DIP Episode 265 - Male Reproductive Pathologies and the USMLEs

Okay, welcome. My name is Devine. This is episode 265 of the Divine Intervention Podcast. And in this podcast, I'll be talking about the meal reproductive pathologies. I don't know. I feel like men almost get like no attention from study resources and stuff. I feel like most study resources is really for step 2, CK step 3. They almost even both are talking about meal reproductive pathologies. So I figured out me like this one comprehensive podcast where you know pretty much all the meal reproductive pathologies you can see on the USML exam. You know, it's disgusting good detail. Although this should be a podcast that's on the relatively short end of the spectrum. Okay, now what do you think you have a question about a patient? And they tell you that, oh, that this is like a newborn. And they tell you that this newborn has not year-in-eated since he was born, right? And then they show you like a picture of the penis of the newborn. And you notice that at the top of the penis, right? So like the dorsal surface, you notice that the top of the penis doesn't have has like a groove at the very top, right? Like a groove at the top of the penis. If you see that, I'll really hope you're thinking about epispadias, right? Remember, epispadias again, they tend to be found on the top of the penis, down the ventral surface, right? So if you're thinking about like a guy's erect penis, right, the very top, right? That's the dorsal surface.

Because urethra is supposed to come out straight through the middle. If it comes out on top, right? That's an epispadial. And remember that these epispadias tend to be associated with these guys ultimately have been bladder extrophy. Right? Blood extrophy is basically a situation where the bladder is almost like outside of the body. To be honest, if you think of blood extrophy almost like a gastroskysis or a non-follow seal of the bladder, right? So remember between epispadias and hypospadias. Epispadias has the more classic association, right? Epispadias has the more classic association there. Just one of those weird, high-yield things you want to keep at the back of your mind, for example. And remember that when a kid has epispadias or hypospadias, any of these are bladder, I mean any of these are urethra and anomalies. One thing you always try to do on an MBME is to not recommend circumcision, right? Because you need that foreskin to fix the problem. You need the foreskin to fix the problem. And remember that hypospadias, right? That's when you have the urethral, the urethra coming out on the back. Coming out on the bottom, right? On the ventral surface of the penis. Again, many times these things can cause UT Is. They can cause problems with ejaculation if they are not fixed, right? And sometimes people that have these problems, they can actually have a cryptorchidism, right?

Cryptorchidism has a very well established association on MBME exams with epispadias and hypospadias. Okay, now what is the biggest risk factor for a pinal cancer? What is the biggest risk factor for pinal cancer on MBME exams? I would really, really hope that you're thinking about the HP Vs, especially 16, 18, and those in the 30s, right? That's how people get pinal cancer on MBME exams. And remember most pinal cancers, right? They tend to be of the squamous cell kind, right? They tend to be of the squamous cell kind. But the thing is, sometimes if the MBME wants to get a little nifty, right? They can give you a personal question about a person that has like a pinal malignancy, right? But they may tell you that all that, they may give you a question where, oh, biopsy of the lesion shows a lot of caratinization, right? So obviously that tells you that, oh, this is a squamous cell thing, right? And then they'll tell you that, oh, the malignan cells are limited by the basement membrane. So that means they've not crossed the basement membrane. Whenever you see stuff like that, right? Whenever it's almost like a carcinoma inside, too, that's a pinal cancer. They want to think about like boi and disease on your exam, right? They want to think about boi and disease on your test, right? And then if they ask which of the following is the most likely outcome of this boi and disease, right? Then you want to think about resolution, right?

Many times this stuff results on its own, but about 10% of them, right? Can progress to invasive like cancer, right? So if they ask you what's the most likely outcome of boi and disease, right? Pick the answer that says resolution, right? But if they say, oh, which of the following is the most dangerous complication of this disorder? Obviously, it's becoming like invasive a squamous cell cancer, right? So again, don't forget, HPV 16 and 18, and those in the 30s are the biggest risk factor for squamous cell cancer of the penis. I mean, if they don't put that as an answer, right? If they don't put HPV as an answer, there are some other things that can increase the person's risk for a pinal cancer, right? So like for prison smokes, right? And for a person who has no been circumcised, right? That definitely increases that person's risk of squamous cell cancer of the penis. And again, remember, like I said, because most of these squamous cell cancers, because most of these pinal cancers are squamous cell cancers, right? They will tell you on the exam, right? That these things, if you're trying to describe biopsie results. Again, just to mention your head, they'll tell you that there's a lot of caretin, right? Whenever you see the word caretin, in the description of any kind of malignancy on an end-beaming exam, it's a squamous cell cancer, simple as that. And pretty much any squamous cell cancer in any part of the body can produce PT-HRP in a pranioplastic fashion, okay?

