Disorders of the Male Genitourinary System

Disorders of the Male Genitourinary and Their Effects

Disorders Structural defects Inflammation Neoplasms Affect Urine elimination Sexual function Fertility

Hypospadia and Epispadia

Hypospadias The termination of the urethra is on the ventral surface of the penis Categorized as glandular (involving the glans penis), penile, or perineoscrotal

Epispadias
The opening of the urethra is on the dorsal surface of the penis

Phimosis and Paraphimosis

Phimosis Tightening of the prepuce or penile foreskin that prevents its retraction over the glans

Paraphimosis
The foreskin is so tight and constricted that it cannot cover the glans

Balanitis and Balanoposthitis

Balanitis An acute or chronic inflammation of the glans penis. Balanoposthitis Inflammation of the glans and prepuce Usually encountered in males with phimosis or a large, redundant prepuce that interferes with cleanliness and predisposes to bacterial growth in the accumulated secretions and smegma

Peyronies Disease
Definition A localized and progressive fibrosis of unknown origin that affects the tunica albuginea

Manifestations
Painful erection, bent erection, and the presence of a hard mass at the site of fibrosis

Components Involved in an Erection

Autonomic nervous system Neurotransmitters and endothelial relaxing factors The vascular smooth muscle of the arteries and veins supplying the penile tissue The trabecular smooth muscle of the sinusoids of the corpora cavernosa

Erectile Dysfunction
Definition The inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse

1-Psychogenic causes
Performance anxiety A strained relationship with a sexual partner

Depression
Overt psychotic disorders such as schizophrenia

Erectile Dysfunction (cont.)

2-Organic causes Neurogenic Hormonal Vascular Drug-induced Penile-related etiologies.

Risk Factors for Generalized Penile Arterial Insufficiency

Hypertension Hyperlipidemia Cigarette smoking Diabetes mellitus Pelvic irradiation

Drugs Causing Erectile Dysfunction

Antidepressants Antipsychotics Antiandrogens Antihypertensive medications

Diagnosis of Erectile Dysfunction

Careful history (medical, sexual, and psychosocial) Physical examination Laboratory tests aimed at determining what other tests are needed to rule out organic causes of the disorder

Treatment Methods for Erectile Dysfunction

Psychosexual counseling Androgen replacement therapy Oral and intracavernous drug therapy Vacuum constriction devices Surgical treatment (prosthesis and vascular surgery)

Mechanisms Causing Priapism

Priapism: is painful prolonged penile erection. 1-Low-flow (ischemic) priapism There is stasis of blood flow in the corpora cavernosa with a resultant failure of detumescence 2-High-flow (non-ischemic) priapism Involves persistent arterial flow into the corpora cavernosa

Classifications of Priapism
Primary priapism The result of conditions such as trauma, infection, and neoplasms

Secondary priapism
Hematologic conditions such as leukemia, sickle cell disease, and thrombocytopenia Neurologic conditions such as stroke, spinal cord injury, and other central nervous system lesions Renal failure

Risk Factors for Cancer of the Penis

Increasing age Poor hygiene Smoking Human papillomavirus (HPV) infections Ultraviolet radiation exposure Immunodeficiency states

Cryptorchidism (Undescended Testes)

Occurs when one or both of the testicles fail to move down into the scrotal sac The testes develop intra-abdominally in the fetus and usually descend into the scrotum through the inguinal canal during the seventh to ninth months of gestation The undescended testes may remain in the lower abdomen or at a point of descent in the inguinal canal

Consequences of Cryptorchidism
Infertility Malignancy Testicular torsion (10x increased risk) The possible psychological effects of an empty scrotum

Disorders of the Scrotum and Testes

Hydrocele , Hematocele , Spermatocele , Varicocele Testicular tortion

Epididymitis
Definition Inflammation of the epididymis Types

Sexually transmitted infections associated with urethritis

Primary non-sexually transmitted infections associated with urinary tract infections and prostatitis Causes Bacterial pathogens

Diagnosis of Epididymitis
Laboratory findings usually reveal an elevated white blood cell count Urinalysis and urine culture are important

The cause can be differentiated by Grams stain examination or culture of a midstream urine specimen or a urethral specimen
Doppler ultrasound may be useful, revealing increased blood flow to the affected testis

Orchitis
Definition An infection of the testes Causes Can be precipitated by a primary infection in the genitourinary tract The infection can be spread to testes through the bloodstream or the lymphatics

Neoplasms
Scrotal cancer Testicular cancer

Classification for Testicular Cancer

Stage I: tumor confined to testes, epididymis, or spermatic cord Stage II: tumor spread to retroperitoneal lymph nodes below the diaphragm Stage III: metastases outside the retroperitoneal nodes or above the diaphragm

Methods of Staging Tumors

CT scans of the chest, abdomen, and pelvis Ultrasonography for detection of bulky inferior nodal metastases

Lymphangiography
Radiographic methods to detect metastatic spread

Types of Prostatitis
Acute bacterial prostatitis Chronic bacterial prostatitis Chronic prostatitis/Chronic Pelvic Pain Syndrome Inflammatory prostatitis Non-inflammatory prostatitis

Benign Prostatic Hyperplasia

Age-related, nonmalignant enlargement of the prostate gland Characterized by the formation of large, discrete lesions in the periurethral region of the prostate rather than the peripheral zones, which commonly are affected by prostate cancer

Factors Protective Against Prostate Cancer

Dietary factors such as lycopene, selenium and vitamin E Chemoprevention (using drugs to prevent disease) with the 5-reductase inhibitor

Finasteride, was recently shown to prevent the development of prostate cancer in men without BPH

Sperm Characteristics and Testing

Sperm Characteristics Azoospermia: absence of sperm Oligospermia decreased numbers of sperm

Asthenospermia: poor motility of sperm.

Tests of sperm function Cervical mucus penetration tests (e.g., postcoital test, Penetrak) Sperm penetration assay (i.e., Hamster Zona Free Ovum test) Sperm antibody testing

Causes of Male Infertility

Varicocele (by increased temperature) Ejaculatory dysfunction Hyperprolactinemia Hypogonadotropic hypogonadism Infection (Orchitis) Immunologic problems (i.e., anti-sperm antibodies) Obstruction Congenital anomalies