This document discusses various structural lesions and disorders of the urethral wall and scrotum that can be identified on imaging. It describes urethral diverticulum, urethral fistulas, ambiguous genitalia/intersex disorders, undescended testes, hydrocele, hematocele, pyocele, spermatocele, epididymal cysts, epididymitis, and varicocele. For each condition, it provides information on definition, causes, symptoms, and imaging appearance to allow for diagnosis.

2. Contents
Structural Lesions of the Urethral Wall
Congenital Scrotal Disorders
Extra testicular Scrotal Disorders

4. Urethral Diverticulum
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

15. Urethral Fistulas
Urethral fistulas develop if there is failure of closure
after urethral rupture or laceration.
They may be caused by;
- Rectal or Gynecological surgery.
-Obstetric injury.
-Radiotherapy.
-Inflammatory lesions.
-Strictures or Carcinomas.

16.  Urethrorectal, urethroperineal, urethrovaginal,
urethrovesical and urethrocutaneous.
IMAGING
 Cystourethroscopy
 VCUG
 Retrograde urethrography
 MRI
 CT scan

18. 1 month old girl

21. 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.

22. Types
1.True Hermaphrodite (ovotesticular DSD)
2.Pseudohermaphrodite
a. Male Pseudo hermaphrodite (46 XY with two
testes)
b. Female Pseudo hermaphrodite (46 XX with two
ovaries)
3.Gonadal Dysgenesis
a. Pure (bilateral streak gonads)
b. Mixed(testis and a streak gonad)

23. Teenage girl presented with primary amenorrhea and
prominent labioscrotal folds

24. A child with ambiguous genitalia

25. Ambiguous genitalia in a newborn with congenital
adrenal hyperplasia

26. A newborn with Ambiguous genitalia

28. Undescended Testes
(Cryptorchidism)
Cryptorchidism is defined as failure of the testis to
descend from its intra-abdominal location into the
scrotum.
Preterm infants
28-32 wks
Unilateral or bilateral
20-48 times more likely to undergo malignant
degeneration

29. 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

30. Imaging
Ultrasound
CT scan
MRI
Angiography

32. 34 years old male with infertility

33. 28-year-old man with history of left cryptorchidism after
orchiopexy at age 6 years.

34. 34 years old male with severe pain in the RIF along with
fever and chills.

35. 1 year old boy with non palpable testes

36. 9 year old boy…

38. Hydrocele
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
by tumor.

39. Chronic infective hydrocele (especially tuberculous)
may be associated with considerable calcification of
the tunica.
Hydrocele may demonstrate internal echoes.

46. Hematocele
It is an accumulation of blood distending the tunica
vaginalis.
Acute or Chronic
Is most often caused by trauma.
Is occasionally due to tumor.

47. Complex appearance with echogenic debris and
septations.

49. Pyocele
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
and shadowing

51. Spermatocele
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.

52. Epididymal Cysts
Epididymal cysts form in the head as well as in the
body and tail of the epididymis.
Are anechoic.
Contains serous fluid.
Indistinguishable from spermatoceles.

55. Epididymitis
Inflammation of the epididymis, usually due to
ascending infection with gram negative bacilli or
Chlamydia.
Young adult males, late middle age and elderly.

56. 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.

62. Patient with severe pain in the scrotum.

63. Varicocele
Varicoceles are dilated peritesticular veins that form
as the result of incompetent valves in the spermatic
veins.
Extremely common(8-16% of male population)
15-25 years of age.
85% Left sided
15% Bilateral.
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.

64. Gray scale sonography depicts Varicoceles as
numerous, dilated(>2mm), tortuous, tubular channels
in the peritesticular tissues.
Located lateral, posterior and/or superior to the
testis.
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.