Can produce PT-HRP in a pranioplastic fashion. That's a high-yield thing to know, right? So if they give you a question about a person that has a pinal cancer and the person has hypercalcemia, you know the reasoning behind that on an end-beaming exam, right? And then one thing I want to see, right, like you've heard me use the term cryptorchidism, right? Well, what in the world does cryptorchidism mean? Cryptorchidism basically means that the testes did not descend, right? Because remember, the testes develop in the lower abdominal cavity when a person is in uterine, right? And then it's supposed to descend, right? In the third trimester, under the action of Androgens. Androgens cause a person to have descent of the testes, right? So you can already begin to imagine a kid that has Androgens sensitivity, same from chances are, they're not going to have any kind of descent, right? Because guess what? They have Androgens, but those Androgens do not work, right? And maybe like, divine Nokia, why can we just keep these testes in the pelvic cavity and be fine, no big deal, no problems? Well, the reason we don't do that is, again, if the testes are in the abdomen and the pelvic cavity, right? Then they will be maintained at body temperature. The thing is, again, remember enzymes, they work based on temperatures, right? So the thing is, many of these testes can only experiment at body temperature, right?

They make sperms, like sperm production is effective at body temperatures of like 35 degrees Celsius. So like two degrees below body temperature, that's why your test is going to the scrotum, right? That's why you need that testicular descent, right? So basically, whenever you have increased temperature of the testes, right, of the scrotum, that basically is going to inhibit the production of a sperm, right? So, I mean, they ask you like, what is the most common location of cryptorchidism? Like, where is the testes usually trapped, right? It does not descend entirely to the scrotum. I want you to pick an answer choice that says in the inguinal canal. Most times, almost in almost every case of cryptorchidism, right? The testes descent, they just don't get to the scrotum. They get stuck in the inguinal canal, right? They get stuck in the inguinal canal. And sometimes on endemic exams, again, especially these new endemic exams, you know, if they want to be get all cute and smart, one thing they can say is, oh, which of the fulini is the most likely associated reproductive anomaly in a person that has cryptorchidism? I want you to think about picking the answer that says inguinal hernia, right? Inguna hernia is extremely common in kids that have cryptorchidism. Again, we know that the more recent endemic exams, they are stuck in treat these days, right?

Is to ask about risk factors, most likely association, bigest prognostic factor, bigest predictive prognosis, all those weird stuff, right? So from the male perspective of things, that's what I'm trying to hit on those. In fact, it's almost like something I'm trying to do with most of the pathologies. And as Kossi, my podcast is this to really hit these topics and hit them and hit them hard. And remember, again, cryptorchidism, right? It increases the risk of testicular cancer in either testes. Even if you're like, oh, within three months of the child being born, we brought down the testes that was undescended and actually still increases risk of testicular cancer in either testes, not just the one that did not descent, right? Because again, the endemic can get cute and say, oh, the left test is descended, the right test is not descent. That literally doesn't mean squat. You have an increased risk of testicular cancer in both the descendant testicle and in the undescended testicle. And many times you may be like, okay, divine. Yeah, besides the risk of testicular cancer, why else is it important? Why else is it a problem if the testes does not descend? Let me tell you this. If a testes does not descend and is still stuck, right? After about a year, two years, that testicle actually begins to undergo atrophy, right? That testicle actually begins to undergo atrophy, believe it or not, right? So if it atrophy is, well, by by sperm, right?

And that's a huge problem if you're a guy, right? So that's why cryptorchid testes, you try to get them down as quickly as possible, right? You try to get them down as quickly as possible, right? And what is the genetic disease on an in-beaming exam? There'll be associated things where on the subject of balls, basically, we're talking about balls, you know, testicles. What is the disease on an in-beaming exam? There'll be associated, like, bilateral testicular atrophy. I would hope you think about client-felture syndrome, right? Client-felture syndrome. Remember, client-felture is 47 W, double X, Y, right? So it is really tall guys, you know, micro penis and all that stuff, right? And then what genetic disease is associated with testicular enlargement on an in-beaming exam? I would hope you're thinking about fragile X syndrome. Remember, that's one of those X-link dominant disorders. You may see tested on an in-beaming exam, by the way, the other one is a upward syndrome, right? So fragile X syndrome is associated with testicular enlargement, right? It's X-link dominant. And don't forget that fragile X, right? Is associated with those CGG trying to clear that repeat, right? So, you know, those CGG trying to clear that repeat, and many of those kids, again, tend to get ADHD in the future. And then don't forget mumps, right? Mumps can absolutely cause testicular enlargement, right?

