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Testis
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3.5- 4 cm in length and 2-3 cm in width
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Covered by fibrinous tunica albuginea
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The spermatic cord enters the testis along the posterosuperior margin, known as the mediastinum testes

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Divided into lobules arrayed radially around the mediastinum testes; each lobule being composed of branching seminiferous tubules

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20-30 ducts form the prostate gland
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NOTES: not visualized- undescended

testes
:view- transsagittal, transverse
:white echogenecities- calcification

Prostate
-has 3 zones:
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The peripheral zone (PZ)
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The central zone (CZ)
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The transitional zone (TZ)
Epididymis
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6-7 cm in length
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7-8 mm diameter at the globus major (head of epididymis at mediastinum testis) and

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1-2 mm at the tail where it continues as
the vAS deferens
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The vas deferens courses through the spermatic cord and exits via the deep inguinal ring

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At the base of the prostate, it joins the seminal vesicle to form the ejaculatory duct

COMMON DISEASES
1. Benign Prostate Hypertrophy (BPH)
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affects 50-75% of men over age 60 years
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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

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NOTES: central zone- mostly affected
2. Prostate Cancer
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70% occur in the peripheral zone (PZ)
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20% are found in the transition zone (TZ)
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Trans-rectal biopsy is the gold standard for
diagnosis
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Direct extentsion into the seminal
vesicles, bladder base, and perivesical fat
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Extracapsular spread is evaluated with transrectal prostate ultarasonography with biopsy or endorectal coil MR imaging +/- MR spectroscopy

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Nodal metastases may be evaluated with CT or MRI, and biopsy is performed if nodes are greater than 10 mm

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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.

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

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

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The prostate gland should be evaluated
for gross evidence of adenocarcinoma
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CT SCAN:
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Ill-defined bladder mass at the
bladder base (arrows)
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The mass is well seen because it is outlined by the excreted contrast (M)

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This mass is seen to arise from the
prostate gland (P)
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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
3. Torsion
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Due to abnormal configuration of the testicle on its pedicle (\u201cbell clapper deformity\u201d), 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.

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Torsion is classified as complete or
incomplete.
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Complete torsion: >360 degree twist. Adult males 80% testicular salvage rate when reversed within 5 hours

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Incomplete
torsion:
<360

degrees. Relatively longer period before testicle is unsalvageable

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HIGH RESOLUTION ULTRASOUND
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Enlarged and diffusely hypoechoic
testicle
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Contains multifocal hypoechoic
areas
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Epididymis may be enlarged and
hypoechoic
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Scrotal thickening
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DOPPLER ULTRASOUND
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