Letter from the Editor

Article Outline

• Copyright

The male genitalia encompass the organs of reproduction. They include the penis, testicles, scrotum, prostate, seminal vesicles, epididymis and Cowper’s glands. These organs may be affected by a wide variety of pathological conditions. In this issue I have tried to choose the topics most relevant to radiologists.

The spectrum of conditions that affect the scrotum and its contents ranges from incidental findings that merely require explanation and patient reassurance to acute pathologic events that require urgent diagnosis and treatment. Acute scrotal pain is a frequent symptom, accounting for approximately 0.5% of all complaints presenting to an emergency department. The first article is a superbly illustrated review by Monica Smith Pearl and Michael Hill from the Department of Radiology, The George Washington University Hospital, Washington DC, on the vital role of ultrasound in diagnosing scrotal disease.

Ultrasound is also indispensable in the evaluation of the prostate. More specifically, transrectal ultrasonography (TRUS) is an essential tool for detecting prostate pathology and performing biopsies. Recent exciting advances in TRUS as a diagnostic and also as a therapeutic tool, are wonderfully reviewed in the next article by Robert Linden and Ethan Halpern from Jefferson Prostate Diagnostic Center and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.

The male urethra may be affected by a host of pathological conditions, such as trauma and inflammation, often resulting in stricture. Imaging these pathological processes is primarily performed with conventional radiographic contrast studies, most often retrograde urethrography. The cross-sectional imaging modalities, ultrasound, CT and MR imaging, are being increasingly utilized as adjunctive tools for urethral and periurethral abnormalities. Drs. Kim, Kawashima, and LeRoy from the Mayo Clinic in Rochester, Minnesota, extensively describe the imaging techniques, anatomy and findings of a range of male urethral and periurethral pathology.

The role of imaging in the evaluation of erectile dysfunction has decreased with the advent of oral pharmacotherapy. However, evaluation with modalities such as color Doppler ultrasound, cavernosography and angiography, still remains the cornerstone of the diagnostic work-up of these patients. Ismail Mihmanli and Fatih Kantarci from Istanbul University, Turkey, provide a thorough review focusing on the pathophysiology of erection and on radiological techniques for investigating vascular causes of erectile dysfunction and their relevant imaging findings.

Penile carcinoma is rare in developed countries, accounting for less than 1% of all male malignancies in the United States. By contrast, in developing nations, particularly some parts of Africa and South America, it accounts for up to 10% of cancers in men. The rarity of this condition, coupled with its variable clinical appearance and frequent hesitation by the patient to seek treatment, often leads to long delays in diagnosis and treatment. Cross-sectional imaging is increasingly used in order to accurately stage penile malignancy. Ajay Singh and his associates from the Massachusetts General Hospital, Boston, provide a brilliant review focusing on imaging approaches for characterization of the primary tumor and for nodal staging.

A separate article focuses on the conditions that may affect the scrotum and its contents in the pediatric age group. Similar to the evaluation in adults, sonography is the preferred imaging method for the evaluation of pediatric scrotal swelling. Scrotal pathology differs in pediatric patients, especially prior to puberty, making understanding of pediatric conditions essential. Brian Coley, from Columbus Children’s Hospital, Ohio, has contributed a well illustrated and comprehensive review of sonographic findings of common intra- and extra-testicular causes of pediatric scrotal swelling.

The role of diagnostic imaging in the evaluation of cryptorchidism is controversial, but US is generally considered the initial study of choice in the setting of a palpable undescended testis. CT and MR may be performed for localization, if the testis is non-palpable. The complex embryology pertaining to testicular development and descent, their clinical significance and the role of imaging are discussed in depth by Jared Christensen and Vikram Dogra from the University of Rochester School of Medicine, NY.

The last review is dedicated to the most dramatic and perhaps the most serious of the acute processes affecting the scrotal contents—testicular torsion. The clinical and sonographic findings of testicular torsion with emphasis on color flow Doppler and spectral Doppler are thoroughly discussed and beautifully illustrated by Vikram Dogra and his associates from the University of Rochester School of Medicine, NY. New developments such as contrast-enhanced ultrasound, dynamic contrast magnetic resonance imaging and near infrared imaging are also described.

I would like to extend my appreciation to all authors who have contributed their time, knowledge and invaluable experience to provide reviews that make this issue a fascinating up-to-date reference on imaging of the male genitalia.