Skip to main content

Male Genital Tract

  • Chapter
  • First Online:
Pediatric Body MRI

Abstract

The male genital tract is a complex set of pelvic anatomic structures. In recent years, MR imaging has assumed an important role as a primary or problem-solving tool for evaluating various congenital and acquired male genital tract disorders in the pediatric population. In this chapter, relevant embryology, anatomy, and variants of male genital tract disorders are described, followed by up-to-date MR imaging techniques and protocols including pediatric patient preparation. In addition, clinically important male genital tract disorders that occur in infants and children are also discussed with emphasis on characteristic MR imaging findings. A clear understanding of MR imaging techniques and characteristic imaging findings of male genital tract disorders has great potential for the optimal pediatric patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Darge K, Anupindi SA, Jaramillo D. MR imaging of the abdomen and pelvis in infants, children, and adolescents. Radiology. 2011;261(1):12–29.

    Article  PubMed  Google Scholar 

  2. Raza SA, Jhaveri KS. MR imaging of urinary bladder carcinoma and beyond. Radiol Clin N Am. 2012;50(6):1085–110.

    Article  PubMed  Google Scholar 

  3. Levin TL, Han B, Little BP. Congenital anomalies of the male urethra. Pediatr Radiol. 2007;37(9):851–62; quiz 945

    Article  PubMed  PubMed Central  Google Scholar 

  4. Berrocal T, Lopez-Pereira P, Arjonilla A, Gutierrez J. Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Radiographics. 2002;22(5):1139–64.

    Article  PubMed  Google Scholar 

  5. Pichler R, Oswald J, Glodny B, Skradski V, Aigner F, Rehder P. Unilateral renal agenesis with absent ductus deferens, epididymis and seminal vesicle: incidental finding in a 22-year-old patient with maldevelopment of the mesonephric duct. Urol Int. 2011;86(3):365–9.

    Article  PubMed  Google Scholar 

  6. Kim B, Kawashima A, Ryu JA, Takahashi N, Hartman RP, King BF Jr. Imaging of the seminal vesicle and vas deferens. Radiographics. 2009;29(4):1105–21.

    Article  PubMed  Google Scholar 

  7. Bouzouita A, Kerkeni W, Abouda H, Khrouf M, Elloumi H, Mnif N, et al. Seminal vesicle agenesis: an uncommon cause of azoospermia. Can Urol Assoc J. 2014;8(3–4):E266–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Choi HK, Cho KS, Lee HW, Kim KS. MR imaging of intersexuality. Radiographics. 1998;18(1):83–96.

    Article  CAS  PubMed  Google Scholar 

  9. Riccabona M. Pediatric urogenital radiology: Springer International Publishing. Switzerland: Cham; 2018.

    Google Scholar 

  10. Epelman M, Dinan D, Gee MS, Servaes S, Lee EY, Darge K. Müllerian duct and related anomalies in children and adolescents. Magn Reson Imaging Clin N Am. 2013;21(4):773–89.

    Article  PubMed  Google Scholar 

  11. Cassidy FH, Ishioka KM, McMahon CJ, Chu P, Sakamoto K, Lee KS, et al. MR imaging of scrotal tumors and pseudotumors. Radiographics. 2010;30(3):665–83.

    Article  PubMed  Google Scholar 

  12. Atobatele MO, Oyinloye OI, Nasir AA, Bamidele JO. Posterior urethral valve with unilateral vesicoureteral reflux and patent urachus: a rare combination of urinary tract anomalies. Urol Ann. 2015;7(2):240–3.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lebowitz RL. Voiding cystourethrography in boys: the presence of the catheter does not obscure the diagnosis of posterior urethral valves but prevents estimation of the adequacy of transurethral fulguration. Am J Roentgenol. 1996;166(3):724.

    Article  CAS  Google Scholar 

  14. Ditchfield MR, GrattanSmith JD, deCampo JF, Hutson JM. Voiding cystourethrography in boys: the presence of the catheter does not obscure the diagnosis of posterior urethral valves but prevents estimation of the adequacy of transurethral fulguration—reply. Am J Roentgenol. 1996;166(3):724–5.

    Article  Google Scholar 

  15. Ditchfield MR, Grattansmith JD, Decampo JF, Hutson JM. Voiding cystourethrography in boys—does the presence of the catheter obscure the diagnosis of posterior urethral valves. Am J Roentgenol. 1995;164(5):1233–5.

