Unit 3 - Chapter 26 alterations in male reproductive system

Question 1

Puberty in boys

Answer 1

9-14 y/o onset
* remained unchanged each generation

delayed puberty
* HPG or hypothalamic-pituitary-gonadal axis intact but surge of activity that stimulates puberty is delayed (common situation in boys

precocious puberty – early before general timeline
* intact HPG, mistiming of stimulatory surge
* complete (sex appropriate), mixed (not sex appropriate, opposite?), or partial (developing limited secondary sex characteristic)
* Causes of “delayed” or “incomplete” puberty – can be divded into these following categories => hypergonadotropism (increased FSH + LH) or hypogondatropism (decreased LH + FSH)

Question 2

D/o of urethra

Answer 2

urethritis (inflammation of urethra)
1) noninfectious urethritis can occur, however most cases are sexually transmitted pathogens

sx -
* dysuria
* frequency
* urgency
* urethral tingling or itching
* clear or purulent discharge

tx-
* antibiotic therapy
* avoid future chemical or mechanical irritation

urethral strictures (narrowing or obstruction of urthral lumen caused by scarring) // strictures usually manifest itself as lower UT sx or UTI’s with significant impaired QOL
* scarring obtained via trauma or severe or untreated urethral infection

primary sx -
* diminised force and caliber of stream
* urinary frequency and hesitancy
* mild dysuria (burning senstation when you pee
* double urine stream or spraying
* postvoid dribbling

tx-
* surgical

Question 3

Phimosis and paraphimosis

Answer 3

foreskin d/o
* foreskin cannot retract over glans
* d/t poor hygiene and chronic infection and l/t paraphimosis [another foreskin d/o where retracted foreskin cannot return to original position where it sits over glans]
* Paraphimosis can constrict penile blood vessels => prevent circulation to glans

Question 4

Peyronie disease

Answer 4

• fibrosis of corpora cavernosa (responsible for penile curvature during erection
• this fibrosis can engorge affected side causing lateral curvature that can prevent intercourse
• prevalence of 9% in male population

Question 5

Priapism

Answer 5

• prolonged painful erection not d/t arousal
• only copora cavernosa (not spongiosium) fills with blood that does not drain; likely d/t venous obstruction

causes:
* spinal cord trauma, sickle cell disease, leukemia, and pelvic tumors
* can be idiopathic and occur w/ cocaine use

Question 6

Balanitis

Answer 6

• inflammatoin of glans penise; usually happens in conjunction w/ posthitis (inflammation of your foreskin)
• balantis is associated with phimosis, poor hygiene under foreskin, skin d/o, and infections

Question 7

Cancer of penis?

Answer 7

• rare
• major risk factors: HPV, smoking, and consequences of treatemnt for psoriasis
• penile carcinoma in situ - tends to involve glans
• invasive carcinoma of penis involves shaft

Question 8

Variococele

Answer 8

• abnormal dilation of veins inside spermatic cord (cord-like structure in the male reproductive system that contains nerves, blood and lymph vessels, and the vas deferens (a coiled tube that carries sperm out of the testicle) [before vans deferens]
• d/t congenital absence of valves in the internal spermatic vein or acquired valvular incompetence

Question 9

Hydrocele

Answer 9

collection of fluid between testicular and scrotal layers of tunic vaginalis (visceral and parieta, 1st / 2nd layer of testes => fluid => skin)
* can be idiopathic or d/t trauma or infection of testes

Question 10

spermatocele

Answer 10

• cyst located between the testis and epididymis that is filled with fluid and sperm

Question 11

Cryptorchidism

Answer 11

• when one or both testes fail to descend into scrotum
• multifactorial (genetic, maternal, environmental factors)
• occurs often as an isolated d/o w/ no obvious cause
• uncorrected condition associated with infertility and significant risk of testicular cancer

Question 12

testicular torsion

Answer 12

• rotation of testis
• twisting of blood vessels in spermatic cord
• interrupting blood supply to testis => edema => if not corrected within 4-6 l/t necrosis and atrophy of testicular tissues

