Male Reproductive Disorders

normal process of an erection

sexual stimulation activates the parasympathetic nervous system → nerves release nitric oxide → smooth muscle in the corpora cavernosa relax → penile arteries dilate → more blood flows in → tissue expands, compressing the veins and trapping more blood inside → erection

erectile dysfunction - definition

inability to achieve and maintain an erection sufficient to permit satifactory sexual intercourse

erectile dysfunction - causes

• psychogenic: depression, anxiety, etc.

• neurologic: parkinsons, stroke, spinal cord injury

• low androgen levels

• high prolactin levels

• arterial insufficiency: hypertension, diabetes mellitus

• age

• medications: antihypertensives, antipsychotics, andtidepressants

erectile dysfunction - patho

problem with 1+ of the systems needed to create and maintain an erection: blood flow, nerve signaling, hormones, and psychological input

• vascular cause (most common): diabetes, HTN, CV disease, etc.

  • damage to the blood vessels or endothelium cause decreased nitric oxide production → less smooth muscle relaxation → less blood flow → arteries cannot dilate enough for adequate filling

• neurogenic: SC injury, stroke, MS, diabetic neuropathy

  • damage to the nerves that control erection can interrupt the signal from the brain/spinal cord to the penis

• hormonal cause: hypogonadism, pituitary disorders, endocrine disorders

  • low testosterone can reduce libido and impair the physiologic erection process

• psychogenic cause: stress, anxiety, depression

  • these conditions activate the sympathetic nervous system → vasoconstriction, which opposes erection

erectile dysfunction - treatment

• increase blood flow via medication: oral, injectable, suppository

• some meds can be unsafe for men with CV disease/taking CV meds

  • risk of severe hypotension

• testosterone replacement

• implants

varicocele - definition

inflammation/dilation of the veins around the spermatic cord

• think of it like varicose veins of the scrotum

varicocele - cause

inadequate or absent valves in the spermatic veins → blood flows backward and pools → veins dilate

varicocele - signs & symptoms

• “bag of worms”

• dull aching pain

• swelling

• visible enlarged veins

• worse with standing & activity/better when lying down

varicocele - consequences

can affect sperm production → male infertility and possible testicular atrophy

hydrocele - definition

a collection of fluid around the testicle, specifically between the layers of the tunica vaginalis, the sac that surrounds the testis → swelling

hydrocele - causes

• acute

  • injury

  • infection

• chronic

  • adults: imbalance between fluid secretion and reabsorption

  • children: connection between scrotum and peritoneal cavity → peritoneal fluid can move into the scrotum → fluid buildup around the testicle

hydrocele - signs & symptoms

• painless scrotal swelling

• heaviness

• enlarged scrotum

• may transilluminate with light

• usually smooth and soft

hydrocele - treatment

• needle aspiration fluid

• surgery to close defect

cryptorchidism - definition

failure of one or more of the testes to descend from the abdominal cavity into the scrotum

• testicle may be located:

  • in the abdomen (15%)

  • in the inguinal canal (25%)

  • high in the scrotum (60%)

cryptorchidism - who is at risk

• premature infants (30% of them)

• full term infants (5% of them)

they may descend spontaneously

cryptorchidism - consequences

• infertility

• increased risk of testicular cancer

testicular torsion - definition

rotation of the testis → twisting of the blood vessels in the spermatic cord → venous outflow blocked first (swelling and congestion) → arterial inflow is blocked → ischemia → testicular infarction if not treated quickly

testicular torsion - who is at risk

• often spontaneous especially in neonates and early adolescence

• can also be associated with physical exertion or trauma

testicular torsion - signs & symptoms

• painful and swollen testes

• acute onset of sx

• may have N/V

• tachycardia

testicular torsion - consequences

may lose testicle is blood flow is not restored with surgery immediately

testicular cancer - patho

normal germ cells undergo genetic mutations that allow uncontrolled proliferation → abnormal germ cells proliferate within the testicle → lymphatic spread most common (hematogenous spread also possible)

• arise from seminal epithelium in testis

testicular cancer - who is at risk

• men ages 15-35

• genetic component (klinefelter syndrome) and hx of cryptorchidism may be associated with risk

testicular cancer - signs & symptoms

• testicular enlargement

• painless or dull ache/heaviness

epididymitis - definition

inflammation of the epididymis

• microorganism ascends from bladder/urethra → vas deferens → epididymis

epididymitis - causes

• typically associated with STI or UTI

epididymitis - signs & symptoms

• urethral discharge

• urinary sx

• acute or severe scrotal/inguinal pain (unilateral)

• red swollen scrotum

epididymitis - diagnosis

• urinalysis

• culture and sensitivity

prostatitis - definition

inflammation of the prostate gland

prostatitis - causes

• acute bacterial prostatitis: bacteria ascend from the urethra or reflux from the bladder into prostate → inflammatory response

• chronic bacterial prostatitis: persistent bacterial infection in the prostate, often recurrent UTIs with the same organism

• chronic prostatitis/chronic pelvic pain syndrome (nonbacterial): most common, inflammation without detectable infection (may involve reflux of urine, autoimmune), difficult to treat

prostatitis - how does the prostate protect itself from infections

• urethral length

• micturition

• antimicrobial substances in prostate fluid

prostatitis - signs & symptoms

• dysuria

• frequency

• perineal pain

• if acute: sudden onset, perineal pain, high fever

prostate cancer - who is at risk

• hormones

• genetic/epigenetic

• age

• diet (unclear)

most common cancer in US males

prostate cancer - patho

multistep process involving genes that control cell differentiation

• inflammation from urine reflux, infection, oxidative stress

• androgens act as tumor promoters

• altered growth factors

• genetic and environmental factors

aggressiveness related to degree of dysplasia

prostate cancer - signs & symptoms

early

• often asymptomatic

• mild urinary changes may occur if tumor compresses the urethrea

  • slight difficulty urinating

  • mild urinary frequency

  • weak urine stream

• late

  • difficulty urinating: weak stream, hesitancy, dribbling

  • urinary retention

  • hematuria

  • blood in semen

  • pain or burning with urination

  • metastatic symptoms: bone and lung sx

prostate cancer - diagnosis and treatment

diagnosis

• PSA screening (increased proliferation of prostate cells): controversial

• transrectal biopsy for diagnosis

  • gleason score important for prognosis

treatment

• prostatectomy

• radiation

• hormones

• watchful waiting

*survival almost 100% at 5 years with early detection