Diseases of the testes system

Hypogonadism

• Diminshed functional activity of the gonads can result in:

• Decreased biosynthesis of sex hormones — defective primary or secondary sexual development

• impaired spermatogenesis/ovulation - partial or complete infertiltiy possible

• congential or acquired

Cryptorchidisim

• Undescended testicle

• During prenatal development, testes migrate from near kindey

• Corrected withs urgery shortly after birth

• Can lead to infertility and increased risk of testicular cancer

Healthy vs. Unhelahty sperm

• abnormal shape

• low count

• reduced fertilization rate

• IVF

This can

• impact ability to swim and fertilize

• head defects

• neck defects

• tail defects

What happens with a low sperm count

• <15 million/mL

• symptoms include watery or semen

• reduced chances of fertility — but not zero! Always use protection

• To avoid: Eat a healthy diet (including zinc), drink

  lots of water, avoid alcohol and drugs, no hot tubs

  or tight pants, avoid pesticides, exercise

How does IVF work?

To treat sperm infertility

• Collection of sperm and direct insertion into uterus is less expensive and less sucessful

• INtracytoplasmic sperm injection is very expensive, very efficient, and only select the strongest fertilized eggs for implantation

What is the cost of IVF?

$10-25K per cycle

Increased costs for genetic testing, ICSI, surgical procedures

Estimated 95% non-viable, multiple rounds expected (especially if 35+)

You must also account for the emotional response

Benign prostate hyperplasia

• Common in older age

• Enlarged prostate

• troubled and frequent urination

Medications include

• alpha blockers (relax muscles)

• phosphodiesterase inhibitors (+ ED)

• Alpha reductase inhibitors (lower T → DHEA)

Prostatitis

• Infection of the prostate

• Painful urination, pelvic pain

• Actue (bacterial infection, similar to other UTI symptoms)

• Chronic (greater than 3 months, infection or nerve damage)

• Treat with antibiotics

Prostate cancer

• 98% survival rate

• Primary treatment: radiation

Detection

• PSA testing (prostate specific antigen)

• Painful urination

Prostate exams beginning at age 50 (Note increased incidence of early prostate

cancer, will likely begin testing earlier with family history of cancer)

Testicular cancer

• most common malignancy 20-40 years

• self-check monthly

• 95% survival rate

• primary treatment is removal of testicle

How to clinically determine potential prostate issues

1. Rectal exam and palpation

a. Determine if the prostate feels

enlarged, abnormal in shape, etc

2. PSA test

a. Blood test that detects Prostate

Specific Antigen levels in blood

b. Note that this increases normally

with age, must compare to

age-matched expected values

3. Ultrasound -can be performed, but less

informative

4. Transurethral resection of prostate

(TURP)