Alterations of male reproductive system

Question 1

Delayed puberty in boys is when puberty does not begin

Answer 1

By 14 years old

Question 2

Causes of delayed puberty

Answer 2

Genetic late bloomer whereby puberty starts late but progresses normally.

Hypogonadism (testes produce too little testosterone)

Question 3

Treatments:

Answer 3

Underlying causes and hormone medication

Bone mineralisation is also a consequence of delayed puberty in boys

Question 4

Precocious puberty in boys:

Answer 4

Is a rare event and can be defined as sexual maturation before the age of 9.

It can be partial, complete or mixed and can be further categorised by central (GnHR dependant) or peripheral (non-GnHR dependant)

Question 5

Other signs of precocious puberty in boys:

Answer 5

Enlarged testes
Growth or facial hair
Spontaneous erections and ejaculations
A deepening of voice

Question 6

Treatment:

Answer 6

Involves removing underlying cause and also administering appropriate hormones.

Question 7

Management:

Answer 7

Arresting maturation until teens, maximising eventual adult height.

GnHR agonist used

Question 8

Phimosis/paraphimosis

Answer 8

Refers to a condition in which the foreskin cannot be drawn back to expose the glans.

It is normal in infants and many boys but not men.

Question 9

Signs/symptoms

Answer 9

In teenagers/men it can result in pain during erection.

Those affected are at greater risk of inflammation of the glans.

Question 10

Treatment:

Answer 10

If symptoms persist, a steroid cream may be used to attempt to loosen the tight skin.

Stretching exercises

If these don’t work, circumcision may be recommended

Question 11

Peyronies disease

Answer 11

Is the development of fibrous scar tissue inside the penis that causes curved, painful erections.

Question 12

Signs and symptoms

Answer 12

Scar tissue (plaques) associated with peyronies can be felt under the skin of the penis as flat lumps or a band or hard tissue.

Significant bend to the penis

Erectile dysfunction

Shortening of the penis

Pain with or without erection

Question 13

Causes:

Answer 13

Injury to the penis

Poor wound healing

Hereditary

Connective tissue disorders

Prevalence increases with age

Question 14

Treatment:

Answer 14

Drugs injected into the penis, and medications to reduce collagen production.

Surgery is an alternate option for these patients.

Question 15

Priaprism

Answer 15

Prolonged erection of the penis

Usually painful

Question 16

Causes:

Answer 16

Ischaemic priaprism, when blood isn’t able to leave the penis (requires immediate treatment)

Non ischaemic priaprism pccurs when the penile blood flow isn’t regulated appropriately (usually painless)

Erection for more than four hours or unrelated to sexual interest or stimulation

Question 17

Signs/symptoms:

Answer 17

Rigid penile shaft but the glans is soft

Progressive penile pain

Question 18

Treatment:

Answer 18

Blood is drained from the penis using a small needle and syringe.

The penis may be flushed with saline solution, this treatment often relieves pain, removes oxygen-poor blood and might stop the erection.

Sympathomimetic medication may be injected into the penis to constrict blood vessels that carry blood out of the penis to open up and allow increased blood flow out.

Question 19

Penile cancer:

Answer 19

Cancer that begins and grows in the penis, most penile cancers are squamous cell carcinomas.

It is rare.

HPV is a risk factor

Question 20

Symptoms:

Answer 20

Colour changes, bumps, thickening of skin can be signs of penis cancer.

Bleeding or discharge

Question 21

Treatment:

Answer 21

Chemotherapy, radiation and surgery.

Question 22

Hydrocele:

Answer 22

A type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding the testicle

It is common in newborns and usually disappears by age 1 without treatment.

Can develop before birth

Can occur in boys and men

Question 23

S&S

Answer 23

Usually isn’t painful and won’t need treatment

‘painless swelling of one or both testes’

Boys and men may experience pain dependant on the severity of inflammation

Question 24

Causes

Answer 24

A sac accompanies each testis and allowing fluid to build up. that might be caused by infection in the testicle

Question 25

Risk factors for later life development:

Answer 25

Injury

Infection (STI’s)

Question 26

Treatment:

Answer 26

A hydrocele that doesn’t go away on its own may need surgery to remove it.

