Structural Lesions of the Urethral Wall
Congenital Scrotal Disorders
Extra testicular Scrotal Disorders
Urethral diverticulum may be defined as a localized
out pouching of tissue from the urethra into the
potential space surrounding the urethra.
The cause is uncertain.
Symptoms are variable, the most common being
frequency, urgency, and dysuria.
Congenital or Acquired
Female > Male
Urethral fistulas develop if there is failure of closure
after urethral rupture or laceration.
They may be caused by;
- Rectal or Gynecological surgery.
-Strictures or Carcinomas.
Ambiguous Genitalia And Intersex
(Disorders of Sex Development)
Atypical appearance of the external genitalia making
sex determination difficult
Occur when Genetic sex, Gonadal sex, or Genital sex
of an individual are discordant.
Complex situation with a wide variety of phenotypes.
1.True Hermaphrodite (ovotesticular DSD)
a. Male Pseudo hermaphrodite (46 XY with two
b. Female Pseudo hermaphrodite (46 XX with two
a. Pure (bilateral streak gonads)
b. Mixed(testis and a streak gonad)
Teenage girl presented with primary amenorrhea and
prominent labioscrotal folds
Cryptorchidism is defined as failure of the testis to
descend from its intra-abdominal location into the
Unilateral or bilateral
20-48 times more likely to undergo malignant
Cryptorchid: testis neither resides nor can be
manipulated into the scrotum
Ectopic: aberrant course
Retractile: can be manipulated into scrotum where it
remains without tension
Gliding: can be manipulated into upper scrotum but
retracts when released
A hydrocele is filling of serous fluid between the
visceral and parietal layers of tunica vaginalis.
Congenital or Acquired.
Is most often idiopathic.
Can be secondary to infection or lymphatic blockage
Chronic infective hydrocele (especially tuberculous)
may be associated with considerable calcification of
Hydrocele may demonstrate internal echoes.
It is an accumulation of blood distending the tunica
Acute or Chronic
Is most often caused by trauma.
Is occasionally due to tumor.
Complex appearance with echogenic debris and
A scrotal abscess, or pyocele, is most often a
complication of epididymo-orchitis, which has
crossed the mesothelial lining of the tunica vaginalis.
On US scans, an abscess appears as a complex,
heterogeneous fluid collection.
Gas may be present, causing bright specular reflectors
The most common scrotal mass is spermatocele.
Cystic lesions in the head of epididymis.
Filled with spermatozoa containing fluid.
Low level echoes can be seen in some cases.
Septations --- with large spermatoceles.
Epididymal cysts form in the head as well as in the
body and tail of the epididymis.
Contains serous fluid.
Indistinguishable from spermatoceles.
Inflammation of the epididymis, usually due to
ascending infection with gram negative bacilli or
Young adult males, late middle age and elderly.
Imaging of epididymitis
The preferred imaging examination is ultrasonography.
Enlarged (>17 mm) epididymis .
Hypoechoic, hyperechoic, or heterogeneous echotexture.
Increased blood flow.
Associated reactive hydrocele .
Scrotal wall thickening.
Varicoceles are dilated peritesticular veins that form
as the result of incompetent valves in the spermatic
Extremely common(8-16% of male population)
15-25 years of age.
85% Left sided
If only right sided-Malignancy should be suspected.
If presenting in old age(>40 yrs) for the first time-
Malignancy should be suspected.
Pain ,discomfort and Infertility.
Gray scale sonography depicts Varicoceles as
numerous, dilated(>2mm), tortuous, tubular channels
in the peritesticular tissues.
Located lateral, posterior and/or superior to the
Visible flow may be seen within larger varicoceles on
conventional ultrasound, but it is usually too slow to
be detected with color Doppler imaging.
Their prominence is increased in the upright position
and with valsalva maneuver, and this is detectable on
color Doppler imaging.