Male Reproductive Pathology

Clinical History A 63-year-old man presented with acute abdominal pain and had been unable to urinate for five days. He reported a two-year history of urinary frequency, hesitancy, double voiding, nocturia, and poor stream. Examination revealed a distended bladder and an enlarged prostate. Bladder scan showed >1?L urine retention; labs confirmed acute renal failure. Catheterisation attempts failed, leading to a total prostatectomy. He recovered well post-op.Pathology The enlarged prostate, sliced transversely, shows multiple nodules (2–10?mm) consistent with benign prostatic hyperplasia (BPH).Further Information BPH is a common condition in older men, caused by nodular overgrowth of stromal and epithelial cells in the periurethral zone, stimulated by dihydrotestosterone. The median lobe may enlarge disproportionately and obstruct the urethra.Prevalence increases with age: 20% by 40, 70% by 60, 90% by 80. Risk factors include family history, obesity, and androgenic steroids.Typical symptoms: urinary frequency, nocturia, hesitancy, double voiding, dribbling. Acute urinary retention can lead to UTIs and kidney damage.Diagnosis includes history, digital rectal exam (DRE), PSA test, and imaging. Treatments: alpha-blockers, 5-alpha-reductase inhibitors, or in severe cases transurethral resection of the prostate (TURP). Total prostatectomy is rarely used due to complications.

Clinical History A patient with diabetes and previous myocardial infarctions presented with bilateral pleural effusion, peripheral oedema, and a swollen scrotum showing transillumination. Chest x-ray revealed congestive heart failure. Despite treatment, the patient died during admission.Pathology The testis and coverings show a distended cavity between the visceral and parietal layers of the tunica vaginalis due to fluid accumulation, representing a hydrocele secondary to generalized oedema from heart failure.Further Information A hydrocele is serous fluid between the layers of the tunica vaginalis. It can be communicating (linked to the peritoneal cavity) or non-communicating. Communicating hydroceles arise from failure of processus vaginalis closure and may be congenital or develop later, often due to increased abdominal pressure, like heart failure. Non-communicating types result from fluid imbalances due to infections, trauma, tumors, or lymphatic issues.Patients notice a scrotal swelling, uni- or bilateral. Communicating hydroceles may vary in size with pressure; non-communicating are usually stable. Swellings are generally painless unless complicated by infection or torsion. Larger hydroceles can cause skin problems.Diagnosis is clinical, aided by transillumination and ultrasound to rule out other causes. Tumor markers like AFP and B-HCG may exclude cancer. Many congenital hydroceles resolve by age two; persistent or symptomatic cases may require surgical repair. Treating the underlying cause can also resolve reactive hydroceles.

Clinical History An 80-year-old male with alcoholic liver cirrhosis and oesophageal varices presented with haematemesis. Examination showed spider naevi, large ascites, and a scrotal swelling that transmitted red light on transillumination. He had another severe haematemesis and died shortly after admission.Pathology The specimen includes the testis, tunica vaginalis, and spermatic cord. The tunica vaginalis is thickened with a distended cavity, while the testis is normal. This represents a chronic secondary communicating hydrocele.Further InformationA hydrocele is fluid between the parietal and visceral layers of the tunica vaginalis. Hydroceles can be communicating (connected to the peritoneal cavity) or non-communicating. Communicating hydroceles result from failure of processus vaginalis closure and may appear at birth or later due to increased intra-abdominal pressure, like heart or liver failure. Non-communicating hydroceles arise from fluid imbalance due to infections, tumors, trauma, or lymphatic obstruction.Patients present with a scrotal mass that may be uni- or bilateral. Communicating hydroceles can be reducible and change size with pressure; non-communicating are usually fixed. Swellings are generally painless unless complicated. Larger hydroceles may cause skin irritation or infections.Diagnosis is clinical, aided by transillumination and ultrasound to exclude other testicular conditions. Tumor markers (AFP and B-HCG) may rule out cancer. Many congenital hydroceles resolve by age 2; persistent or symptomatic hydroceles require surgical repair to avoid hernia risk. Treating the underlying cause can also resolve reactive hydroceles.