Chapter039

Chapter 39
Disorders of the Male
Genitourinary System
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Male Reproductive Anatomy

Androgens
• Testosterone
– Main testicular hormone
• Dihydrotestosterone
– Formed from testosterone in peripheral
tissues
– Produced by the enzyme 5-alpha reductase

Hypothalamus
GnRH
Pituitary
LH FSH Inhibin
Negative
feedback
Interstitial cells
of Leydig
Sertoli
cells
Testosterone Spermatogenesis
Maturation
of sperm

Question
Tell whether the following statement is true or false:
Male reproductive hormones are regulated by the HPA axis.

Answer
False
The regulation of reproductive hormones is accomplished
by the HPG axis (hypothalamic-pituitary-gonadal).
Gonads are sex organs.

Erection—Vasodilation Fills Spongy Tissue
with Blood

Penile Disorders
• Inflammations
– Balanitis
– Balanoposthitis
– Peyronie disease
• Penile cancer

Embryonic Development and Descent of
Testes
• Testes develop
from embryonic
kidneys
• Descend into
scrotum
through inguinal
canal

Hernia

Testicular Disorders
• Varicocele
• Hydrocele
• Testicular torsion
• Inflammations
– Epididymitis
– Orchitis

Scenario
An 8-year-old boy is in the emergency room. His babysitter says
the boy has a GI bug because he has been throwing up and
complains of severe abdominal pain…
• When alone with you, he admits the pain is in his testes
• He presents with HR 115 bpm; RR 29 breaths/min; BP 135/95
mm Hg; pale, cold skin; no bowel sounds; severe pain in right
testis; and slight swelling on the right side of the scrotum.
• His uncle recently had the mumps
Question
• What problems might this boy have? What has caused his
symptoms?

Question
Which testicular disorder would be the most likely to result
from trauma to the scrotum?
a. Varicocele
b. Hematocele
c. Spermatocele
d. Testicular torsion

Answer
b. Hematocele
Hematocele is characterized by the accumulation of blood
in the tunica vaginalis, and may be caused by scrotal
trauma.
Varicoceles are varicosities in veins supporting the testes.
A spermatocele is a cyst at the end of the epididymis.
Testicular torsion is caused by the twisting of the
spermatic cord.

Testicular Cancers
• Usually arise from germ cells
– These cells have the potential to contribute to a
new body
– Therefore, they have the potential to do
everything that a new body will do: multipotent
o Alpha fetoprotein
o Human chorionic gonadotropin
o Lactate dehydrogenase

Prostate Surrounds Urethra
• Prostate
enlargement
compresses
urethra
• Causes alterations
in urination
– Weak stream
– Urgency
– Dysuria
– Discharge

Kinds of Prostatitis
• Asymptomatic inflammatory
• Acute bacterial
• Chronic bacterial
• Chronic prostatitis/pelvic pain syndrome
– Inflammatory
– Noninflammatory

Benign Prostatic Hyperplasia (BPH)
• Nodules have
compressed the
urethra to a
narrow slit
• Decreasing
testosterone
levels can
decrease the
prostate growth

Question
Which type of prostatitis is the most common?
a. Asymptomatic bacterial
b. Acute bacterial
c. Chronic bacterial
d. Pelvic pain syndrome

Answer
d. Pelvic pain syndrome
Pelvic pain syndrome (aka chronic prostatitis) is the most
common prostatic syndrome. It can be inflammatory or
noninflammatory, and is treated with antibiotics, anti-inflammatories,
anticholinergics, or alpha-adrenergic
antagonists.

Scenario
• An elderly man has problems with night urgency and joint pain.
• Blood tests show:
– Elevated plasma creatinine
– Elevated BUN
– Elevated calcium
– Prostate-specific antigen
Question
• What do you suspect is causing his symptoms?

Childhood Disorders
• Hypospadias
• Epispadias
• Phimosis
• Paraphimosis
• Cryptorchidism

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