testes is 2 to 
and may be 2 to 3 after prepubertal orchidopexy 8 •
 , •

VARICOCELE •
an abnormal dilation and tortuosity of the •
internal spermatic veins within the pampiniform plexus of •
the
may contribute significantly •
to the risk of infertility in adulthood
Left > right
The left internal spermatic •
vein is longer than the right; in addition, it usually joins •
the left renal vein at right angles. The right internal spermatic •
vein has a more oblique insertion into the inferior •
vena cava. This particular anatomy in the standing man •
may cause higher venous pressures to be transmitted to the •
left scrotal veins and result in retrograde reflux of blood •
into the pampiniform plexus •

Classification •
Grade 0 (subclinical) •
varicoceles are visualized by CDUS but are nonpalpable •
grade 1, palpable only with Valsalva •
grade 2, easily palpable but •
grade 3, easily visible •
Surgical Repair of Varicocele •
Subinguinal/Inguinal Microsurgical •
Varicocelectomy •
Open/Laparoscopic Suprainguinal Varicocelectomy •
Sclerotherapy/Embolotherapy •
Pain is the presenting complaint in less than 10% of adolescents •
with varicocele •
,Treatment of adolescent varicocele should be selective •
because about 85% of adults with varicocele do not present •
.with problems related to fertility •
Ultrasonography is the most sensitive method for determining •
volume discrepancy between testes, and the Lambert •
formula (length × width × depth × 0.71) is preferable for •
.volume calculation •
,Testicular hypotrophy involving the affected or both testes •
abnormal semen analysis, and pain are current indications •
for adolescent varicocele repair •
Laparoscopic or microscopic subinguinal artery- and •
lymphatic-sparing techniques for varicocele repair are associated •
with the lowest risk of both recurrence and •
.hydrocele •
HERNIAS AND HYDROCELES
The processus vaginalis and inguinal canal develop in both sexes •
in the first trimester of gestation •
Persistent patency of all or a portion of the processus vaginalis •
within the inguinal canal may but does not always result in a •
symptomatic hernia or hydrocele •
indirect inguinal hernia •
Communicating \non comunicating hydrocele •
spermatic cord hydrocele •
 Diagnosis
Scrotal or inguinal sweling •
Change size with activity •
Sometime pain,nausia ,vomiting ,acute scrotum •
Treatment •
Surgical repair •
 ACUTE SCROTUM
The new onset of pain, swelling, and/or tenderness of •
intrascrotal content
Differential Diagnosis of Pediatric/Adolescent •
Appendage torsion •
Spermatic cord torsion •
Intravaginal, acute or intermittent •
Extravaginal
Epididymitis/ Infectious non infectious traumatic
Scrotal edema/erythema
Varicocele With acute rupture or thrombosis
,Intrascrotal mass,Hernia/hydrocele,Trauma,Orchitis
, Referred pain,Musculoskeletal pain
 Spermatic Cord Torsion
Acute spermatic cord torsion with reduction or cessation of blood •
.flow to the testis may occur in susceptible individuals •
Intravaginal spermatic cord (testicular) torsion •
occurs when the testis twists within the tunica vaginalis •
extravaginal testicular torsion •
occurs in the perinatal period before fixation of the tunica vaginalis •
.within the scrotum •
peak age at occurrence is 12 to 16 years •
Diagnostic Studies •
CDUS •
High-resolution ultrasonography (HRUS •
 Treatment
manual detorsion attempt •
Surgical •
Intrascrotal fixation of the testis must be •
performed bilaterally because a contralateral
bell-clapper deformity usually exists
 Epididymal Cyst (Spermatocele) •
usually asymptomatic
Epididymal cysts are smooth, spherical,
and in many cases located at the head
of the epididymis
.most cases intervention is unnecessary
Hematocele •