    Article  CAS  Google Scholar 

  16. Chauvin NA, Epelman M, Victoria T, Johnson AM. Complex genitourinary abnormalities on fetal mri: imaging findings and approach to diagnosis. Am J Roentgenol. 2012;199(2):W222–W31.

    Article  Google Scholar 

  17. Lima M, Manzoni G, editors. Pediatric urology: contemporary strategies from fetal life to adolescence. Milan: Springer; 2015.

    Google Scholar 

  18. Levin TL, Han B, Little BP. Congenital anomalies of the male urethra. Pediatr Radiol. 2007;37(9):851–62.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Aminsharifi A, Afsar F, Pakbaz S. Laparoscopic management of Müllerian duct cysts in infants. J Pediatr Surg. 2011;46(9):1859–64.

    Article  PubMed  Google Scholar 

  20. Jia W, Liu GC, Zhang LY, Wen YQ, Fu W, Hu JH, et al. Comparison of laparoscopic excision versus open transvesical excision for symptomatic prostatic utricle in children. J Pediatr Surg. 2016;51(10):1597–601.

    Article  PubMed  Google Scholar 

  21. Kato H, Hayama M, Furuya S, Kobayashi S, Islam AM, Nishizawa O. Anatomical and histological studies of so-called Müllerian duct cyst. Int J Urol. 2005;12(5):465–8.

    Article  PubMed  Google Scholar 

  22. Shebel HM, Farg HM, Kolokythas O, El-Diasty T. Cysts of the lower male genitourinary tract: embryologic and anatomic considerations and differential diagnosis. Radiographics. 2013;33(4):1125–43.

    Article  PubMed  Google Scholar 

  23. Krishnaswami S, Fonnesbeck C, Penson D, McPheeters ML. Magnetic resonance imaging for locating nonpalpable undescended testicles: a meta-analysis. Pediatrics. 2013;131(6):E1908–E16.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tasian GE, Copp HL. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics. 2011;127(1):119–28.

    Article  PubMed  Google Scholar 

  25. Kantarci M, Doganay S, Yalcin A, Aksoy Y, Yilmaz-Cankaya B, Salman B. Diagnostic performance of diffusion-weighted mri in the detection of nonpalpable undescended testes: comparison with conventional MRI and surgical findings. Am J Roentgenol. 2010;195(4):W268–W73.

    Article  Google Scholar 

  26. Miyano T, Kobayashi H, Shimomura H, Yamataka A, Tomita T. Magnetic-resonance-imaging for localizing the nonpalpable undescended testis. J Pediatr Surg. 1991;26(5):607–9.

    Article  CAS  PubMed  Google Scholar 

  27. Yeung CK, Tam YH, Chan YL, Lee KH, Metreweli C. A new management algorithm for impalpable undescended testis with gadolinium enhanced magnetic resonance angiography. J Urol. 1999;162(3):998–1002.

    Article  CAS  PubMed  Google Scholar 

  28. Tonolini M, Ippolito S. Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs. Insights Imaging. 2016;7(5):689–711.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cristoforo TA. Evaluating the necessity of antibiotics in the treatment of acute epididymitis in pediatric patients: a literature review of retrospective studies and data analysis. Pediatr Emerg Care. 2017; https://doi.org/10.1097/PEC.0000000000001018. [Epub ahead of print]

  30. Louette A, Krahn J, Caine V, Ha S, Lau TTY, Singh AE. Treatment of acute epididymitis: a systematic review and discussion of the implications for treatment based on etiology. Sex Transm Dis. 2018;45(12):e104–e8.

    Article  PubMed  Google Scholar 

  31. Livingston L, Larsen CR. Seminal vesicle cyst with ipsilateral renal agenesis. AJR Am J Roentgenol. 2000;175(1):177–80.

    Article  CAS  PubMed  Google Scholar 

  32. Cascini V, Di Renzo D, Guerriero V, Lauriti G, Lelli Chiesa P. Zinner syndrome in pediatric age: issues in the diagnosis and treatment of a rare malformation complex. Front Pediatr. 2019;7:129.

    Article  PubMed  PubMed Central  Google Scholar 

  33. VanderBrink BA, Sivan B, Levitt MA, Pena A, Sheldon CA, Alam S. Epididymitis in patients with anorectal malformations: a cause for urologic concern. Int Braz J Urol. 2014;40(5):676–82.

