Reproductive: Unit 5

MALE GU

5.1 - Testicular Disorders & Cancer

1) Orchid:
testes (before birth, normally descend from abdomen → through inguinal canal → into
scrotum)

2) Holding back tethered ball:

CRYPTORCHIDISM (incomplete descent of a testicle) (may be located anywhere along
path of descent)

3) ONE pocket pulled out:

in CRYPTORCHIDISM, the undescended testes is most commonly in the inguinal canal
→ inguinal fullness or palpable mass (usually UNILATERAL)

4) Unripened green fruit:

CRYPTORCHIDISM is common in premature infants

5) 2 outturned pockets:
CRYPTORCHIDISM associated with a genetic disorders is more likely to be
BILATERAL (however, cryptorchidism is usually an ISOLATED finding)
6) Calvin KLEIN FELT sweater:
KLINEFELTER syndrome can present with CRYPTORCHIDISM (also hypogonadism
due to small firm hypofunctional testes)

7) "Y" collar with "X" argyle design:

47 XXY is the genotype in KLINEFELTER syndrome

8) Trampled male trowels:

genetic disorders that cause abnormal sexual development or hypogonadism can
present with CRYPTORCHIDISM (initial state of testicular descent is controlled by
androgens and other hormones)

9) Tetherball with cancer crab & mass:

CRYPTORCHIDISM increases the risk of testicular cancer (particularly in undescended
testes, but also small risk in contralateral side)

10) High temperature read on thermometer:

normal body temperature is higher than scrotal temperature

11) Dried up infertility tree:

CRYPTORCHIDISM can present with infertility (exposure of undescended testis to
higher temperature of the abdomen → atrophy of Sertoli cells and seminiferous tubules)

12) Twisted tetherball string:

CRYPTORCHIDISM can be complicated by testicular TORSION (since the
undescended testicle is not properly secured inferiorly)

13) Scalpel:
CRYPTORCHIDISM is treated with surgery to bring undescended testis into scrotum
(orchiopexy) (decreases cancer risk)

14) Worms in LEFT pocket:

increased pressure in left renal vein → increased pressure in left testicular vein →
retrograde flow → eventually dilation of pampiniform plexus in spermatic cord →
VARICOCELE on LEFT

15) Kidney reservoir attached to gutter system:

LEFT KIDNEY is drained by left renal vein

16) 90⁰ angle:

LEFT RENAL vein connects to LEFT TESTICULAR vein at a 90⁰ angle (inefficient
design for drainage) (angle is less acute on right side)

17) tree branch overlying gutter:

SUPERIOR MESENTERIC ARTERY (coming off aorta) passes OVER LEFT renal vein
→ potential for vein compression → left sided varicocele

18) Standing in pain:

VARICOCELE presents with aching pain in affected scrotum (most noticeable when
standing and improved with lying supine)

19) Wormy infertility tree:

chronic varicocele → pressure in scrotum → testicular atrophy/infertility

20) Tether ball twisted around pole:

TESTICULAR TORSION (testes twist around the spermatic cord)

21) "VIRGINIA":
TESTICULAR TORSION is usually due to inadequate fixation of the testis to the tunica
Vaginalis of the scrotal sac (congenital defect) → free to rotate

22) Twisted blue & red strings:

in TESTICULAR TORSION, rotation around spermatic cord → compression of testicular
vein → testicular edema → arterial compression

23) Scalpel:
TESTICULAR TORSION is treated with emergency surgery (in order to prevent
irreversible infarction of testis)
24) Clutching crotch & grimacing:
TESTICULAR TORSION presents with acute scrotal pain

25) Green face:

TESTICULAR TORSION presents with nausea & vomiting

26) No CREAM cookies:

TESTICULAR TORSION presents with absent CREMasteric reflex (normally, pinching
skin of upper thigh → elevation of ipsilateral testis)

27) Water balloon & "VIRGINIA" pants:

HYDROCELE (collection of serous fluid within the tunica VAGINALIS)

28) Smiling:
HYDROCELE presents with painLESS swelling of the scrotum

29) Persistently patent pants:

a COMMUNICATING HYDROCELE (congenital) results from incomplete obliteration of
processus vaginalis (peritoneal tissue that travels with testes through inguinal canal
during development) → fluid from peritoneal cavity can flow into tunica VAGINALIS

30) Bacteria balloon:

acquired HYDROCELE (generally NONcommunicating) commonly occurs after an
infection (epididymitis), torsion, trauma, or tumor

31) Glowing spot beneath balloon:

HYDROCELES will transilluminate (a beam of light can pass through it) (in contrast to
varicocele or tumor)

32) Tetherball with cancer crab & mass:

TESTICULAR CANCER (most common malignancy in males between ages 15-35)