Question 13

Orchitis

Answer 13

• acute infection of testes
• pathogenic organisms reach testes via blood or lymphatics
• most commonly, ascend via vas deferens and epididymis

complications
* hydrocele and atrophy

Another one granulomatous orchitis
* autoimmune disease
* nonspecific, noninfectious, inflammatory process that occurs in middle aged men

Question 14

Testicular cancer

Answer 14

• most common malignancy in males 15-35
• cause unknown…
• other causes: elevated androgen, genetic predisposition, history of cryptorchidism (failure to descend - testes), trauma, or infection can l/t tumorigenesis
• most testicular neoplasms => germ cell tumors (cells that turn into sperm or egg; originate in testicle or ovary)

Question 15

Epididymitis

Answer 15

• inflammation of epididymis
• usually sexually transmitted pathogen that ascends via vasa deferentia from an already infected urethra or bladder

Question 16

Benign prostatic hyperplasia

Answer 16

• BPH
• enlargement of prostage gland
• becomes sympthomatic as enlarging prostate compresses on urethra, causing bladder outlet syndrome (blockage that slows or stops urine flow out of the bladder. Bladder outlet obstruction can cause urine to back up in your system, leading to difficulty urinating and other uncomfortable urinary symptoms) and urine retention
• can also be d/t activation of chronic, inflammatory prostatic response that can impact the likelihood of BPH progression and prostate cancer

Question 17

Prostatitis

Answer 17

• inflammation of prostate

1) acute bacterial prostatitis (ABP) - causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise

2) chronic bacterial prostatitis (CBP) - ongoing or recurring bacterial infection usually with less severe symptoms

sx-
* urinary frequency.
* urinary urgency.
* a burning feeling or pain during urination.
* pain in the genital area, groin, lower abdomen, or lower back.
* nocturia.
* painful ejaculation.
* urinary retention.
* trouble starting a urine stream.

3) chronic pelvic pain syndrome (CPPS) - ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection

sx:
* Abdominal Pain.
* Frequent Urination.
* Genital Pain.
* Lower Back Pain.
* Pain During or After Sex.
* Pain while Sitting.

4) asymptomatic inflammatory prostatitis - signs of an inflamed prostate with no symptoms
* no sx
* can be diagnosed as this if WBC present

Question 18

Prostate cancer

Answer 18

• most common cancer in American men
• causes - genetic predisposition, environmental + dietary factors, inflammation, altered levels of hormones (testosterone, dihydrotestosterone [embryonic - sex differentiation of organs, adolescent/adult - promotes prostate growth, sebaceous gland activity, male pattern baldness, and body, facial and pubic hair growth] and estradoiol [modulating libido, erectile function, and spermatogenesis]), and growth factors
• Greatest incidence amongst northwestern European and NA men [mainly black) older than 65
• estrogen - ensuring that muscle mass gain is processed in the correct way. preservation of bone strength. maintaining a stable nervous system and emotional state.
• most of these cancers are are adenocarcinomas that develop at the periphery of the gland

Question 19

Serrmatogenesis

Answer 19

• sperm production by testes
• can be imparied by HPG disruptions that redue testosterone secretion and by testicular trauma or atrophy from any cause
• can also impaired by neoplastic disease, cryptorchidism, or factors that raise testicular temperature

Question 20

Sperm quality

Answer 20

• impaired by chromosomal abnormalities d/t genetic factors, irradiation, or toxins
• Motility - can be impaired by unfavorable constituents or semen characteritics

Question 21

Gynecomastia

Answer 21

• hyperplasia; overdevelopment of breast tissue in male from hormonal alterations
• idiopathic or d/t systemic d/o, drugs or neoplasms
• USUALLY imbalance of estrogen and testosterone ratio
• affects 32-40% of men; greater among adolescent and men older than 50

caused by hormonal or breast tissue changes that cause estrogen to dominate
* breast cancer uncommon but has poor prognosis because men delay it - usually 60-70 y/o; indicative of estrogen positive for men