Male Reproductive System Disorders

Question 1

List relevant characteristics of normal semen

Answer 1

Ejaculate volume >1ml
Sperm conc > 20Million/ml
Initial forward motility >50% of sperm
Normal morphology >60% of sperm

VOLUME
CONCENTRATION
MOTILITY
MORPHOLOGY

Question 2

What do you need to know about breast cancer in men

Answer 2

100x more common in F>M
occur at an older age in men than in women.
Blacks higher rate and poorer prognosis
Risk factors include family history, obesity, sedentary lifestyle, Jewish ancestry, and prior chest-wall irradiation.
Invasive ductal breast cancers account for more than 90% of male breast cancers.
The typical presenting sign is a painless, firm, subareolar mass.

Question 3

How is male breast cancer diagnosed and treated?

Answer 3

Mammography
with a biopsy to confirm the diagnosis
Check hormone receptors for HER2 exp
Simple mastectomy with Lymph node eval

Additional therapies may include chest-wall radiation, tamoxifen, and chemotherapy, depending on the risk of relapse, lymph node involvement, hormone receptor status, and tumor size.

Genetic counseling and BRCA1 and BRCA2 gene mutation testing gene testing should be strongly considered.

Question 4

Three main risk factors for prostate cancer

Answer 4

Age:rare <40 incr with age 60% @80

Race: Black>white>asian

Family history : men w/ fhx more likely to develop at younger age and die from it than those without fhx

Question 5

How do you recognize prostate cancer on step 3

Answer 5

Pt >50
Late presentation due to asymptomatic
BPH sxs: urinary hesitancy, dysuria, freq
With hematuria and/or elevated PSA
Prostate irregularities nodules on rectal exam
Back pain from vertebral mets.. osteoblastic

Question 6

How is prostate cancer treated?

Answer 6

Local
Surgery(prostatectomy) and local radiation

Metastatic
Standard chemotherapy is usually ineffective

several options for hormonal therapy:
orchiectomy,
gonadotropin-releasing hormone (GnRH) agonists (leuprolide, goserelin, buserelin, triptorelin),
an androgen-receptor antagonist (flutamide),
and a GnRH antagonists (degarelix).

Radiation therapy is used for local disease or pain from bony metastases

Question 7

Define Cryptorchidism

Answer 7

Arrested decent of the testicles between the renal area and the scrotum

Question 8

When does cryptorchidism occur?

Answer 8

The more premature the infant, the greater the likelihood of cryptorchidism.

Question 9

How is cryptochidism treated?

Answer 9

Many arrested testes eventually descend on their own within the first year.

Intramuscular human chorionic gonadotropin may be used to induce testicular descent.

After 1 year, surgical intervention (orchiopexy) is warranted in an attempt to preserve fertility and facilitate future testicular examinations.

Question 10

What is the risk for cryptorchidism

Answer 10

Affected testes have an increased risk of testicular cancer

Question 11

True or false: It is important to place abdominal testes in the scrotum surgically to decrease the risk of cancer.

Answer 11

False

Cryptorchidism is a major risk factor for testicular cancer (fortyfold increased risk), but bringing the testis into the scrotum probably does not alter the increased risk. The higher the testicle is found (the further away from the scrotum), and the longer that the undescended testicle is left undescended, the higher the risk of developing testicular cancer and the lower the likelihood of retaining fertility.

Question 12

What do we need to know about testicular cancer?

Answer 12

It is the most common solid malignancy in adult men younger than 30 years. The main risk factor is cryptorchidism. Transillumination and ultrasound help to distinguish a hydrocele,
which is filled with fluid and transilluminates

from cancer,
which is solid and does not transilluminate.

The most common histologic type is seminoma, which is radiosensitive and highly curable.

Use ultrasound to make the diagnosis.

Question 13

What is the usual presenting sign of testicular cancer?

Answer 13

Testicular cancer usually presents as a painless testicular mass in a young man (15 to 35 years of age).

Question 14

Describe the major risk factors for testicular cancer.

Answer 14

The main risk factor is cryptorchidism.

Question 15

What is the usual treatment for testicular cancer.

Answer 15

Testicular cancer is generally treated with orchiectomy and radiation;
if the disease is widespread, use chemotherapy.
Alpha-fetoprotein (AFP) is a marker for yolk sac tumors;
human chorionic gonadotropin is a marker for choriocarcinoma.
Leydig cell tumors may secrete androgens and cause precocious puberty.

Question 16

What is Alpha-fetoprotein (AFP) is a marker for?

Answer 16

yolk sac tumors;

Question 17

What is human chorionic gonadotropin a marker for?

Answer 17

choriocarcinoma.

Question 18

What may Leydig cell tumors secrete?

What does this cause?

Answer 18

androgens

cause precocious puberty.

Question 19

Testicular torsion vs Epididymitis

AGE

Appearance

Prehn sign (testicular elevation)

Treatment

Answer 19

Torsion
Age: <30 yr. usually prepubertal
Appearance: Testis may be elevated into the inguinal canal; swelling
Prehn sign: pain stays the same or worsens
Tx: immediate surgery to salvage testis;
surgical ochipexy for both testes.