    Article  PubMed  Google Scholar 

  34. Levenson RB, Singh AK, Novelline RA. Fournier gangrene: role of imaging. Radiographics. 2008;28(2):519–28.

    Article  PubMed  Google Scholar 

  35. Rouzrokh M, Tavassoli A, Mirshemirani A. Fournier’s gangrene in children: report on 7 cases and review of literature. Iran J Pediatr. 2014;24(5):660–1.

    PubMed  PubMed Central  Google Scholar 

  36. Cundy TP, Boucaut HA, Kirby CP. Fournier’s gangrene in a child with congenital genitourinary anomalies. J Pediatr Surg. 2012;47(4):808–11.

    Article  PubMed  Google Scholar 

  37. Bosl GJ, Motzer RJ. Testicular germ-cell cancer. N Engl J Med. 1997;337(4):242–53.

    Article  CAS  PubMed  Google Scholar 

  38. Taskinen S, Fagerholm R, Aronniemi J, Rintala R, Taskinen M. Testicular tumors in children and adolescents. J Pediatr Urol. 2008;4(2):134–7.

    Article  PubMed  Google Scholar 

  39. Ahmed HU, Arya M, Muneer A, Mushtaq I, Sebire N. Testicular and paratesticular tumours in the prepubertal population. Lancet Oncol. 2010;11(5):476–83.

    Article  PubMed  Google Scholar 

  40. Nerli RB, Ajay G, Shivangouda P, Pravin P, Reddy M, Pujar VC. Prepubertal testicular tumors: our 10 years experience. Indian J Cancer. 2010;47(3):292–5.

    Article  CAS  PubMed  Google Scholar 

  41. Sohaib SA, Koh DM, Barbachano Y, Parikh J, Husband JE, Dearnaley DP, et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol. 2009;64(4):362–7.

    Article  CAS  PubMed  Google Scholar 

  42. Kok HK, Leong S, Torreggiani WC. Is magnetic resonance imaging comparable with computed tomography in the diagnosis of retroperitoneal metastasis in patients with testicular cancer? Can Assoc Radiol J. 2014;65(3):196–8.

    Article  PubMed  Google Scholar 

  43. Marko J, Wolfman DJ, Aubin AL, Sesterhenn IA. Testicular seminoma and its mimics: from the radiologic pathology archives. Radiographics. 2017;37(4):1085–98.

    Article  PubMed  Google Scholar 

  44. Tsili AC, Tsampoulas C, Giannakopoulos X, Stefanou D, Alamanos Y, Sofikitis N, et al. MRI in the histologic characterization of testicular neoplasms. AJR Am J Roentgenol. 2007;189(6):W331–7.

    Article  PubMed  Google Scholar 

  45. Secil M, Altay C, Basara I. State of the art in germ cell tumor imaging. Urol Oncol-Semin Ori. 2016;34(3):156–64.

    Article  Google Scholar 

  46. Tsili AC, Argyropoulou MI, Astrakas LG, Ntoulia EA, Giannakis D, Sofikitis N, et al. Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions. AJR Am J Roentgenol. 2013;200(3):578–85.

    Article  PubMed  Google Scholar 

  47. Mohrs OK, Thoms H, Egner T, Brunier A, Eiers M, Kauczor HU, et al. MRI of patients with suspected scrotal or testicular lesions: diagnostic value in daily practice. Am J Roentgenol. 2012;199(3):609–15.

    Article  Google Scholar 

  48. Froehlich JM, Metens T, Chilla B, Hauser N, Hohl MK, Kubik-Huch RA. MRI of the female pelvis: a possible pitfall in the differentiation of haemorrhagic vs. fatty lesions using fat saturated sequences with inversion recovery. Eur J Radiol. 2012;81(3):598–602.

    Article  PubMed  Google Scholar 

  49. Epifanio M, Baldissera M, Esteban FG, Baldisserotto M. Mature testicular teratoma in children: multifaceted tumors on ultrasound. Urology. 2014;83(1):195–7.

    Article  PubMed  Google Scholar 

  50. Coley BD, editor. Caffey’s pediatric diagnostic imaging, vol. 2. 13th ed. Philadelphia: Elsevier; 2019.

    Google Scholar 

  51. Koenigsberg RA, Kelsey D, Friedman AC. Case report: ultrasound and MRI findings in a scrotal epidermoid cyst. Clin Radiol. 1995;50(8):576–8.

