33 The Reproductive System Lesson 4: Pathology of the Male Reproductive System

Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. List common disorders associated with the female and male reproductive systems.

Disorders of the Male Reproductive System Anorchism Congenital absence of one or both testes Aspermia The lack of, or failure to, eject sperm Azoospermia Absence of sperm in the semen

Critical Thinking Question What communication guidelines can you suggest for discussing sensitive issues with patients?

Disorders of the Male Reproductive System Carcinoma of the testes Cancer of one or both testes Cryptorchidism Failure of the testes to descend into the scrotal sac before birth Could result in sterility A surgical procedure called an orchidopexy may be required to bring the testes down into the scrotum and secure them permanently

Epispadias Congenital opening of the male urethra on the dorsal surface of the penis

Hypospadias Congenital opening of the male urethra on the underside of the penis

Phimosis Narrowing of the foreskin over the glans penis Can lead to infection or difficulty with urination Treated with circumcision, the surgical removal of the foreskin Circumcision using the Plastibell. The bell is fitted over the glans. A suture is tied around the bell’s rim, and then the excess prepuce is cut away. The plastic rim remains in place for 3 to 4 days until healing occurs. The bell may be allowed to fall off; it is removed if still in place after 8 days.

Disorders of the Male Reproductive System Prostatitis An inflamed condition of the prostate gland that may be the result of infection Varicocele Enlargement of the veins of the spermatic cord Commonly occurs on the left side of adolescent males Seldom needs treatment

Benign Prostatic Hyperplasia (BPH) Also known as benign prostatic hypertrophy Enlargement of the prostate gland

Characteristics of BPH May occur in men 50 years of age and older By age 60, four out of five men have an enlarged prostate As the prostate enlarges, it compresses the urethra, restricting the normal flow of urine The restriction generally causes a number of symptoms collectively known as prostatism (any condition of the prostate gland that interferes with the flow of urine from the bladder)

Symptoms of BPH Weak or hard-to-start urine stream Feeling that the bladder is not empty Need to urinate often, especially at night Feeling of urgency (sudden need to urinate) Abdominal straining Interruption of the stream Acute urinary retention Recurrent urinary infections

Treatment for BPH Drug therapy Nonsurgical procedures Surgery Medications work either by: Reducing the size of the prostate Relaxing the smooth muscle of the prostate and the bladder neck to improve urine flow and reduce bladder outlet obstruction

Epididymitis Inflammation or infection of the epididymis (the long coiled tube attached to the upper part of each testicle, where mature sperm are stored before ejaculation) Most common cause of pain in the scrotum Most severe pain and swelling are usually associated with the acute form

Epididymitis If symptoms last for more than 6 weeks after treatment begins, the condition is considered chronic Can occur anytime after the onset of puberty, but is most common between the ages of 18 and 40

Risk Factors of Epididymitis Infection of the bladder, kidney, prostate, or urinary tract Other recent illness A narrowing of the urethra Use of a urethral catheter

Cause of Epididymitis Can be caused by the same organisms that cause some STIs or as a result of prostate surgery Generally caused by pus-generating bacteria associated with infections in other parts of the body Can also be caused by injury or infection of the scrotum or by irritation from urine that has accumulated in the vas deferens

Characterizations of Epididymitis Sudden redness and swelling of the scrotum Affected testicle is hard and sore, and the other testicle may feel tender Chills, fever, and acute urethritis, or inflammation of the urethra Enlarged lymph nodes in the groin may cause scrotal pain that intensifies throughout the day, sometimes to the point that walking becomes impossible

Treatment of Epididymitis Because it can cause sterility antibiotic therapy must be initiated as soon as symptoms appear To prevent reinfection, medication must be taken exactly as prescribed, even if symptoms disappear or the patient begins to feel better If approved by a family physician or urologist, over-the-counter anti-inflammatories can be used for pain relief

Treatment of Epididymitis Bed rest is also recommended until symptoms subside Patients are advised to wear athletic supporters when they resume normal activities

Erectile Dysfunction Inability to achieve or maintain an erection sufficient for sexual intercourse Occurs When not enough blood is supplied to the penis When the smooth muscle in the penis fails to relax, or When the penis does not retain the blood that flows into it

Erectile Dysfunction According to studies at the National Institutes of Health, 5 percent of men have some degree of erectile dysfunction at age 40, and by age 65 and older that figure rises to 15 to 25 percent Erectile dysfunction is not an inevitable part of aging

Risk Factors of Erectile Dysfunction Hypertension Hyperlipidemia Endocrine disorders Low testosterone Thyroid disease Diabetes Coronary artery disease Peripheral vascular disease Anemia Smoking Alcohol abuse Medications Surgical procedures Neurological conditions Psychiatric illness

Treatment Options for Erectile Dysfunction Medication therapy Medication changes Vacuum constriction device Urethral and penile injection therapies Surgery, including penile prostheses

Hydrocele Painless buildup of watery fluid around one or both testicles that causes swelling in the scrotum or groin area

Hydrocele Although it may be unsightly and uncomfortable, this swelling is not painful and generally not dangerous Can be congenital (present at birth) or acquired (develops after birth) A congenital hydrocele develops when, after the normal process of testicle migration, the space around the testicles does not close, or the closure is delayed – Fluid from the abdominal cavity fills this space, creating the hydrocele

Symptoms of Hydrocele A swollen scrotum or groin area The scrotum may: Have a bluish tinge The swelling is painless, may be soft or firm, and cannot be reduced by changing its position or gently pushing it up The swelling may change size, starting out small in the morning and gradually increasing in size throughout the day, and the skin on the scrotum may appear to be translucent

Symptoms of Hydrocele Any pain accompanying the swelling may indicate the presence of an inguinal hernia, injury to the testicles, or some other problem

Prostate Cancer Malignant tumor that grows in the prostate gland Most common cancer among American men Second leading cause of death as a result of cancer in men, exceeded only by lung cancer By age 50, one in four American men have some cancerous cells in the prostate gland

Prostate Cancer By age 80, the ratio increases to one in two The average age of diagnosis is 70 – However, only 1 in 32 men with this diagnosis actually dies from prostate cancer

Risk Factors Associated with Prostate Cancer Advanced age A diet high in animal fats Being of African or Northern European origin Family history of cancer History of vasectomy, smoking, or cadmium exposure

Symptoms of Prostate Cancer Dull pain in the lower pelvic area General pain in the lower back, hips, and upper thighs Blood in the urine or semen Dribbling when urinating Erectile dysfunction Frequent urination, especially at night Painful urination or ejaculation Smaller stream of urine or urgent need to urinate Loss of appetite and weight

Treatment Options for Prostate Cancer Chemotherapy Cryosurgery to freeze cancer cells External radiation to the prostate and pelvis Hormone therapy Radioactive implants in the prostate Surgery to remove part or all of the prostate and the surrounding tissue

Treatment Options for Prostate Cancer Surgical removal of the testes to block testosterone production Hormones and chemotherapy are used for advanced cancer

Critical Thinking Question Men put their testes in physical danger with sports. How catastrophic can injuries be to the testes? 35

Questions? 36