overviews of male reproductive system

1. MALE REPRODUCTIVE SYSTEM
DISEASES
&
PROCEDURES
©DR. SHISHIR KUMAR
RIMS, RANCHI

2. Course Content
• Male Reproductive system: Diseases
– Prostate enlargement
– Hydrocele
– Impotence
• Male Reproductive system: Procedures
– TURP (Transurethral Resection of Prostate)

3. Prostate Enlargement
Benign Prostate Hyperplasia (BPH)

4. Introduction
• Benign Prostatic Hyperplasia (BPH) also k/a
Prostate Gland Enlargement is a common in older
males.
• It can cause uncomfortable urinary symptoms,
such as blocking the flow of urine
• It can also cause bladder, urinary tract or kidney
problems

5. Symptoms
• Common symptoms:
– Frequent urination (Frequency)
– Urgent need to urinate (Urgency)
– Increased frequency of urination at night (Nocturia)
– Difficulty starting urination (Hesitancy)
– Weak urine stream or a stream that stops and starts
– Dribbling at the end of urination
– Inability to completely empty the bladder
• Less common symptoms:
– Urinary tract infection
– Inability to urinate (Urinary retention)
– Blood in the urine (Hematuria)

6. Comparing Normal
and
Enlarged Prostate
Glands
At normal size, the
prostate gland is
about the size and
shape of a walnut or
golf ball
When enlarged,
the prostate may
obstruct urine flow
from the bladder
and out the urethra.

7. Causes & Risk Factors
• Males have continued prostate growth with increasing
age under the influence of Testosterone
• This continued growth enlarges the prostate enough
to cause urinary symptoms
• Risk factors:
– Aging
– Positive Family history
– Diabetes and heart disease (more use of beta blockers)
– Lifestyle: Obesity increases the risk of BPH, while exercise
can lower the risk

8. Complications
• Sudden inability to urinate (urinary retention):
– A catheter is needed to drain urine
– Sometimes surgery is needed
• Urinary tract infections (UTIs):
– Inability to fully empty the bladder increases the risk of
UTIs
• Bladder stones
• Bladder damage
• Kidney damage

9. Diagnosis
• Clinical Examination (DRE: Digital Rectal Exam.)
• Routine Examination of Urine
• Blood test:
– The results can indicate kidney problems.
• Prostate Specific Antigen (PSA):
– Marker to distinguish BPH with Prostate cancer
• Uroflometry
• USG:
– Transabdominal/Transrectal
– Size of Prostate and PVR (Post Void Residual) Urine can be assessed
• Cystoscopy
• Prostate biopsy

10. Treatment
• Treatment depends upon:
– Severity of symptoms
– Age of the patient
– General health of the patient
• Medical Management:
– Drugs like Alpha Blockers (e.g. Tamsulosin, Silodosin etc.) and 5-
Alpha Reductase Inhibitors (e.g. Dutasteride, Finasteride etc.)
are used
• Surgical Management:
– Minimal invasive surgery: TURP, Laser Therapy
– Open surgery: Prostectomy

11. Hydrocele

12. Introduction
• A hydrocele is a type of swelling in the scrotum
that occurs when fluid collects in the thin sheath
surrounding testis
• Common in newborns and usually disappears
without treatment by age 1
• Older boys and adult men can develop a hydrocele
due to inflammation or injury within the scrotum

14. Clinical Features
• Painless swelling of one or both sides of scrotum
• Discomfort from the heaviness of a swollen
scrotum
• Pain due to infection and inflammation

15. Causes and Risk Factors
• Congenital Hydrocele:
– Present since birth due to presence of sac in scrotum which
communicates with abdominal cavity
– Most of the cases are congenital hydrocele
• Injury or inflammation of scrotum:
– Present in older age
• Risk Factors:
– Injury
– Infection
– Inflammation

16. Complications
• Infection or Tumor of testes
• May lead to development of inguinal hernia

17. Diagnosis
• Clinical Examination is the mainstay of diagnosis:
– Palpation of scrotum for tenderness
– Cough reflex to rule out inguinal hernia
– Transillumination test
• Blood and urine examination to rule out any
infection
• Ultrasound

18. Treatment
• Wait & Watch as most of the Congenital hydrocele
regress itself with age
• Surgery is the definitive treatment for persistent
and complicated cases (Hydrocelectomy)

19. Impotence
(Erectile Dysfunction)

20. Introduction
• Erectile dysfunction (impotence) is the inability to
get and keep an erection firm enough for sexual
intercourse
• One of the common causes of male infertility
• Can lead to stress, affects self-confidence and
contribute to relationship problems

21. Clinical Features
• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire (libido)

22. Causes
• Multifactorial, causes can be Psychological or Physical
• Psychological causes: (Most Important)
– Depression, anxiety or other mental health conditions
– Stress
• Physical causes:
– High cholesterol, High blood pressure
– Diabetes and Obesity
– Tobacco and alcohol abuse
– Sleep disorders
– Some medications (Alpha & Beta blockers)
– Surgeries or injuries that affect the pelvic area or spinal cord

23. Complications
• An unsatisfactory sex life
• Stress or anxiety
• Embarrassment or low self-esteem
• Relationship problems
• The inability to get female partner pregnant

24. Treatment
• Psychological Counseling and Treatment
• Medications:
– Sildenafil, Tadalafil etc.
– These medications increase the risk of heart diseases and cause
hypotension so contraindicated in Patients with heart disease
and low blood pressure (Hypotension)
• To take care of other associated clinical conditions like
Diabetes, Obesity etc.
• Exercise

25. TURP
(Trans Urethral Resection of Prostate)

26. Introduction
• TURP is a surgical procedure used to treat urinary
problems due to an enlarged prostate (BPH)
• An instrument k/a Resectoscope is used (a
combined visual and surgical instrument)
• It is inserted through the tip of urethra and excess
prostate tissues that's blocking urine flow, are
trimmed

27. Indications
TURP helps reducing urinary symptoms caused by BPH
like
• Frequent, urgent need to urinate
(increased frequency and urgency)
• Difficulty starting urination (hesitancy)
• Slow (prolonged) urination
• Increased frequency of urination at night (nocturia)
• The feeling of incomplete emptiness of bladder
• Urinary tract infections

28. Procedure
• The resectoscope is inserted into the tip of urethra and
extended through the prostate area
• The resectoscope is used to trim tissue from the inside of
prostate gland, one small piece at a time
• As small pieces of tissue are cut from inside of prostate,
irrigating fluid carries them into the bladder
• They're removed at the end of the operation
• No cuts (incisions) are made on the outside of body

30. Complications
• Temporary difficulty in urination
• Urinary tract infection
• Retrograde ejaculation
• Erectile dysfunction
• Heavy bleeding
• Difficulty holding urine (Urinary incontinence)
• Low sodium in the blood (Hyponatremia)
• Need for retreatment