    Article  CAS  PubMed  Google Scholar 

  52. Hanna NH, Einhorn LH. Testicular cancer—discoveries and updates. N Engl J Med. 2014;371(21):2005–16.

    Article  PubMed  CAS  Google Scholar 

  53. Woo LL, Ross JH. The role of testis-sparing surgery in children and adolescents with testicular tumors. Urol Oncol. 2016;34(2):76–83.

    Article  PubMed  Google Scholar 

  54. Moreno CC, Small WC, Camacho JC, Master V, Kokabi N, Lewis M, et al. Testicular tumors: what radiologists need to know-differential diagnosis, staging, and management. Radiographics. 2015;35(2):400–15.

    Article  Google Scholar 

  55. Coley BD. Caffey’s pediatric diagnostic imaging. 13th. ed. Philadelphia: Elsevier; 2019.

    Google Scholar 

  56. Liu S, Koscheski P. Neonatal juvenile granulosa cell tumor of the testis. Appl Radiol. 2016;45(7):32A–B.

    Google Scholar 

  57. Yikilmaz A, Lee EY. MRI findings of bilateral juvenile granulosa cell tumor of the testis in a newborn presenting as intraabdominal masses. Pediatr Radiol. 2007;37(10):1031–4.

    Article  PubMed  Google Scholar 

  58. Tsitouridis I, Maskalidis C, Panagiotidou D, Kariki EP. Eleven patients with testicular leydig cell tumors clinical, imaging, and pathologic correlation. J Ultrasound Med. 2014;33(10):1855–64.

    Article  PubMed  Google Scholar 

  59. Shapiro E, Strother D. Pediatric genitourinary rhabdomyosarcoma. J Urol. 1992;148(6):1761–8.

    Article  CAS  PubMed  Google Scholar 

  60. Royal SA, Hedlund GL, Galliani CA. Rhabdomyosarcoma of the dome of the urinary bladder: a difficult imaging diagnosis. AJR Am J Roentgenol. 1996;167(2):524–5.

    Article  CAS  PubMed  Google Scholar 

  61. Agrons GA, Wagner BJ, Lonergan GJ, Dickey GE, Kaufman MS. From the archives of the AFIP. Genitourinary rhabdomyosarcoma in children: radiologic-pathologic correlation. Radiographics. 1997;17(4):919–37.

    Article  CAS  PubMed  Google Scholar 

  62. Shelmerdine SC, Lorenzo AJ, Gupta AA, Chavhan GB. Pearls and pitfalls in diagnosing pediatric urinary bladder masses. Radiographics. 2017;37(6):1872–91.

    Article  PubMed  Google Scholar 

  63. Pai DR, Ladino-Torres MF. Magnetic resonance imaging of pediatric pelvic masses. Magn Reson Imaging Clin N Am. 2013;21(4):751–72.

    Article  PubMed  Google Scholar 

  64. Park K, van Rijn R, McHugh K. The role of radiology in paediatric soft tissue sarcomas. Cancer Imaging. 2008;8:102–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Van Rijn RR, Wilde JC, Bras J, Oldenburger F, McHugh KM, Merks JH. Imaging findings in noncraniofacial childhood rhabdomyosarcoma. Pediatr Radiol. 2008;38(6):617–34.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Stehr M. Pediatric urologic rhabdomyosarcoma. Curr Opin Urol. 2009;19(4):402–6.

    Article  PubMed  Google Scholar 

  67. Aganovic L, Cassidy F. Imaging of the scrotum. Radiol Clin N Am. 2012;50(6):1145–65.

    Article  PubMed  Google Scholar 

  68. Sung T, Riedlinger WF, Diamond DA, Chow JS. Solid extratesticular masses in children: radiographic and pathologic correlation. AJR Am J Roentgenol. 2006;186(2):483–90.

    Article  PubMed  Google Scholar 

  69. Dangle PP, Correa A, Tennyson L, Gayed B, Reyes-Mugica M, Ost M. Current management of paratesticular rhabdomyosarcoma. Urol Oncol. 2016;34(2):84–92.

