B93 inflammatory lesions of testis and epididymis, cyrptochidism, infertility Flashcards
What are causes of inflammation of the testis and epididymis? Where is the more common site for inflammation
More common in the epididymis
Caused by:
- Infections:
- STDs, gonoccous, syphillis,
- Mumps,
- Tuberculosis
- Ascending UTIs infecting through the vas deferens
- Most often: Chlamydia, then E coli.
What are the symptoms of Ochitis, Epididymitis?
Gradual onset of testicular pain, mild or severe,
Swollen, red, tender scrotum
Neutrophilic inflammatory infiltrate
Ejaculation of blood or discolored ejaculate
Urinating blood
Inguinal lymph swelling.
E coli/pyogenic infections can cause abscess formations on the testis
Mumps orchitis
Rubula virus,
orchitis occurs in 20% of mumps infections
edematous, dongested testis.
Lymphocyte, plasmacyte infiltration (not neutrophil)
Can cause necrosis of the seminiferous tubules, atrophy and fibrosis, subsequent sterility
Granulomatous orchitis
Syphilitic orchitis and gumma.
Tuberculosis
Granulomatous inflammation in the testis, with central caseous necrosis.
Causes of Cryptorchidism
Testes normally descend in the fetus by the 3rd month, in an androgen dependent process.
present in 3% of infants, most will eventually descend.
by 1 year, 1%
less after that
Causes of cryptorchidism:
- Vast majority are idiopathic
- Prematurity
- Kallmann’s syndrome
- Prader Willi syndrome
- Cystic fibrosis
- Testicular feminization
FUture risks associated with cryptorchidism
h) Complications
bilateral cryptorchidism causes sterility.
ii. Unilateral cryptorchidism may be associated with atrophy of the contralateral descended gonad and therefore may also lead to sterility.
iii. Other complications: trauma, torsion and inguinal hernia.
iv. In addition to infertility, even unilateral cryptorchidism is associated with a 3‐ to 5‐fold increased risk of testicular malignancy (usually seminoma), in both testicles.
- Individuals with unilateral cryptorchidism are also at increased risk for the
development of cancer in the contralateral, normally descended testis, suggesting
that some intrinsic abnormality, rather than simple failure of descent, may be
responsible for the increased cancer risk.
v. Surgical placement of the undescended testis into the scrotum (orchiopexy) before age 2‐3 should be done to decrease the risk of malignancy, infertility and atrophy.
Microscopic evidence of tubular atrophy is evident by the age of 5 to 6 years, and hyalinization is present by the time of puberty. Foci of intratubular germ cell neoplasia (discussed later), may be present in cryptorchidtestes and are likely precursors of subsequent germ cell tumors.
Causes of male infertility
Pre-testicular:
- Low hormonal support
- Deficient GnRH - Kalmann syndrome
- Hypopituitarism
- Or poor general health, causing inadequte nutrition/trophic levels of the testes.
- Drugs, alcoholism, smoking
- Certain mediations
Testicular
- Cryptorchidism and testicular atrophy
- Deficient activity of the Leydig cells
- Trauma, direct, extensive bicycle or horse riding
- Idiopathic oligospermia - 30%
- Excessive heat exposure to testes
- Age related atrophy and low testosterone
- Genetic Y defects
- Swyer XY gondal dysgenesis
- Androgen insensitivity syndrome
- Y chromosome microdeletions
- Klinefelter syndrome, XXY, microorchidism
- Hydrocele
- Mumps
- Testicular cancer
Post testicular
- Vas deferense obstruction, fibrosis from previous infection
- Vas deferens agenesis -affecting 98% of males with cystic fibrosis (it is actually the most common feature of CF) also commonly copresents with renal unilateral agenesis.
- Active infections
- Retrograde ejaculation to the bladder - from autonomic dysfunctions, prior prostate surgeries and damage.
- Hypospadias
- Erectile dysfunction
Infertility treatment
Treating the underlying cause.
Check the female as well 50% chance its her
Intrauterine insemination or in vitro fertilization options