33) "GERMINATING" seeds:

most testicular tumors are GERM cell tumors (divided into pure seminomas &
NONseminomas)
34) Sea-man superhero:
SEMINOMAS (most common testicular tumor) (identical to dysgerminomas of the
ovary)

35) Homogenously enlarged sperm whale:

SEMINOMAS present as homogenous testicular enlargement (as opposed to an
isolated mass)

36) Purple sunny side up egg:

on histology, SEMINOMAS display a “fried egg” appearance (identical to ovarian
dysgerminomas)

37) β-hCG babysitter:

β-hCG is a tumor marker for SEMINOMAS (and ovarian dysgerminomas)

38) Dehydrated LDH milk:

lactate dehydrogenase (LDH) is a tumor marker for SEMINOMAS (and ovarian
dysgerminomas)

39) Egg yolk:

YOLK SAC (endodermal sinus) tumors (NONseminomas) (similar to ovarian yolk sac
tumor) (most common tumor in boys age <3)

40) Egg chiller:

on histology, YOLK SAC tumors display Schiller-Duval bodies (papillary structures with
central vessel)

41) "Alf’s Fresh Produce":

α-fetoprotein (AFP) is a tumor marker for YOLK SAC tumors

42) Terrariums:
TERATOMAS (NONseminomas) (similar to ovarian teratomas)

43) Three-layered terrarium:

MATURE TERATOMAS contain cells from 3 germ layers (ectoderm, mesoderm,
endoderm) (often includes hair & teeth)
44) Addition of cancer crab:
MATURE TERATOMAS in the testicles can be benign or MALIGNANT (in contrast to ovary, where
they are ALWAYS benign)

45) Terrarium with amorphous rocks and escaping crabs:

IMMATURE TERATOMAS (contain poorly differentiated tissues) (malignant in both testicle and
ovary)
46) Frog EMBRYO:
EMBRYONAL CARCINOMAS (NONseminomas) (far more common in testes compared to ovaries)
47) Bleeding skull shirt:
EMBRYONAL CARCINOMA appears as hemorrhagic masses with areas of necrosis

48) Purple amorphous algae:

on histology, EMBRYONAL CARCINOMA displays sheets of atypical poorly
differentiated cells

49) β-hCG babysitter:

β-hCG is a tumor marker for EMBRYONAL CARCINOMAS

50) CHOIR music box:

CHORIOCARCINOMAS (NONseminomas) (similar to placental trophoblastic tumor in
females)

51) Trophy case:

CHORIOCARCINOMAS in FEMALES are derived from chorionic villi (composed of 2
cell types: syncytiotrophoblasts and cytotrophoblasts)

52) Falling CYTO-cycling & SYNCHRONIZED swimming trophies:

TESTICULAR CHORIOCARCINOMAS contain disordered proliferations of both
mononuclear CYTOtrophoblasts & multinucleated SYNCYTIOtrophoblasts

53) Hit in the head & bleeding:

CHORIOCARCINOMAS disseminate hematogenously early in the disease (highly
aggressive) → frequently metastasize to lung or brain by the time of diagnosis

54) Large β-hCG babysitter:

CHORIOCARCINOMAS are characterized by EXTREMELY high levels of β-hCG
(similar to female choriocarcinomas)
55) Tying large bowtie:
CHORIOCARCINOMAS can present with hyperthyroidism (due to extremely high β-
hCG) (hCG and TSH have a common alpha subunit → hCG binds TSH receptor on
thyroid gland → stimulate production of thyroid hormone)

56) Vases projected onto chest:

CHORIOCARCINOMA can present with gynecomastia (extremely high β-hCG levels →
leydig cell dysfunction → increased estrogen production)
5.2 - Benign Prostatic Hyperplasia (BPH) & Prostate Cancer

1) Old fire fighter squeezing light pole:

benign prostatic hyperPLASIA (BPH) is an extremely common enlargement of the
prostate seen in older men
Symbols

2) "TRANSIT" sign:
BPH is caused by hyperplasia of cells in the transitional (innermost) zone of the prostate
(which surrounds urethra)
Symbols

3) "Mid Day and Late Day" busses:

the transitional zone of the prostate includes the middle and lateral lobes, which
surround the urethra (enlargement causes urinary obstruction)
Symbols

4) Alpha team volunteer opening dihydro hydrant:

5-alpha reductase converts testosterone into the more potent dihydrotestosterone→
prostatic epithelial and stromal hyperplasia→ prostate enlargement
Symbols

5) Epithelial clovers with smooth pink leaves:

DHT stimulates an increase in the NUMBER of glandular epithelial and smooth muscle
cells (hyperPLASIA) in the prostate (along with increased stroma)
Symbols

6) Circular, smooth concrete slab:

BPH forms smooth, symmetric enlargement of the prostate containing both stromal and
epithelial components (asymmetry or nodularity should raise suspicion for malignancy)
Symbols