Question 27

Varicocele

Answer 27

An enlargement of the veins within the scrotum. It is a common cause of low sperm production and decreased sperm quality which can cause infertility.

Not all varicocele affect sperm production but may cause testicles to fail to develop or shrink.

Question 28

Causes and treatment:

Answer 28

Often occurs after puberty and is usually congenital.

If they cause pain, testicular atrophy surgical repair can occur.

Question 29

Testicular torsion:

Answer 29

Occurs when a testicle rotates, twisting the spermatic cord that allows blood to enter the scrotum.

Question 30

S&S:

Answer 30

Pain, swelling, abdo pain, N&V, frequent urination.

It is most common between 12-18 but can occur at any age and even before birth.

Question 31

Treatment:

Answer 31

Usually requires emergency surgery

Code 1 job

Question 32

Orchitis

Answer 32

Uncommon inflammation of the testicles, can be bacterial or viral, often associated with the mumps virus or other systemic infections.

In about 30% of affected testes, there will be irreversible damage to spermatogenesis. (infertility)

Question 33

Testicular cancer:

Answer 33

Second most common cancer in young men (18 - 39)

Seminoma in men 25-50 and non-seminoma more common in younger.

Question 34

Symptoms

Answer 34

May be asymptomatic, however most common symptom is a painless swelling or lump in a testicle

More likely in people with family Hx

No link between testicular injury and cancer

Question 35

Epididymitis

Answer 35

The epididymis is a series of small tubes that collects and stores sperm, attached to the back each testicle.

It is one of the most common causes of pain in the scrotum (inflammation of these coiled tubes)

Question 36

Causes:

Answer 36

May be to due infection

Is usually a secondary bacterial infection that can be triggered by a range of conditions such as UTI’s, STI’s.

The bacteria in the urinary tract move through the tracts to the epididymis.

Question 37

Symptoms:

Answer 37

Swollen testicles, red warm and heavy.

Burning feeling when urinating

Discharge from penis

Blood in urine

Pain on ejaculation

Slight fever/chills

Question 38

Treatment:

Answer 38

Options include antibiotics and bed rest.

Some men develop chronic epididymitis

Question 39

Benign prostatic hyperplasia:

Answer 39

Most common prostate disease which is the non-cancerous enlargement or growth of the prostate gland.

Question 40

Causes

Answer 40

Not well known but thought to be genetic.

Older age and testosterone are linked to BPH but may not be the cause.

Question 41

Symptoms:

Answer 41

Some men do not have any symptoms but usually notice changes to their urination due to the prostate pushing against the urethra causing slow, dribbling of urine.

Question 42

Prostatitis:

Answer 42

Inflammation of the prostate gland.

Caused by a bacterial or non-bacterial infection.

Can be very painful and cause pain while pissing and urgency to piss.

Additionally, lower back pain, pain on ejaculation, general malaise.

Question 43

Prostate cancer:

Answer 43

Develops when abnormal cells in the prostate gland grow more quickly than in a normal prostate, forming a malignant tumour.

Second most common cancer diagnosed in men in Australia.

Question 44

Symptoms:

Answer 44

Frequent urination particularly at night

Pain on urination

Weak stream

Pain in back of pelvis

Unexplained weight loss and fatigue if spreads

Question 45

Risk factors

Answer 45

Old age

High testosterone

Diet high in fats and low in fruit/vegetables

Family Hx

Question 46

Inguinal Hernia

Answer 46

Protrusion of a part of the intestine through a weak spot in the abdominal muscles.

Question 47

Pre-hospital assessment of reproductive pathologies:

Answer 47

Pt pHx

• Genito-urinary
• Gastro-intestinal

Hx of this episode

• Pain and referred pain
• Discharge
• Swelling
• Associated symptoms

Assess discretely and treat symptoms.