CLINICAL ANATOMY

Male Reproductive

• Epispadia – urethral opening @ dorsal aspect of penile shaft

• Hypospadia – on the ventral aspect; may be glanular (below glans), penile (ventral aspect of shaft) or scrotal (at
scrotum)
o Treatment: prepuce transplant to cover opening
• Phimosis – opening of prepuce too small  dribbling of urine, ballooning, hardened smegma
• Paraphimosis – retained retraction of a tight foreskin behind coronary sulcus, due to retraction of a congenitally
phimotic prepuce having a small orifice or contraction of an essentially normal prepuce with inflammation or edema
o Treatment: dorsal slit (circumcision) to release constriction
• Trauma to penis (fracture) – corpora cavernosa encased in thick tenacious tunica albuginea; rupture is rare, but may
be due to trauma
• Rupture of the urethra
o External blows, penetrating injuries – straddle injury – fall on perineum, crush bulbous urethra
o Internal injuries – passage of sounds, catheters, etc.
o Spontaneous – increased intraurethral pressure
• Balanitis – gonorrheal urethritis, surface infection of urethral mucosa
• Circumcision – pukpok (old method), German cut (more recent)  dorsal slit (preferred)
• Carcinoma of the penis – eats glands, metastasizes, epitheliomas
• Examination – patient in upright position facing examiner, retract prepuce if present, palmation, transillumination
• Hydrocoele – patency of abdominal connection to tunica vaginalis testis = fluid accumulation
• Varicoele – enlarged testicular veins, usually left (drains into left renal), causes infertility, looks like a “bag of worms”
o Treatment: varicolectomy – removes all vessels but 1, may restore fertility
• Hernia – maintained connection (processus vaginalis), bulging in inguinal canal, bowel can herniate and strangle
o Direct – adults usually
o Indirect – passes through processus vaginalis
o Femoral – females, below inguinal ligament
o Surgery: pectineal ligament repair; tension free (cover with mesh [Marlex]) or plugging
• Spermatocoele – mass on testis
• Cryptorchidism – undescended testis, infertility
o Cause: low GnRH, absence of germ cells, mechanical causes
o Treatment: before 3-4 years old
o Surgery: lengthen the ligaments, get new sac from Dartos muscle, orchidopexi
• Testicular torsion – long gubernaculums testis allows movement of testis  vessels may get blocked; emergency
procedure, very painful
o Treatment: derotate testis, anchor, or else orchidectomy
• Retractile testis – unusually spastic cremaster muscle
• Orchitis – due to mumps (18%), rare before puberty
• Epididymo-orchitis – most common intrascrotal inflammations, tuberculous version secondary to source outside
urogenital tract
• Testicular tumors – 30% are seminomas

• Diagnostic procedures
o Testicular biopsy – most valuable, check male fertility
o Semen analysis – check for sperm abnormalities (2 heads, 2 tails, coiled)  check for % of abnormalities
 Determines volume, motility, number and morphology
 Ejaculate = 3-5 mL, 100-120 million / mL
 80-85% should be actively motile
 20% abnormal = fecund;
  40-50% abnormal or less than 60 million/mL = infertile

***Check pages 11-14 in clinical manual.