And fact, about 25 to 30% of kids that have mumps will ultimately get like an inflammation of the testes, right? You'll get the disorder is called orcitis, right? It's called orcitis, right? So again, just big thing, you want to keep on the back of your mind on the exams, right? And then what if they give you a question about a male patient that is, you know, like 19 years old sexually active, doesn't use condoms consistently, right? And they tell you that the patient has been having like a lot of pain and tenderness along the rim of his scrotum, right? Like they tell you that, oh, the pain is like a linear band extending out of his scrotum, right? And he's radiating towards the groin. If you see that, I really hope you're thinking about epidemiologists, right, on a test, right? And remember, the age, many times they love to ask what is the box causing this person's problem, right? You want to think about a epidemiologist, right? And again, since it's a young person, right? Then the thing I absolutely want you to think about on your test is, like Sarah Gwonorea, right, or Clamedia, right? So, like Sarah Gwonorea or Clamedia, right? So, like Sarah Gwonorea or Clamedia, you absolutely want to think about those things as the box. And I think about those things as the causes of, as the causes of epidemiologists on an epidemi exam, right? But again, if it's an older guy, you know, guy like in his 50s, right?

You know, usually people that are older, not saying in the real world this obtains, but you know, on epidemi exams, old people are generally assumed to be doing things that are upstanding, they don't do anything bad, they don't have sex multiple times without using condoms and all that fun stuff. They don't keep multiple sexual partners, right? So, in old people, he's going to be equalized, right? He's going to be equalized with another person. And again, obviously for a person who has equalized, right? You treat it the way you treat a UTI, right? So, you can give them like a back trim, you can give them a fluoroquin, and that's fine. But if it's a young guy, right? Again, because it's going to coccousen Clamedia, you absolutely want to give those people safe tracks on a boxy cycling, right? Or safe tracks on under, and is it through my send on an epidemi exam? And then, don't forget, right? Like, what if they give you a question about a newborn? You know, the tell you that this newborn is fine, it's coming for like, I don't know, like a two week visit or whatever, right? And they notice this, they notice these, these accumulations of fluid, right? In the child's attestical, right? Or they notice like a small, poppable mass in the child's attestical. If you see that, right, then you want to think about a hydrocell, right? Hydrocell is pretty easy. Basically, right? It's like fluid that accumulates, right? Because your tonic of aginolus did not close completely, right?

So, that's a hydrocell, right? And one thing that you want to do on an epidemi exam, if they ask you like, oh, how can you differentiate between a hydrocell and a testicular cancer on an epidemi exam? That's pretty easy, right? All you have to do is just do that trans illumination business, right? So if you shine light through that testicle, right? Hydrocell trans illuminates, right? It's almost like you're looking at an eclipse when you use that pen light, right? When a child has a hydrocell, right? But again, a testicular cancer, like a testicular mass is not going to trans illuminate. And one thing that the NBME tries to do sometimes, again, just to mess up people's heads, again, this is one of the NBME's primary businesses, right? They take what you know and just put in different terms, right? So instead of seeing a failed obliteration, right? Of the tonic of aginolus or whatever, they can say trans-udits accumulation in the tonic of aginolus. Remember that fluid that accumulates actually an ultra-fuel trait of blood, right? So it's a trans-udit, right? So that hydrocell fluid is actually a trans-udit, just something you want to keep at the back of your mind on an NBME exam, right?

And then what if they give you a question about like some young guy, you know, he's in his 20s or 30s, and they tell you that, you know, he has been infertile, has been trying to have kids with his wife, they have sex like many, many times a week, like, you know, like two hours, they have sex, they don't use condoms, nothing. And let's say the wife has had a kid from a previous marriage, right? So the one is fine, right? And then, you know, the guy is the infertile, blah, blah, blah, blah, blah. Right? If you see that to the number one thing, you absolutely want to think about on your exam is varicocells, right? You want to think about a varicocell, right? And remember a varicocell, the problem that happens in a varicocell is there's a ton of dilation, right? Of the pampini-phomplexus, right? Remember, it's a venousplexus that exists around the testicle, right? And you know, classically, the hotel you're that there's this bug of warmth, a bug of warmth, finding on a physical exam, right? Kind of seems a little weird, but any, you know, about beating your patient's balls, but whatever. So, you know, like, it'll have this bug of warmth up here. So you may be like, divine. Why does a varicocell causing fertility on an in-beaming exam? It's actually for a simple reason. If you want to understand why varicocells cause problems, whenever something is in a stationary spot and you hang out close to it, you get hot, right? So for example, find a light bulb, right?