Epidydimitis
Age:>30 yrs ( <50 may be due to STD)
Appearance: swollen testis, overlying erythema, urethral discharge/urethritis, prostatitis
Prehn sign: pain decreases with testicular elevation
Tx: Antibiotics

Question 20

What imaging test can be used to diagnose and differentiate between testicular torsion and epidydimitis. .

Answer 20

Ultrasound

Question 21

Presenting symptoms for prostatitis.

Answer 21

For acute prostatitis, look for a spiking fever, chills, dysuria, malaise, irritative urinary symptoms (e.g., urgency, frequency, urge incontinence), cloudy urine, and pelvic, perineal, or testicular pain.

Pain at the tip of the penis is common.

Swelling of the prostate can result in voiding symptoms (e.g., hesitancy and dribbling or even acute urinary retention).

Question 22

Examination findings for prostatitis.

Answer 22

tender, firm, edematous prostate gland on digital rectal examination.

Question 23

What tests should be performed if prostatitis is suspected?

Answer 23

A urine Gram stain and culture should be performed.

Question 24

What organisms cause prostatitis?

Answer 24

Escherichia coli is responsible for most cases of prostatitis,
but Proteus, Klebsiella, Enterobacter, Serratia, and Pseudomonas species also cause prostatitis.

Staphylococci, streptococci, and enterococci have been implicated but are much less common.

Question 25

What is the treatment for prostatitis?

Answer 25

Treat empirically with trimethoprim-sulfamethoxazole or a fluoroquinolone for about 2 weeks (although some physicians treat for up to 6 weeks). Urine culture results can further guide the choice of therapy.

Question 26

What are the symptoms and sequelae of benign prostatic hyperplasia (BPH)?

Answer 26

BPH can cause urinary hesitancy, intermittency, terminal dribbling, decreases in the size and force of the urinary stream, a sensation of incomplete emptying, nocturia, urgency, dysuria, and frequency. BPH may result in acute urinary retention, urinary tract infections, hydronephrosis, and even kidney damage or failure in severe cases.

Question 27

How is BPH treated?

Answer 27

Medical therapy, which is started when the patient becomes symptomatic, includes long-acting alpha1-blockers (e.g., terazosin, doxazosin, tamsulosin, alfuzosin, and silodosin) and 5-alpha-reductase inhibitors (finasteride, dutasteride). Transurethral resection of the prostate (TURP) is used for more advanced cases, especially for repeated urinary tract infections, urosepsis, urinary retention, and/or hydronephrosis or kidney damage caused by reflux. Surgical prostatectomy is used in some patients, but is associated with a higher complication rate.

Question 28

How do you recognize and manage acute urinary retention?.

Answer 28

The presenting symptoms of acute urinary retention are generally abdominal pain; a full, distended bladder that can be palpated on abdominal examination; a history of BPH in men; and a lack of urination in the past 24 hours or longer. The first step is to empty the bladder. If you cannot insert a regular Foley catheter, consider the use of a larger catheter with a firm Coude tip, or alternatively perform a suprapubic tap to drain the bladder. Then address the underlying cause—usually BPH, which in this setting is generally treated with TURP. Neurogenic causes of urinary retention should also be considered including spinal cord compression and multiple sclerosis.

Question 29

What are the common causes of erectile dysfunction?

Answer 29

vascular problems and atherosclerosis.

Medications are also a common culprit (especially antihypertensive and antidepressant agents).

Diabetes can cause impotence through vascular (increased atherosclerosis) or neurogenic (diabetic autonomic neuropathy) compromise.

Patients undergoing dialysis often have erectile dysfunction.

Remember the mnemonic point and shoot: parasympathetic agents mediate erection; sympathetic agents mediate ejaculation.

The history often gives you a clue if the cause of impotence is psychogenic. Look for a normal pattern of nocturnal erections, selective dysfunction (the patient has normal erections when masturbating but not with his partner), and a history of stress, anxiety, or fear.

Question 30

Distinguish between hydrocele and varicocele.

Answer 30

A hydrocele represents a remnant of the processus vaginalis (remember embryology?)
transilluminates.
It generally causes no symptoms and needs
no treatment.

A varicocele is a dilatation of the pampiniform venous plexus (so-called bag of worms, usually on the left).
It does not transilluminate, disappears in the supine position, and becomes prominent on standing or if the Valsalva maneuver is performed.
Varicoceles may cause infertility or pain.
If they are symptomatic, they can be treated surgically.

Question 31

Define epispadias and hypospadias. How are they treated?

Answer 31

Both are congenital penile anomalies. In hypospadias the urethra opens on the dorsal (under) side of the penis. In epispadias the urethra opens on the ventral (top) side of the penis. Epispadias is associated with exstrophy of the bladder. Both conditions are treated with surgical correction.