Urogenital Pathology · Study Notes

🫀 Penis

Congenital
- Epispadias – urethral meatus on dorsal surface
- Hypospadias – urethral meatus on ventral surface
- Both ↑ risk UTI & infertility; may associate with undescended testes
Acquired inflammatory
- Balanitis – inflammation of glans; balanoposthitis – glans + foreskin
- Poor hygiene & lack of circumcision predispose
Peyronie disease – penile fibromatosis → curvature during erection
HPV‑associated
- Condyloma acuminatum – cauliflower-like; HPV 6,11
- Squamous cell carcinoma – HPV 16,18; ↑ risk in uncircumcised
- Precursor: Bowen disease, bowenoid papulosis, erythroplasia of Queyrat
Erectile dysfunction
- Vascular insufficiency (most common >50 yr)
- Neurologic: MS, diabetic neuropathy, post‑radical prostatectomy
- Endocrine: low testosterone, hypothyroidism, prolactinoma
- Drugs: leuprolide, methyldopa, finasteride, psychotropics
Priapism – persistent painful erection
- Sickle cell anemia (sludging), trauma, trazodone

Epispadias/hypospadias often coexist with cryptorchidism – always examine both.

Varicocele – dilated pampiniform plexus; left > right
- “bag of worms” superior to testis; may cause infertility
Hydrocele – fluid in tunica vaginalis
Spermatocele – epididymal cyst containing sperm; transilluminates
Epididymitis
- Acute <35 yr: N. gonorrhoeae, C. trachomatis
- Acute >35 yr: E. coli, Pseudomonas
- Chronic: TB
Orchitis – sudden pain + fever; mumps virus most common
Testicular torsion – twisting of spermatic cord; hemorrhagic infarction; surgical emergency
Cryptorchidism – failure to descend; inguinal canal most common; ↑ risk seminoma

Testicular torsion: painful hemorrhagic infarction → gangrene – do not delay surgical exploration.

Male infertility – mechanisms
- Primary testicular: Leydig cell or seminiferous tubule dysfunction
- Secondary hypogonadism: pituitary/hypothalamic failure
- Obstructive: vas deferens obstruction or ejaculatory disorder

Presentation – firm, painless mass; nonseminomas may metastasize widely
Risk factors
- Cryptorchidism (3‑5×)
- Testicular dysgenesis (Klinefelter, testicular feminization)
- Family history; Caucasian > African American
Diagnostic approach
- Ultrasound: hypoechoic intratesticular mass
- Serum markers: AFP, β‑hCG, LDH (tumor burden)
- Staging: orchiectomy + retroperitoneal lymph node dissection
Serum markers – source
- AFP → yolk sac tumor
- β‑hCG → choriocarcinoma / syncytiotrophoblasts
- LDH → nonspecific, reflects tumor bulk

Histologic type	Key features	Prognosis
Seminoma	sheets of clear cells, fibrous septa; mean age 40	excellent (95% cure early)
Embryonal carcinoma	aggressive, bulky, hemorrhage/necrosis	more aggressive
Choriocarcinoma	small, hemorrhagic; syncytio‑ + cytotrophoblasts	highly malignant, early hematogenous spread
Yolk sac tumor	Schiller‑Duval bodies; most common in children	good in children; variable in adults
Teratoma	cystic, cartilage/bone; mature vs. immature	benign in prepubertal; malignant potential in adults

Mixed germ cell tumors – ≥2 components (e.g., teratocarcinoma)
Sex cord‑stromal
- Leydig cell: bimodal (prepubertal, >50); may secrete androgens/estrogens → gynecomastia (adults) or precocious puberty (children); 90% benign
- Sertoli cell: rare, usually benign; tubule formation
Other
- Testicular lymphoma: most common in men >60; diffuse large B‑cell
- Scrotal SCC: chimney sweeps (soot exposure)

Para‑aortic lymph nodes are the first regional metastatic site for testicular cancer.

Benign prostatic hyperplasia (BPH)
- Androgen (DHT)‑driven; not premalignant
- Incidence: 70% at age 60, 80% at age 70
- Transition/periurethral zone enlargement → urethral compression
BPH – symptoms
- Decreased stream caliber/force, hesitancy, postvoid dribbling
- Urgency, frequency, nocturia, dysuria
- PSA may be mildly elevated (usually <10 ng/mL)
BPH – complications UTI, bladder diverticula, hydronephrosis (rare)
BPH – treatment
- TURP (transurethral resection)
- 5α‑reductase inhibitor: finasteride
- α‑1 blockers: terazosin, prazosin

DHT→ stromal/glandular hyperplasia→ periurethral nodules→ urethral compression

Prostate adenocarcinoma – most common cancer in U.S. men; 2nd cancer death
Key features
- Peripheral zone origin (vs. BPH – transitional)
- Often asymptomatic; may present with back pain (bone mets)
- DRE: induration; PSA elevation; transrectal US + biopsy
Metastasis – obturator/pelvic lymph nodes; osteoblastic bone (lumbar spine) → ↑ alkaline phosphatase
Grading – Gleason score (glandular differentiation); TMPRSS2‑ETS fusion in ~50%
Treatment
- Local: prostatectomy, radiation
- Metastatic: orchiectomy, estrogens, LHRH agonists, anti‑androgens
Prostatitis
- Acute: intraprostatic reflux of urinary pathogens
- Chronic: recurrent; nonbacterial chronic pelvic pain syndrome more common
- Findings: fever, perineal/suprapubic pain, dysuria, hematuria

Prostate cancer metastasis to lumbar spine is osteoblastic – elevated ALP, not lytic.

BPH involves the transitional zone; prostate cancer arises in the peripheral zone – a key anatomical distinction.