7) Struggling to open valve:

BPH commonly causes hesitancy (difficulty initiating micturition)
Symbols

8) Weak pressure hose:

BPH commonly causes weak urinary stream, or “dribbling”
Symbols

9) Urgent situation:
BPH commonly causes urgency (an intense feeling the need to void)
Symbols

10) Multiple little puddles:

BPH commonly causes increased frequency of micturition due to incomplete voiding
Symbols

11) Sleepy fireman:

BPH commonly causes nocturia (waking up to urinate) due to incomplete voiding during
the day
Symbols

12) Full bladder tank:

ureteral obstruction due to BPH can cause urinary retention and bladder distention
Symbols

13) Dilated yellow hose from kidney tank:

chronic urinary obstruction from BPH can cause bilateral ureteral dilation and
hydronephrosis
Symbols

14) Cracked kidney water tank:

chronic urinary obstruction from BPH can cause post-renal azotemia, AKI, and even
renal failure
Symbols

15) UTI cup in truck:

chronic urinary retention in BPH can lead to recurrent urinary tract infections (though
rare)
Symbols

16) Smooth ballooning hose:

on digital rectal exam, BPH will feature smooth, symmetric enlargement of the prostate
without nodules or tenderness
Symbols

17) Blowing out alpha candle:

alpha-1 antagonists (such as terazosin) improve BPH by causing relaxation of smooth
muscle surrounding the prostatic urethra (no effect on prostate VOLUME)
Symbols

18) Asteride asteroid debris:

5-alpha reductase inhibitors (finasteride, dutasteride) inhibit the conversion of
testosterone to DHT in prostatic tissue→ decrease glandular and stromal volume→
decrease prostate size
Symbols

19) #1 fire fighter fan:

prostate adenocarcinoma is the most common malignancy and the SECOND most
common cause of cancer death in males
Symbols

20) Family affair:

family history of prostate carcinoma (especially in first degree relatives) is a risk factor
for prostate carcinoma development
Symbols

21) Black firefighter with cancer crab:

prostate is more common in African American males
Symbols

22) Seasoned smoking fire fighter:

smoking is a risk factor for prostate adenocarcinoma
Symbols

23) Staying out in peripheral zone:

prostate cancer is often asymptomatic due to its development in the PERIPHERAL zone
of the prostate
Symbols

24) POSTal box:

prostate cancer most commonly develops in the POSTERIOR lobe of the peripheral
zone→ rarely causes urinary symptoms
Symbols

25) Boosted up one side of knotty tree:

on DRE, prostate CANCER features asymmetrical enlargement, nodule formation, and
areas of induration (as opposed to firm, symmetrical enlargement in BPH)
Symbols

26) Climbing bony ladder:

prostate cancer metastasizes early, especially to the vertebral column, via lymphatic
and hematogenous spread
Symbols

27) Painful fall onto back:

prostate cancer metastasis to the vertebral column typically presents with back pain
Symbols

28) Osteobuilder holding bony ladder:

prostate cancer forms osteoBLASTIC (bone forming) metastases
Symbols

29) "PSA" awareness sign:

prostate specific antigen (PSA) is produced by prostatic epithelial cells and is used to
monitor for recurrence in men with a history of prior prostate cancer (asymptomatic PSA
screening is controversial)
Symbols

30) Irregular puddle:

histologically, prostate cancer has well defined glands composed of cells with dark
cytoplasm and large nuclei
Symbols

31) "GaRdener’s Hardware continuous service":

continuous administration of GnRH agonists (leuprolide) inhibits secretion of LH and
FSH→ decreased androgens (pharmacologic treatment of prostate cancer)
Symbols

32) Cracked window over male symbol tools:

continuous GnRH agonist administration decreases androgens→ inhibition of prostate
cancer growth (prostate cancer is androgen dependent)
Symbols
5.3 - Bladder Cancer & Penile Disorders

1) Crabs in cystic fish bowl:

BLADDER CANCER (urothelial [transitional cell] carcinoma OR squamous cell
carcinoma)
Symbols

2) Transitional window treatment:

urothelium is the epithelial lining from the renal pelvis to the urethra (stratified and
changes shape as it contracts or expands [as with bladder emptying])
Symbols

3) Bladder rock with ureter sprouts:

urothelial carcinoma can form anywhere along the urothelial tract (renal pelvis to
superior urethra)
Symbols

4) Multifocal hermit crabs:

urothelial carcinoma tends to be multifocal (most likely due to diffusion of carcinogens or
metastases throughout the urine)
Symbols

5) Spotty transitional curtains:

histologically, urothelial cancer resembles normal urothelium but with hypercellularity,
hyperchromasia, and loss of cellular polarity
Symbols
6) Gloves, leather belt, and hard hat to mix blue paint:
exposure to aromatic amines or beta-naphthylamine (as in the rubber, plastic, dye,
paint, and leather industries) is a risk factor for urothelial carcinoma (metabolites of
these products are excreted in the urine)
Symbols

7) Smoker:
smoking is a risk factor for urothelial cancer
Symbols

8) Cyclops by hermit crabs:

treatment with the antineoplastic and immunosuppressant cyclophosphamide (alkylating
agent) is a risk factor for urothelial carcinoma
Symbols

9) New squamous tile floors:

squamous cell epithelium
Symbols

10) Burned squamous tile floor:

Chronic inflammation of transitional epithelium→ metaplastic change to tougher
squamous epithelium
Symbols

11) Swordfish clock by fire:

Schistosoma haematobium infection causes chronic infection and inflammation of the
bladder urothelium and its venous plexus→ squamous metaplasia
Symbols

12) Smoking squamous sailor:

smoking is a risk factor for squamous cell carcinoma of the bladder and urinary tract
Symbols

13) UTI cup:

inflammation from chronic urinary tract infections is a risk factor for squamous cell
carcinoma of the bladder and urinary tract
Symbols

14) Crushed berries dripping red:

both urothelial and squamous cell carcinoma of the bladder and urinary tract commonly
present with PAINLESS hematuria (gross or microscopic)
Symbols

15) "Drains to Atlantic":

the allantois is a fetal structure that connects the yolk sac to the urogenital sinus
Symbols

16) Raking clogged leaves to open allantoic drain:

failure of the allantois to completely involute results in a PATENT urachus→ abnormal
open conduit from bladder to umbilicus
Symbols

17) Leaf on belly leaking yellow:

a patent urachus presents with urine leaking from the umbilicus
Symbols

18) Crab on squamous door with phallic canopy:

squamous cell carcinoma is the most common penile cancer and is more common in
developing countries
Symbols

19) Pill bugs by phallic door:

human papillomavirus infection (especially high risk strains 16 and 18) is a risk factor for
penile squamous cell carcinoma
Symbols

20) Weiner wizard hat:

HIV infection is a risk factor for penile squamous cell carcinoma
Symbols

21) Dirty flesh colored canopy:

uncircumcised males with a history of poor hygiene or phimosis (fibrosed foreskin that
can’t be retracted from the glans) have a higher risk of penile carcinoma
Symbols

22) Captain Johnson smoking:

smoking is a risk factor for penile squamous cell carcinoma
Symbols

23) Old salty seamen under canopy:

penile squamous cell carcinoma typically presents in men over 60 with a painless lesion
on the glans or foreskin
Symbols

24) "Canine InSide":

carcinoma in situ (CIS) involves full thickness epithelial expansion of malignant cells
WITHOUT invasion of the basement membrane (NO malignant cells in dermis)
Symbols

25) Crusty red stone under bow:

Bowen disease is a penile carcinoma in situ that typically presents with a crusting,
oozing erythematous plaque on the shaft of the penis (5% progress to squamous cell
carcinoma)
Symbols

26) Beefy red doormat:

Erythroplasia of Queyrat is a penile carcinoma in situ that typically presents as a velvety
red lesion on the glans penis (10-30% progress to squamous carcinoma)
Symbols

27) Bowenoid bows on package:

Bowenoid papulosis presents with multiple red papules throughout the penis and
RARELY progresses to carcinoma
Symbols

28) Buried spade tool:

hypospadias is a urethral opening on the VENTRAL surface of the penis and is the most
common congenital penile disorder
Symbols

29) Unfused "General" tool basket:

hypospadias develops due to incomplete fusion of the urogenital (urethral) folds during
fetal development
Symbols

30) Unplanted berry orchid:

hypospadias is associated with an increased incidence of cryptorchidism (undescended
testicle)
Symbols

31) Dilated pipe:

hypospadias can cause urinary outlet obstruction (can lead to post-renal AKI and
hydronephrosis in severe cases)
Symbols

32) Erecting spade tool:

epispadias is an abnormal urethral opening on the DORSAL surface of the penis
Symbols

33) Jimmy’s tuber garden:

epispadias results due to abnormal positioning of the genital tubercle during
development
Symbols

34) Red fanny sack:

epispadias is associated with bladder exstrophy, an abdominal wall defect that results in
opening of the interior bladder mucosa to the environment
Symbols

35) Droopy Peyronie pine:

Peyronie disease is bending and contracture of the penile shaft caused by fibrosis
Symbols

36) Alabama sweatshirt:

Peyronie disease is caused by excessive fibrosis of the tunica ALBUGINEA (fibrous
tissue surrounding penis)
Symbols

37) Painful crotch shot:

contractures in Peyronie disease cause penile pain
Symbols

38) Hose no goes:

Peyronie disease can cause erectile dysfunction
Symbols