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HCR240-Chapter27DisordersoftheMaleReproductiveSystem.pptx

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Chapter 27

Disorders of the Male Reproductive Tract

Epidemiology

Congenital abnormalities

Cryptorchidism

Undescended testes

Descent of testes should occur by 1 year of age

Surgical correction necessary

Normal sperm development requires lower than normal body temperatures

Hypospadias

Abnormal position of urethral orifice

Epidemiology (continued)

Cancers

Testicular cancer is more common in young, adult males

Prostate cancer is overall leading cancer in older men

Infertility

10%–15% of couples in Western societies experience

50% at least of cases are due to male reproductive dysfunction

Male Reproductive System

Basic Concepts

Genes on Y chromosome signal male gonad development

GnRH stimulates FSH (spermatozoa synthesis) and LH (testosterone synthesis by Leydig cells)

Inhibin by testes suppresses GnRH and FSH/LH

Hormonal Signaling

Male Reproduction

Sperm produced in seminiferous tubules, millions daily travel to epididymis

Epididymis

Sperm gain final maturation

Vas deferens

Ascends from epididymis

Part of spermatic cord

Vasectomy: vas deference cut to block sperm delivery to penis

Male Reproduction (continued_1)

Spermatic cord

Suspends testicles from abdomen into inguinal region

Spermatic Cord and Epididymis

Male Reproduction (continued_2)

Prostate gland

Encircles urethra below urinary bladder

Normally enlarges with age

Benign prostatic hyperplasia (BPH)

Secretes alkaline fluid, contributes to semen

Prostate surface antigen (PSA)

Used to assess prostate structure and function

Bulbourethral glands

Located below prostate and lubricating fluid during sexual arousal

Male Reproduction (continued_3)

Penis

Erectile tissue

Corpus spongiosum and corpus cavernosa

Erection requires adequate circulation (vasodilation: nitric oxide) and autonomic neurological control

Fertility

Quantity of sperm, sperm count, motility of sperm, adequate circulation, hormonal regulation

Basic Concepts of Male Reproductive Dysfunction—Overview

Infertility

Anatomical abnormalities

Inflammation and infection

Precocious puberty

Delayed puberty

Priapism

Male Infertility

10%–15% of couples

Unprotected, frequent intercourse for a year

Obstructive causes

Repeated infections, swelling, vasectomy

Nonobstructive causes

Deficiencies in sperm formation, oligospermia, azoospermia (no sperm in ejaculate)

Male Infertility (continued)

Low sperm count or poor semen quality account for 90% of male infertility

Genetic factors in poor spermatogenesis

Androgens and functional androgen receptor (AR) are needed for normal male development and function

Contributors to Male Infertility

Abnormal production or function of sperm

Cryptorchidism, low sperm concentration, impaired sperm shape and movement

Impaired delivery of sperm

Antisperm antibodies, no semen, psychological issues, erectile dysfunction

General health and lifestyle

Alcohol or drug abuse, emotional stress, cancer and its treatments

Contributors to Male Infertility (continued)

Overexposure to environmental elements

Overheating of testicles, substance abuse, environmental toxins

Anatomical Abnormalities

Phimosis

Foreskin too constricted

Paraphimosis

Foreskin permanently retracted

Peyronie’s disease

Middle-age to elderly

Inflammatory vasculitis, unknown etiology

Penis takes on curvature

Priapism

Abnormally prolonged erection

Painful

Drug: sildenafil

Sickle cell crisis

Infection

Commonly represent with lesions on penis and discharge

Urination may be painful

Condyloma

Wart-like lesions that may appear with syphilis and HPV

Orchitis

Inflammation of testes (can be unilateral)

Mumps virus

Puberty

Tanner staging to evaluate puberty stage

Precocious puberty

Secondary sex characteristics before the age of 9

Reduced adult height due to early closure of growth plates

Delayed puberty

Lack of testicular development, pubic hair by age 14

Can be due to lack of hormonal signal from pituitary

Assessment of Male Reproductive Disorders

Risk factors

Injury/trauma

Teratogens

Testicular dysgenesis syndrome (TDS)

Results from disruption of embryological programming and gonadal development

Benign Prostatic Hyperplasia (BPH)

Excessive cell growth of prostate, occurs with aging

80% of men age 80 years or older

Testosterone-sensitive growth of prostate

Cellular growth encroaches on urethra, obstructs urine outflow

Benign Prostatic Hyperplasia (BPH) (continued)

Prostate gland adds secretions to semen and blocks off bladder opening during ejaculation

Cell proliferation

Causes obstruction of flow of urine from the bladder

Bladder outlet obstruction (BOO)

Diagnosis: Signs and Symptoms

Frequent need to urinate

Void small amounts of urine

Incomplete bladder emptying

DRE performed

PSA test to rule out prostate cancer

Cannot diagnosis prostate cancer solely with PSA

Digital Rectal Exam (DRE)

Benign Prostatic Hyperplasia: Medications

5-alpha-reducatase inhibitors

Block testosterone

Increase urinary flow, help shrink prostate

Drugs for 6 to 12 months to achieve full benefit

Decreases PSA levels, which may mask cancer

Women should not handle finasteride tablets when pregnant

Phosphodiesterase-5 (PDE5) inhibitors

Relax lower urinary tract

Cialis

Benign Prostatic Hyperplasia: Surgery

Surgical treatment

Transurethral needle ablation (TUNA)

Transurethral resection of the prostate (TURP)

Transurethral incision of prostate (TUIP)

Goal

Obstructive prostatic tissue is excised

Free flow of urine restored

Erectile Dysfunction (ED)

Complete ED defined as:

Total inability to obtain/maintain an erection

Absence of nocturnal emissions

Vascular disease

Usually combination of causes

Erectile Dysfunction Causes

Alcoholism and other forms of substance abuse

Atherosclerosis

Certain prescription medications

Diabetes

Fatigue

Heart disease

High blood pressure

Low testosterone

Mental health conditions such as depression and anxiety

Metabolic syndrome

Multiple sclerosis

Obesity

Parkinson’s disease

Peyronie’s disease

Development of scar tissue inside the penis

Stress

Surgeries or injuries that affect the pelvic area or spinal cord

Tobacco use

Treatments for prostate cancer or enlarged prostate

Erectile Dysfunction (ED) (continued_1)

Diagnosis

Often patient self-report

Sexual history

Hormones (LH, testosterone)

Urinalysis

Penile blood flow studies

Erectile Dysfunction (ED) (continued_2)

Treatment

Oral phosphodiesterase (PDE) inhibitors

Block PDE, enhance effects of nitric oxide (NO)

Increase vasodilation in penis

Sildenafil (Viagra), tadalafil (Cialis)

Contraindicated in patients taking nitrates (hypotension may result)

Testicular Cancer

Most common cancer in males age 15 to 35 years in U.S.

High cure rate if detected early

Germ cell tumors most common type

Risk increases with cryptorchidism

Painless swelling, nodule, or mass on one testicle is most common sign

On physical exam, mass can not be separated from testis

Dull ache or heavy sensation in abdomen may be present

Testicular Cancer (continued)

Diagnostic tests

Chemistry profile, tumor markers

AFP and b-HCG

CT scan and lymph node assessment

Treatment

Orchiectomy

Radiation

Chemotherapy

MODULE 7

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