In your apartment or whatever and go and touch that light bulb, right? You feel that it's pretty hot, right? Because it's almost like concentrated energy at that point, right? So the thing is, whenever there is the pampini-phomplexus helps you return blood away from the testicle, right? So if the pampini-phomplexus is dilated and is not drained appropriately, right? All that blood is just hanging around, hanging around, hanging around, keeping, keeping, keeping heat in the testicle. Basically, you're essentially going to be keeping the scrotum at body temperature. You already remember what I said about that and that generation of scrum. Sperm is not going to be generated very nicely in that situation, right? So that's why those men tend to be infertile, right? They tend to be infertile. And then what if they give you a question about like, you know, a young guy, right? Give you a question about a young guy and they tell you that, you know, he was studying for like step two, see here something weird, right? And Danny has like sodium onset, severe growing pain, right? Severe testicular pain, right? And then, you know, the detail that is rushed to the hospital and the ask for your next best step in management. I hope that you are going to surgically explore this guy's testicle, right? Essentially, this guy has a testicular torsion, right? Testicular torsion, right? Remember a testicular torsion, right? You don't do any kind of diagnostic testing.

Diagnostic testing is not done for testicular torsion on the name of the exam. Listen to me again. Because you'll put an answer choice that says to don't do that, right? If you pick that answer and guarantee it, right? You get the question wrong, right? So don't do that, right? So, you're, again, remember this is a good approach and essentially, right? Again, the thing that happens is the ospermatic chord just twists suddenly, right? And when he twists, right, that basically cuts off venous drainage. He's actually not really on a tear or problem. Believe it or not, it's more of a venous problem, right? So you're cutting off venous drainage from the testicle, right? So if the testicle is not draining, right? That's almost like this. It's almost like, I almost think of it as like a central rate no venous occlusion. But in this case, it's a venous occlusion of the testicle, right? So whenever that happens, the screen is going to hold a tongue, right? It's going to hurt a tongue, right? And the thing that will ultimately happen is if the testicle, right, doesn't drain properly for like six hours, it will die, right? And that's not very good if you're a guy that plans to have kids or you know, plans to have sex because you need hundreds of gens in the future, right? So that's why you literally, you take that person, pick the answer to the choice that says to surgically explore the testicle. And basically what you're going to do is you're going to detour the testicle surgically.

And then you're going to do something called an orcupexe, a bilateral orcupexe. So that again, you're going to detour the testicle. And then you're going to do a bilateral orcupexe. Or you're going to do a bilateral orcupexe. Basically, an orcupexe means that you sing each testicle to the walls of the scrotum, right? So that you don't have those testicles towards again because when you have one episode of testicle at torsion, that increases your risk of having another torsion in the future. Again, just one of those weird bizarre things to keep at the back of your mind on exams, right? And sometimes if we may say, oh, which of the following is the most likely finding on this school or ultrasound in a person that has a torsion, remember, you'll have decreased blood flow, right? You'll have decreased blood flow. And remember that people that have testicle at torsion, they have like an absent crema story flex. So you stroke the inside of a guy's thigh, right? When you do that, that generally causes the scrotum to elevate upright. If you don't see that happening, right? That's an absent crema story flex. That's an ominous finding, right? Again, that's more consistent with testicle at torsion. But the thing is your friends at the end of the year are little really, really smart, right? There is this weird thing you've started doing on the newer exams, right? Let me give you a question, Larry, same presentation as the testicle at torsion, right?

Well, they'll tell you that, oh, this guy, you know, sought in on set, testicle of pain, studying for step two CK, I'm just using the study for step two CK example. It'll be some other example they throw in the text, right? But you know, gotta add a little humor to this podcast so that you can chuckle or laugh if you're driving to work or something, right?

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blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, b

lah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, bl

ah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, bla

h, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah

, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah

, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah,

blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah,

blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah

Epispadias.

Bladder exstrophy.

Squamous cell carcinoma.

HPV infection (especially types 16, 18, and those in the 30s).

A "bag of worms" feeling due to dilated pampiniform plexus veins.

The testes must be maintained at body temperature (around 35°C), which is optimal for sperm production, unlike the warmer abdominal cavity.

Transillumination; fluid-filled structures transilluminate when light passes through them.

Gonorrhea or Chlamydia (requires specific antibiotics).

Bladder exstrophy.

Squamous cell carcinoma.

Smoking and lack of circumcision.

The inguinal canal.

Klinefelter Syndrome (47, XXY).

Hydrocele.

Inguinal hernia.

Fragile X Syndrome.

Emergency surgical exploration (detorsion/orchiopexy).

Because time is critical; delaying surgery for imaging can lead to irreversible ischemia and necrosis.

Bladder exstrophy.

Squamous cell carcinoma.

Smoking and lack of circumcision.

The inguinal canal.

Klinefelter Syndrome (47, XXY).

Hydrocele.

Inguinal hernia.

Fragile X Syndrome.

Emergency surgical exploration (detorsion/orchiopexy).

Because time is critical; delaying surgery for imaging can lead to irreversible ischemia and necrosis.