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Diseases of the Male Genitalia

The male genitalia consist of the penis and structures in the scrotum.

Diseases of the penis include problems with the foreskin (prepuce) including phimosis and paraphimosis and other penile swelling.

The structures in the scrotum are the testes and structures related tot he testes such as the epididymis, the spermatic cord and the vas deferens. The most common diseases in the scrotum are swellings of the structures in the scrotum. Theses include hydrocele, spermatocele, epididymal cyst, varicocele, and inguinal hernia.

The male genitalia consist of the penis and structures in the scrotum.

 

 

1.    Diseases of the Penis

Diseases of the penis include problems with the foreskin (prepuce) including phimosis and paraphimosis and other penile swelling.

Phimosis

This refers to the inability to retract the distal prepuce over the glans penis due to a tight opening. Usually the glans penis cannot be fully exposed.

Most phimosis is congenital. These usually do not cause any problems and can be left alone.

In acquired phimosis, there may be a history of poor hygiene, chronic infection of the prepuce and glans penis known as balanoposthitis, repeated trauma or forceful retraction of a congenital phimosis.

If there is pain, bleeding after sexual intercourse, recurrent infections, severe purulent infections, bleeding in the urine, decreasing force in the urine stream, suspicion of penis cancer, the phimosis may be treated by a circumcision.

Paraphimosis

Paraphimosis is the entrapment of a retracted foreskin behind the coronal sulcus. The retracted foreskin cannot be retracted over the glans penis into its naturally occurring position. This may be due to a constriction by the tight band of retracted foreskin and can lead to edema and venous engorgement of the glans and foreskin.

The immediate treatment is reduction of the paraphimosis failing which the patient will need a circumcision.

Circumcision

Circumcision is the surgical removal of the prepuce or foreskin that covers the tip of the penis. The foreskin is excised and the adjacent skin reapproximated with fine sutures. Excision can be performed using a knife or laser. The latter procedure is known as Laser Circumcision. Laser circumcision is the preferred method for young children. Circumcision including laser circumcision can be done under local or general anesthesia. No hospital stay is required. The patient usually goes some after a short period of observation

 

2.    Diseases of the Structures in the Scrotum

The structures in the scrotum are the testes and structures related tot he testes such as the epididymis, the spermatic cord and the vas deferens. The most common diseases in the scrotum are swellings of the structures in the scrotum. Theses include hydrocele, spermatocele, epididymal cyst, varicocele, and inguinal hernia.

The most ominous is a testis swelling suggestive of testis cancer. Please read the section in the Cancer Clinic under Testis Cancer to find out more.

  1. Hydrocele
    A hydrocele is a fluid-filled sac that surrounds a testis, causing swelling of the scrotum. It may arise at birth. Most hydroceles at birth disappear without treatment within the first year of life. It can appear later in life, usually in men older than 40. This may be due to inflammation or injury within the scrotum. In rare cases, especially when it appears within a short time, they may arise from an underlying testis cancer. Hydroceles are usually not painful. If they are not the result of infection or testis cancer, hydroceles may require no treatment.

  2. Spermatocele
    A spermatocele is a cyst arising from the coiled tube transports sperm called the epididymis. It is usually located above the testis. It is painless and non-cancerous (benign). A spermatocele is usually is filled with milky fluid that may contain dead sperm. Spermatoceles are usually less than 2 to 3 centimeters in diameter, although some may be larger. A common condition, a spermatocele doesn't impair fertility, nor does it require treatment unless is grows large enough to cause discomfort.

  3. Varicocele
    Varicocele is a mass of enlarged and dilated veins of the spermatic cord that lies within the scrotum. The valves that regulate bloodflow from these veins are congenitally (from birth) defective. Blood does not flow from the testis efficiently, causing swelling in the veins above and behind the testis. This may lead to pain in the scrotum, shrinking (atrophy) or maldevelopment of the testis and poor sperm production with infertility

  4. Epididymal Cyst
    Epididymal cysts are fluid filled sacs related to the epididymis but not communicating with the tubules of the epididymis. In that way, they are different from the spermatoceles. These cysts are likely blind-ending tubules that failed to join with the main epididymis during the formation of the epididymis. The fluid content is clear. There are harmless and do not need to be removed unless they enlarge and cause discomfort.

  5. Hernia
    An inguinal hernia is a condition in which part of the intestine bulges through a weak area in muscles of the lower abdomen. An inguinal hernia occurs in the groin (the area between the abdomen and thigh). In severe cases, the intestine may extend down into the scrotum.



    Inguinal hernias are not necessarily dangerous in themselves but they can lead to life-threatening complications. If the protruding intestine becomes twisted or entrapped, part of the intestine might strangulate and need to be removed. For this reason, your doctor is likely to recommend surgical repair of a hernia that's painful or becoming larger.

    Surgery

    Repair of Hernia (Herniorraphy, Hernioplasty, Laparoscopic Herniorraphy)


    The main treatment for inguinal hernia is surgery to repair the opening in the muscle wall. This surgery is called herniorraphy. The weak area of the body wall is reinforced with a synthetic mesh. This operation is called mesh herniorraphy. One popular method of mesh herniorraphy is known as the Lichtenstein repair or herniorraphy. In Lichtenstein repair, the herniorraphy is done through a small wound over the lower part of the body. Herniorraphy or hernia repair is done under regional or general anesthesia. The patient can choose to go home the same day or stay overnight in the hospital.

    Inguinal hernias especially those occurring on both sides of the body can be successfully repaired with a technique that uses several small incisions, leading to a faster, less painful recovery. The mesh is applied using thin instruments inserted through tiny key-hole size wounds. This is known as laparoscopic herniorraphy

 

 

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