Plan Disorders of penis Malformations Acquired disorders Semen analysis Male infertility - investigations

Penis Congenital Acquired disorders

Penis Congenital Acquired disorders inflammatory neoplasms

congenital disorder Malformations abnormality in the location of distal urethral orifice Hypospadias (opening of urethra along ventral aspect) epispadias (opening of urethra along dorsal aspect)

congenital disorder Malformations abnormality in the location of distal urethral orifice Hypospadias (opening of urethra along ventral aspect of penis) more common (1 in 300 live male births) urinary obstruction common associated with other genital anomalies inguinal hernia undescended testis

congenital disorder Malformations abnormality in the location of distal urethral orifice Epispadias (opening of urethra along dorsal aspect of penis)

Epispadias

Phimosis Orifice of prepuce is too small to permit normal retraction over the glans penis Maybe due to Anomalous development Scarring of preputial ring following infections Importance Interferes with cleanliness Accumulation of secretions and detritus under prepuce Favours development of infection and carcinoma

Paraphimosis When a phimotic prepuce is forcibly retracted over the glans penis, marked constriction and subsequent swelling of glans may prevent replacement of prepuce creating paraphimosis Condition extremely painful Potential cause of acute urinary retention due to urethral obstruction

Phimosi s Paraphimosis

Inflammations Invariably involve the glans and prepuce Specific infections Syphilis, chancroid, granuloma inguinale Genital herpes Non specific infections Balanoposthitis: caused by Candida albicans Anerobic bacteria Gardnerella Pyogenic bacteria

Inflammations Pathogenesis Consequence of poor local hygiene in uncircumcised males accumulation of desquamated squamous cells, sweat and debris - SMEGMA - acts as local irritant Persistence of infection leads to scarring - phimosis

Tumours Benign Malignant Premalignant

Condyloma Acuminatum Benign tumour Caused by Human papilloma Virus - HPV Related to common wart (verruca vulgaris) Occurs on moist mucocutaneous junctions HPV and associated diseases are sexually transmitted Type 6 and type 11 associated with Condylomata Acuminata

Morphology May occur on genital or perineal areas On penis occurs commonly about the coronal sulcus and inner aspect of prepuce Single or multiple Sessile or pedunculated Red papillary excrescences Vary from 1 mm to several mms

Histology Branching, villous, papillary connective tissue stroma Covered by epithelium which may have hyperkeratosis and thickening of epidermis (acanthosis)

Histology Orderly maturation of epithelial cells Clear vacuolization of prickle cells Basement membrane intact, no evidence of infl

Clinical course Tend to recur Do not evolve into cancers

Tumours Uncommon Most frequent is carcinoma and benign epithelial tumour - condyloma acuminatum Other forms - carcinoma in situ - Bowens disease

Malignant tumors Carcinoma insitu Invasive carcinoma

Carcinoma in situ Histologic term Epithelial lesion Cytologic changes of malignancy are limited to the epithelium No evidence of local invasion or distant metastasis Considered precancerous condition Potential to evolve into invasive cancer

Carcinoma in situ In the male external genitalia there are two distinct lesions that show carcinoma in situ BOWEN Disease BOWENOID papulosis Lesions strongly associated with HPV type 16

Carcinoma in situ Bowen Disease Genital region of both men and women Usually over the age of 35 years In men it involves: skin of shaft of penis, scrotum Grossly: appears solitary thickened gray white opaque plaque with shallow ulcerations and crusting When it occurs on glans or prepuce - single or multiple shiny red velvety plaques - clinically referred to as Erythroplasia of Querat

Carcinoma in situ Bowen Disease Histology Proliferation of epidermis Numerous mitosis, some atpical Cells markedly dysplastic Large hyperchromatic nuclei Over years 10% may transform in carcinoma

Carcinoma in situ Bowenoid papulosis Occurs in sexually active adults Younger age of patients Presence of multiple pigmented (reddish brown) papular lesions, some cases maybe verrucoid mistaken for Candyloma acuminatum Histologically indistinguishable from Bowen disease, related to HPV 16 Never develops into invasive carcinoma Many cases spontaneously regress

Invasive Carcinoma Common in Asia 10% to 20% Uncommon in United states. Less than 1% Striking correlation between Circumcision and occurrence of carcinoma Circumcision confers protection Extremely uncommon in Jews and Moslems

Invasive Carcinoma Circumcision associated with better genital hygiene Reduces exposure to carcinogens that are concentrated in Smegma Decreases likelihood of infection with potentially oncogenic HPV HPV type 16 is the most common, also HPV 18

Invasive Carcinoma Carcinoma in situ - 80% associated with HPV Invasive carcinoma - 50 % association-HPV Indicates that HPV alone may not be sufficient to convert Ca in situ to invasive malignancy. Requires other carcinogenic influences like Cigarette smoking

Verrucous carcinoma Uncommon Well differentiated variant of squamous carcinoma Has low malignant potential Locally invasive, can invade the underlying tissue Rarely metastasize Has a papillary appearance similar to condyloma but larger in size

Invasive Carcinoma Morphology Usually begins on glans or inner surface of prepuce near the coronal sulcus Two macroscopic patterns Papillary : simulate condylomata, produces cauliflower like fungating masses Flat : appear as epithelial thickening accompanied by graying and fissuring.

Invasive Carcinoma Clinical course Slow growing Locally invasive Lesion not painful unless ulcerated/infected Bleed frequently Early metastases to inguinal and iliac nodes Prognosis related to stage of tumor Prognosis poor if regional lymphnodes are involved

Semen Analysis Male infertility - investigations

Semen analysis Constituents spermatozoa secretions from testes epididymis prostate seminal vesicle bulbourethral glands

Semen analysis evaluation of reproductive dysfunction selection of donors for therapeutic insemination to monitor the success of surgical procedures varicocelectomy vasectomy

Semen analysis Includes Microscopic evaluation Macroscopic evaluatin

Semen analysis Includes Microscopic evaluation Concentration Motility Morphology agglutination Macroscopic evaluation physical chemical properties

Semen analysis Macroscopic evaluation Liquefaction - normal : within 60 minutes Appearance - After liquefaction - homogenous grey opalescent Volume - 2 to 5 ml Viscosity pH : 6.4 to 8.0

Semen analysis Includes Microscopic evaluation Concentration Less than 20 mill/ml - Oligospermia Motility less than 50% motile sperms - Asthenospermia Morphology Less than 50% normal morphology - Teratozoospermia agglutination

Semen analysis Classification of sperm morphology Head defects Neck and mid piece defects Tail defects Cytoplasmic droplets

Semen analysis Biochemical assays prostate gland Citric acid, Zinc, GGTP, Acid phosphatase Seminal vesicle Fructose and prostaglandins Epididymis Free L carnitine, glycerophosphocholine

Male infertility Semen analysis FSH/Testosterone Anti sperm antibodies FNAC/biopsy of testes Ctogenetics