    Article  PubMed  Google Scholar 

  70. Shah T, Abu-Sanad O, Marsh H. Role of magnetic resonance imaging in the early diagnosis of paratesticular rhabdomyosarcoma. Ann R Coll Surg Engl. 2016;98(5):e74–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Mason BJ, Kier R. Sonographic and MR imaging appearances of paratesticular rhabdomyosarcoma. AJR Am J Roentgenol. 1998;171(2):523–4.

    Article  CAS  PubMed  Google Scholar 

  72. Porter RP, Kaste SC. Imaging findings of recurrent acute lymphoblastic leukemia in children and young adults, with emphasis on MRI. Pediatr Radiol. 2004;34(5):400–8.

    Article  PubMed  Google Scholar 

  73. Chua SC, Rozalli FI, O'Connor SR. Imaging features of primary extranodal lymphomas. Clin Radiol. 2009;64(6):574–88.

    Article  CAS  PubMed  Google Scholar 

  74. Simon T, Hero B, Berthold F. Testicular and paratesticular involvement by metastatic neuroblastoma. Cancer. 2000;88(11):2636–41.

    Article  CAS  PubMed  Google Scholar 

  75. Bree RL, Hoang DT. Scrotal ultrasound. Radiol Clin N Am. 1996;34(6):1183–205.

    CAS  PubMed  Google Scholar 

  76. Sanelli PC, Burke BJ, Lee L. Color and spectral doppler sonography of partial torsion of the spermatic cord. AJR Am J Roentgenol. 1999;172(1):49–51.

    Article  CAS  PubMed  Google Scholar 

  77. Terai A, Yoshimura K, Ichioka K, Ueda N, Utsunomiya N, Kohei N, et al. Dynamic contrast-enhanced subtraction magnetic resonance imaging in diagnostics of testicular torsion. Urology. 2006;67(6):1278–82.

    Article  PubMed  Google Scholar 

  78. Gotto GT, Chang SD, Nigro MK. MRI in the diagnosis of incomplete testicular torsion. Br J Radiol. 2010;83(989):e105–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Trambert MA, Mattrey RF, Levine D, Berthoty DP. Subacute scrotal pain: evaluation of torsion versus epididymitis with MR imaging. Radiology. 1990;175(1):53–6.

    Article  CAS  PubMed  Google Scholar 

  80. Maki D, Watanabe Y, Nagayama M, Ishimori T, Okumura A, Amoh Y, et al. Diffusion-weighted magnetic resonance imaging in the detection of testicular torsion: feasibility study. J Magn Reson Imaging. 2011;34(5):1137–42.

    Article  PubMed  Google Scholar 

  81. Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics. 2003;23(1):215–40.

    Article  PubMed  Google Scholar 

  82. Baldisserotto M, de Souza JC, Pertence AP, Dora MD. Color Doppler sonography of normal and torsed testicular appendages in children. AJR Am J Roentgenol. 2005;184(4):1287–92.

    Article  PubMed  Google Scholar 

  83. Behr GG, Johnson C. Vascular anomalies: hemangiomas and beyond—part 1. Fast-flow lesions. AJR Am J Roentgenol. 2013;200(2):414–22.

    Article  PubMed  Google Scholar 

  84. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69(3):412–22.

    Article  CAS  PubMed  Google Scholar 

  85. Kulungowski AM, Schook CC, Alomari AI, Vogel AM, Mulliken JB, Fishman SJ. Vascular anomalies of the male genitalia. J Pediatr Surg. 2011;46(6):1214–21.

    Article  PubMed  Google Scholar 

  86. Drolet BA, Chamlin SL, Garzon MC, Adams D, Baselga E, Haggstrom AN, et al. Prospective study of spinal anomalies in children with infantile hemangiomas of the lumbosacral skin. J Pediatr. 2010;157(5):789–94.

    Article  PubMed  Google Scholar 

  87. Behr GG, Johnson CM. Vascular anomalies: hemangiomas and beyond–part 2, slow-flow lesions. AJR Am J Roentgenol. 2013;200(2):423–36.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gerald Behr .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Behr, G., Son, J.K., Restrepo, R., Lee, E.Y. (2020). Male Genital Tract. In: Lee, E., Liszewski, M., Gee, M., Daltro, P., Restrepo, R. (eds) Pediatric Body MRI. Springer, Cham. https://doi.org/10.1007/978-3-030-31989-2_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-31989-2_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-31988-5

  • Online ISBN: 978-3-030-31989-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics