This document discusses various categories of male infertility treatment. It covers common causes of male infertility like varicocele, cryptorchidism, endocrinopathies, and ejaculatory dysfunction. For each category, it describes the etiology, pathophysiology, evaluation, and treatment options. The treatment options discussed include varicocele repair, orchiopexy for cryptorchidism, hormone therapy for endocrinopathies, and assisted reproductive techniques for conditions affecting sperm production or delivery.
This document summarizes the pathology of the adrenal gland. It describes the normal histology and physiology and discusses hyperplasia and neoplasia that can occur in the cortex and medulla. Hyperplasias include subcapsular and cortical hyperplasia. Neoplasms include subcapsular adenomas and carcinomas, cortical adenomas and carcinomas, and various types of pheochromocytomas such as benign, malignant, and complex pheochromocytomas. Neuroblastomas and ganglioneuromas are also mentioned. The document provides examples of photomicrographs to illustrate many of these conditions.
This document summarizes the pathophysiology and management of Cushing's syndrome. It discusses the etiology, clinical manifestations, diagnosis, and treatment of the condition. Cushing's syndrome is caused by prolonged exposure to excess glucocorticoids and can be ACTH-dependent or independent. The signs and symptoms involve changes in body composition, skin, bone, muscle, cardiovascular, metabolic and immune systems. Diagnosis involves biochemical tests and imaging. Treatment focuses on surgical resection of the underlying tumor or adrenal disease when possible to normalize cortisol levels and alleviate symptoms.
Adrenal Gland and its Disorders with surgical management.Manish Shetty
The document discusses adrenal gland tumours including adrenal cortical tumours, phaeochromocytoma, neuroblastoma, and Cushing's syndrome. Key points are:
1) Adrenal cortical tumours can be functioning or non-functioning adenomas. Incidentalomas are adrenal tumours found incidentally on imaging and require hormone evaluation.
2) Phaeochromocytomas arise from chromaffin cells and secrete catecholamines. They present with severe headaches and symptoms of sympathetic overactivity.
3) Neuroblastoma is the most common abdominal tumour in children that arises from adrenal medulla. It has different risk groups and stages that determine prognosis and treatment.
4
This document discusses adrenal incidentalomas, which are adrenal masses discovered incidentally through imaging for unrelated conditions. It covers the relevant anatomy and physiology, defines incidentalomas and classifications, and describes the evaluation, management, and surgical treatment options. Functional adrenal tumors like Cushing's syndrome, Conn's syndrome, pheochromocytoma, and adrenocortical carcinoma are also discussed. Laboratory and imaging tests used in evaluation are outlined, along with signs, symptoms and screening tests for the functional tumors. Surgical resection is the treatment of choice for most cases.
A presentation about Adrenal gland tumors. This presentation contains 43 slides, and is divided into 3 parts :
1 - Adrenal gland tumors (Introduction).
2 - Imaging Adrenal gland tumors.
3 - Cases.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
The adrenal glands are paired endocrine organs located above the kidneys that are comprised of an outer cortex and inner medulla. The cortex secretes mineralocorticoids, glucocorticoids, and sex hormones. The medulla secretes catecholamines. Common non-neoplastic diseases include Cushing's syndrome, hyperaldosteronism, and adrenal insufficiency. Adrenal cortical tumors include adenomas, which can be functional or non-functional, and rare carcinomas. Pheochromocytomas arise from the medulla and secrete catecholamines, causing hypertension. Neuroblastomas are rare tumors seen in young children that often metastasize.
This document discusses the etiology and evaluation of erectile dysfunction (ED). It begins with definitions of ED and classifications of organic vs psychogenic causes. It then covers the epidemiology, risk factors, and various etiologies of ED including vascular, neurological, hormonal, drug-induced, diabetes-related, and other causes. The document outlines the evaluation of ED, including sexual questionnaires, medical history, physical exam, lab tests, and specialized tests like vascular testing using duplex ultrasound, pharmacologic injection, and dynamic infusion cavernosometry and cavernosography. It provides details on techniques, indications, and interpretations for the various diagnostic tests used to evaluate patients with ED.
This document provides an overview of the surgical management of adrenal tumors. It begins by describing the anatomy and embryology of the adrenal glands. It then discusses the various tumor types that can affect the adrenal cortex, including functional tumors like aldosteronoma and Cushing's syndrome. For aldosteronoma, it outlines the diagnostic approach and treatment options. It also summarizes the signs, symptoms, diagnosis, and treatment of Cushing's syndrome. Throughout, it provides clinical details on evaluating and managing different adrenal cortical tumors.
This document summarizes the pathology of the adrenal gland. It describes the normal histology and physiology and discusses hyperplasia and neoplasia that can occur in the cortex and medulla. Hyperplasias include subcapsular and cortical hyperplasia. Neoplasms include subcapsular adenomas and carcinomas, cortical adenomas and carcinomas, and various types of pheochromocytomas such as benign, malignant, and complex pheochromocytomas. Neuroblastomas and ganglioneuromas are also mentioned. The document provides examples of photomicrographs to illustrate many of these conditions.
This document summarizes the pathophysiology and management of Cushing's syndrome. It discusses the etiology, clinical manifestations, diagnosis, and treatment of the condition. Cushing's syndrome is caused by prolonged exposure to excess glucocorticoids and can be ACTH-dependent or independent. The signs and symptoms involve changes in body composition, skin, bone, muscle, cardiovascular, metabolic and immune systems. Diagnosis involves biochemical tests and imaging. Treatment focuses on surgical resection of the underlying tumor or adrenal disease when possible to normalize cortisol levels and alleviate symptoms.
Adrenal Gland and its Disorders with surgical management.Manish Shetty
The document discusses adrenal gland tumours including adrenal cortical tumours, phaeochromocytoma, neuroblastoma, and Cushing's syndrome. Key points are:
1) Adrenal cortical tumours can be functioning or non-functioning adenomas. Incidentalomas are adrenal tumours found incidentally on imaging and require hormone evaluation.
2) Phaeochromocytomas arise from chromaffin cells and secrete catecholamines. They present with severe headaches and symptoms of sympathetic overactivity.
3) Neuroblastoma is the most common abdominal tumour in children that arises from adrenal medulla. It has different risk groups and stages that determine prognosis and treatment.
4
This document discusses adrenal incidentalomas, which are adrenal masses discovered incidentally through imaging for unrelated conditions. It covers the relevant anatomy and physiology, defines incidentalomas and classifications, and describes the evaluation, management, and surgical treatment options. Functional adrenal tumors like Cushing's syndrome, Conn's syndrome, pheochromocytoma, and adrenocortical carcinoma are also discussed. Laboratory and imaging tests used in evaluation are outlined, along with signs, symptoms and screening tests for the functional tumors. Surgical resection is the treatment of choice for most cases.
A presentation about Adrenal gland tumors. This presentation contains 43 slides, and is divided into 3 parts :
1 - Adrenal gland tumors (Introduction).
2 - Imaging Adrenal gland tumors.
3 - Cases.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
The adrenal glands are paired endocrine organs located above the kidneys that are comprised of an outer cortex and inner medulla. The cortex secretes mineralocorticoids, glucocorticoids, and sex hormones. The medulla secretes catecholamines. Common non-neoplastic diseases include Cushing's syndrome, hyperaldosteronism, and adrenal insufficiency. Adrenal cortical tumors include adenomas, which can be functional or non-functional, and rare carcinomas. Pheochromocytomas arise from the medulla and secrete catecholamines, causing hypertension. Neuroblastomas are rare tumors seen in young children that often metastasize.
This document discusses the etiology and evaluation of erectile dysfunction (ED). It begins with definitions of ED and classifications of organic vs psychogenic causes. It then covers the epidemiology, risk factors, and various etiologies of ED including vascular, neurological, hormonal, drug-induced, diabetes-related, and other causes. The document outlines the evaluation of ED, including sexual questionnaires, medical history, physical exam, lab tests, and specialized tests like vascular testing using duplex ultrasound, pharmacologic injection, and dynamic infusion cavernosometry and cavernosography. It provides details on techniques, indications, and interpretations for the various diagnostic tests used to evaluate patients with ED.
This document provides an overview of the surgical management of adrenal tumors. It begins by describing the anatomy and embryology of the adrenal glands. It then discusses the various tumor types that can affect the adrenal cortex, including functional tumors like aldosteronoma and Cushing's syndrome. For aldosteronoma, it outlines the diagnostic approach and treatment options. It also summarizes the signs, symptoms, diagnosis, and treatment of Cushing's syndrome. Throughout, it provides clinical details on evaluating and managing different adrenal cortical tumors.
retract liver superiorly and medially
Surgeon: dissect the periadrenal fat to expose the
adrenal gland
Surgeon: identify and ligate the right adrenal vein
Surgeon: dissect the adrenal gland from the
surrounding tissues and remove the gland
Surgeon: inspect the bed and close the peritoneum
with absorbable suture
Surgeon: insert drain and close port sites
This document provides an overview of pheochromocytoma, which are rare catecholamine-producing tumors. Key points include:
- Pheochromocytomas arise from sympathetic nervous system and can be sporadic or inherited. Approximately 25% of cases are associated with genetic syndromes.
- Presentation involves classic triad of headaches, palpitations, and sweating along with hypertension. Diagnosis is confirmed through urine and plasma tests and imaging studies.
- Complete surgical removal is the primary treatment, with pre-operative medication to control blood pressure. About 10% of cases are malignant with distant metastases. Some pheochromocytomas are associated with genetic syndromes like VHL, MEN2, and
This document provides an overview of adrenal gland anatomy and pathology. It describes the location, structure, and functions of the adrenal cortex and medulla. It discusses various adrenal tumors including aldosteronomas, Cushing's syndrome, and virilizing/feminizing tumors. Diagnosis, evaluation, and treatment of these conditions are explained. Surgical approaches for adrenalectomy are outlined.
The document discusses surgical diseases of the adrenal gland. It covers the anatomy and physiology of the adrenal glands, as well as conditions like pheochromocytoma, Conn's syndrome, Cushing's syndrome, and adrenal cortical carcinoma. It also discusses the evaluation and management of incidental adrenal masses found on imaging, noting that the majority are benign adenomas. Pheochromocytoma is highlighted as a functional tumor of the adrenal medulla that presents with symptoms of elevated catecholamines like hypertension. Surgical removal of pheochromocytoma requires pre-operative management to control blood pressure with medications.
1. The document discusses disorders of the adrenal gland including anatomy, histology, functions, and various disorders affecting the adrenal cortex and medulla.
2. Key disorders covered include Cushing's syndrome, primary hyperaldosteronism, adrenocortical carcinoma, congenital adrenal hyperplasia, adrenal insufficiency, pheochromocytoma, neuroblastoma, and ganglioneuroma.
3. Diagnosis and treatment approaches are summarized for each disorder, including the role of surgery, particularly laparoscopic adrenalectomy.
- For the first case, the woman can have her prolactin levels checked yearly and does not need another MRI unless her prolactin levels rise above 250 μg/liter or she has clinical signs of tumor growth.
- For the second case, the man should have his prolactin levels checked yearly and repeat an MRI in 2-3 years to confirm tumor suppression and ensure prolactin levels reflect tumor size.
- Prolactinomas are usually benign and dopamine agonists are the preferred treatment to normalize prolactin levels and reduce tumor size. Long term management involves monitoring prolactin levels and imaging periodically to check for tumor changes requiring treatment modifications.
A brief overview of pituitary adenomas, their subtypes, classification, investigation protocols, radiological evaluation, and their medical management.
Metastatic renal cell carcinoma (mRCC) has generally poor outcomes with median survival of less than one year. Surgery and chemotherapy are often not effective, leaving patients underserved. The introduction of molecularly targeted therapies like sorafenib and sunitinib have improved outcomes. Cytoreductive nephrectomy followed by targeted therapy may provide benefits for select patients based on prognostic models. Immunotherapy agents are also options for treating mRCC by releasing brakes on the immune system. Ongoing research continues to evaluate combination therapies and predictive biomarkers.
The document provides an overview of adrenal tumors, including:
- The different types such as Conn's syndrome, Cushing's syndrome, adrenal adenomas, adrenal carcinomas, and pheochromocytomas.
- The anatomy, embryology, physiology and functions of the adrenal glands and hormones.
- The clinical presentations, laboratory diagnoses, imaging features, and management principles for each type of adrenal tumor.
Detailed information is given on the pathogenesis and treatment of various functional and non-functional adrenal masses.
This document provides information on pediatric pheochromocytoma including:
- Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells and can cause hypertension.
- Diagnosis involves measuring plasma and urinary metanephrines and imaging studies to locate the tumor(s).
- Treatment requires preoperative medical management to control blood pressure followed by surgical resection, which usually cures the condition.
Acromegaly is a condition caused by excessive growth hormone (GH) secretion after epiphyseal plate closure in adults. It results in enlargement of extremities, soft tissues, and internal organs. The presentation outlines the physiology of GH, epidemiology, etiology as pituitary adenomas in most cases, pathogenesis involving mutations, clinical features, investigations including MRI and biochemical testing, and treatment with surgery, radiation, and medical management to suppress GH and normalize IGF-1 levels. Long term monitoring is needed to manage comorbidities like cardiovascular and respiratory complications. While challenging, a multidisciplinary approach can help reduce mortality and morbidity from acromegaly.
This patient presents with oligospermia and a history of gonococcal infection, suggesting possible obstructive azoospermia. Physical exam shows normal testes size and indurated epididymis. Hormonal levels are normal. Further workup would include a testicular biopsy to differentiate between obstructive versus non-obstructive causes, as reconstruction may be considered if the azoospermia is obstructive in nature. The biopsy can help determine if maturation arrest is present which could mimic an obstructive picture clinically.
Seminar presentation by group C 5th year medical student under supervision Dato Imi, endocrine specialist in HRPZ II.
Reference as mentioned at the end of the slide presentation
Adrenal tumor, classification, management - easy explanationSwatilekha Das
Adrenal tumor- topic for B.Sc Nursing Students, GNM Students
definition
classification
clinical manifestations
treatment
easy explanation for nursing students
This document provides information on the adrenal gland, including its embryology, anatomy, physiology, and various disorders. It discusses topics such as adrenal cortex and medulla disorders, adrenal tumors, adrenal insufficiency, and adrenal surgery. Specific conditions covered include Cushing's syndrome, pheochromocytoma, congenital adrenal hyperplasia, hyperaldosteronism, adrenocortical carcinoma, and adrenal incidentaloma. Diagnostic tests and treatment options are provided for each condition. Adrenal surgery techniques such as open and laparoscopic approaches are also summarized.
Adrenal Gland Tumours and their ManagementFaisal Zia
The document discusses adrenal gland tumors and their management. It begins with the anatomy and physiology of the adrenal glands and outlines the classification of adrenal tumors. It then discusses specific tumor types like adrenocortical adenoma, adrenocortical carcinoma, pheochromocytoma, neuroblastoma, and ganglioneuroma. For each tumor, it covers clinical features, diagnosis, and management strategies including surgery, medication, and follow up. Surgical resection is the primary treatment for most benign functioning and non-functioning tumors, while malignant tumors may also require chemotherapy or radiation.
Adaptations of cellular growth and diffrentiationrashree-singh
This document discusses various types of cellular adaptation in response to environmental changes. It defines key adaptations like hypertrophy, hyperplasia, atrophy, and metaplasia. Hypertrophy involves cell enlargement while hyperplasia is an increase in cell number. Atrophy is a decrease in cell size and number. Metaplasia is the reversible replacement of one cell type with another. Adaptations can be physiological from things like exercise or pathological from issues like hypertension. The mechanisms of adaptations involve growth factors, hormones, and changes in protein expression levels. Cellular adaptations allow tissues to survive stresses but can sometimes progress to disease if the stressors remain.
This document discusses the perioperative care of patients with phaeochromocytoma. It covers the classification, aetiology, incidence, symptoms, diagnosis, localization and preoperative preparation of phaeochromocytoma. For preoperative preparation, the key goals are controlling blood pressure through adrenergic blockade, optimizing volume status and cardiac function, and correcting metabolic disturbances. Intraoperatively, the anaesthetic technique aims to prevent catecholamine release while managing surges in blood pressure from tumour handling and treating hypotension after tumour removal.
This document discusses the anatomy, physiology, and pathologies of the adrenal glands. It begins with an overview of adrenal gland structure and location. It then discusses the arterial supply, venous drainage, nerve supply, and lymphatic drainage. Histology and embryology are also covered. The document focuses on specific adrenal disorders including primary aldosteronism, Cushing's syndrome, adrenal tumors, adrenal metastases, and adrenocortical carcinoma. For each condition, the document discusses signs and symptoms, pathophysiology, diagnosis, subtypes if relevant, and treatment approaches.
This document discusses varicoceles, which are abnormal dilations and tortuosity of the internal spermatic veins. It provides definitions, epidemiology, pathogenesis, diagnosis, associated pathological processes like testicular hypotrophy, and effects on semen quality. Key points include that varicoceles are more common on the left side and prevalence increases with infertility. Causes involve increased venous pressure and valvular incompetence. Diagnosis involves physical exam and ultrasound to assess reflux and testicular size. Associated issues involve hypotrophy, though catch-up growth may occur after repair, and effects on semen quality are unclear in adolescents.
This document discusses bladder cancer and provides information on epidemiology, etiology, pathophysiology, classification, clinical features, and histopathology of benign and malignant bladder tumors. It is from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. The document lists the moderators and their academic titles. It then covers topics such as the higher prevalence of bladder cancer in men compared to women, risk factors including smoking and occupational exposures, genetic factors, pathogenesis, WHO and other classification systems, clinical features of non-muscle invasive and muscle invasive bladder cancers, histopathology of benign lesions and different grades of bladder tumors.
retract liver superiorly and medially
Surgeon: dissect the periadrenal fat to expose the
adrenal gland
Surgeon: identify and ligate the right adrenal vein
Surgeon: dissect the adrenal gland from the
surrounding tissues and remove the gland
Surgeon: inspect the bed and close the peritoneum
with absorbable suture
Surgeon: insert drain and close port sites
This document provides an overview of pheochromocytoma, which are rare catecholamine-producing tumors. Key points include:
- Pheochromocytomas arise from sympathetic nervous system and can be sporadic or inherited. Approximately 25% of cases are associated with genetic syndromes.
- Presentation involves classic triad of headaches, palpitations, and sweating along with hypertension. Diagnosis is confirmed through urine and plasma tests and imaging studies.
- Complete surgical removal is the primary treatment, with pre-operative medication to control blood pressure. About 10% of cases are malignant with distant metastases. Some pheochromocytomas are associated with genetic syndromes like VHL, MEN2, and
This document provides an overview of adrenal gland anatomy and pathology. It describes the location, structure, and functions of the adrenal cortex and medulla. It discusses various adrenal tumors including aldosteronomas, Cushing's syndrome, and virilizing/feminizing tumors. Diagnosis, evaluation, and treatment of these conditions are explained. Surgical approaches for adrenalectomy are outlined.
The document discusses surgical diseases of the adrenal gland. It covers the anatomy and physiology of the adrenal glands, as well as conditions like pheochromocytoma, Conn's syndrome, Cushing's syndrome, and adrenal cortical carcinoma. It also discusses the evaluation and management of incidental adrenal masses found on imaging, noting that the majority are benign adenomas. Pheochromocytoma is highlighted as a functional tumor of the adrenal medulla that presents with symptoms of elevated catecholamines like hypertension. Surgical removal of pheochromocytoma requires pre-operative management to control blood pressure with medications.
1. The document discusses disorders of the adrenal gland including anatomy, histology, functions, and various disorders affecting the adrenal cortex and medulla.
2. Key disorders covered include Cushing's syndrome, primary hyperaldosteronism, adrenocortical carcinoma, congenital adrenal hyperplasia, adrenal insufficiency, pheochromocytoma, neuroblastoma, and ganglioneuroma.
3. Diagnosis and treatment approaches are summarized for each disorder, including the role of surgery, particularly laparoscopic adrenalectomy.
- For the first case, the woman can have her prolactin levels checked yearly and does not need another MRI unless her prolactin levels rise above 250 μg/liter or she has clinical signs of tumor growth.
- For the second case, the man should have his prolactin levels checked yearly and repeat an MRI in 2-3 years to confirm tumor suppression and ensure prolactin levels reflect tumor size.
- Prolactinomas are usually benign and dopamine agonists are the preferred treatment to normalize prolactin levels and reduce tumor size. Long term management involves monitoring prolactin levels and imaging periodically to check for tumor changes requiring treatment modifications.
A brief overview of pituitary adenomas, their subtypes, classification, investigation protocols, radiological evaluation, and their medical management.
Metastatic renal cell carcinoma (mRCC) has generally poor outcomes with median survival of less than one year. Surgery and chemotherapy are often not effective, leaving patients underserved. The introduction of molecularly targeted therapies like sorafenib and sunitinib have improved outcomes. Cytoreductive nephrectomy followed by targeted therapy may provide benefits for select patients based on prognostic models. Immunotherapy agents are also options for treating mRCC by releasing brakes on the immune system. Ongoing research continues to evaluate combination therapies and predictive biomarkers.
The document provides an overview of adrenal tumors, including:
- The different types such as Conn's syndrome, Cushing's syndrome, adrenal adenomas, adrenal carcinomas, and pheochromocytomas.
- The anatomy, embryology, physiology and functions of the adrenal glands and hormones.
- The clinical presentations, laboratory diagnoses, imaging features, and management principles for each type of adrenal tumor.
Detailed information is given on the pathogenesis and treatment of various functional and non-functional adrenal masses.
This document provides information on pediatric pheochromocytoma including:
- Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells and can cause hypertension.
- Diagnosis involves measuring plasma and urinary metanephrines and imaging studies to locate the tumor(s).
- Treatment requires preoperative medical management to control blood pressure followed by surgical resection, which usually cures the condition.
Acromegaly is a condition caused by excessive growth hormone (GH) secretion after epiphyseal plate closure in adults. It results in enlargement of extremities, soft tissues, and internal organs. The presentation outlines the physiology of GH, epidemiology, etiology as pituitary adenomas in most cases, pathogenesis involving mutations, clinical features, investigations including MRI and biochemical testing, and treatment with surgery, radiation, and medical management to suppress GH and normalize IGF-1 levels. Long term monitoring is needed to manage comorbidities like cardiovascular and respiratory complications. While challenging, a multidisciplinary approach can help reduce mortality and morbidity from acromegaly.
This patient presents with oligospermia and a history of gonococcal infection, suggesting possible obstructive azoospermia. Physical exam shows normal testes size and indurated epididymis. Hormonal levels are normal. Further workup would include a testicular biopsy to differentiate between obstructive versus non-obstructive causes, as reconstruction may be considered if the azoospermia is obstructive in nature. The biopsy can help determine if maturation arrest is present which could mimic an obstructive picture clinically.
Seminar presentation by group C 5th year medical student under supervision Dato Imi, endocrine specialist in HRPZ II.
Reference as mentioned at the end of the slide presentation
Adrenal tumor, classification, management - easy explanationSwatilekha Das
Adrenal tumor- topic for B.Sc Nursing Students, GNM Students
definition
classification
clinical manifestations
treatment
easy explanation for nursing students
This document provides information on the adrenal gland, including its embryology, anatomy, physiology, and various disorders. It discusses topics such as adrenal cortex and medulla disorders, adrenal tumors, adrenal insufficiency, and adrenal surgery. Specific conditions covered include Cushing's syndrome, pheochromocytoma, congenital adrenal hyperplasia, hyperaldosteronism, adrenocortical carcinoma, and adrenal incidentaloma. Diagnostic tests and treatment options are provided for each condition. Adrenal surgery techniques such as open and laparoscopic approaches are also summarized.
Adrenal Gland Tumours and their ManagementFaisal Zia
The document discusses adrenal gland tumors and their management. It begins with the anatomy and physiology of the adrenal glands and outlines the classification of adrenal tumors. It then discusses specific tumor types like adrenocortical adenoma, adrenocortical carcinoma, pheochromocytoma, neuroblastoma, and ganglioneuroma. For each tumor, it covers clinical features, diagnosis, and management strategies including surgery, medication, and follow up. Surgical resection is the primary treatment for most benign functioning and non-functioning tumors, while malignant tumors may also require chemotherapy or radiation.
Adaptations of cellular growth and diffrentiationrashree-singh
This document discusses various types of cellular adaptation in response to environmental changes. It defines key adaptations like hypertrophy, hyperplasia, atrophy, and metaplasia. Hypertrophy involves cell enlargement while hyperplasia is an increase in cell number. Atrophy is a decrease in cell size and number. Metaplasia is the reversible replacement of one cell type with another. Adaptations can be physiological from things like exercise or pathological from issues like hypertension. The mechanisms of adaptations involve growth factors, hormones, and changes in protein expression levels. Cellular adaptations allow tissues to survive stresses but can sometimes progress to disease if the stressors remain.
This document discusses the perioperative care of patients with phaeochromocytoma. It covers the classification, aetiology, incidence, symptoms, diagnosis, localization and preoperative preparation of phaeochromocytoma. For preoperative preparation, the key goals are controlling blood pressure through adrenergic blockade, optimizing volume status and cardiac function, and correcting metabolic disturbances. Intraoperatively, the anaesthetic technique aims to prevent catecholamine release while managing surges in blood pressure from tumour handling and treating hypotension after tumour removal.
This document discusses the anatomy, physiology, and pathologies of the adrenal glands. It begins with an overview of adrenal gland structure and location. It then discusses the arterial supply, venous drainage, nerve supply, and lymphatic drainage. Histology and embryology are also covered. The document focuses on specific adrenal disorders including primary aldosteronism, Cushing's syndrome, adrenal tumors, adrenal metastases, and adrenocortical carcinoma. For each condition, the document discusses signs and symptoms, pathophysiology, diagnosis, subtypes if relevant, and treatment approaches.
This document discusses varicoceles, which are abnormal dilations and tortuosity of the internal spermatic veins. It provides definitions, epidemiology, pathogenesis, diagnosis, associated pathological processes like testicular hypotrophy, and effects on semen quality. Key points include that varicoceles are more common on the left side and prevalence increases with infertility. Causes involve increased venous pressure and valvular incompetence. Diagnosis involves physical exam and ultrasound to assess reflux and testicular size. Associated issues involve hypotrophy, though catch-up growth may occur after repair, and effects on semen quality are unclear in adolescents.
This document discusses bladder cancer and provides information on epidemiology, etiology, pathophysiology, classification, clinical features, and histopathology of benign and malignant bladder tumors. It is from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. The document lists the moderators and their academic titles. It then covers topics such as the higher prevalence of bladder cancer in men compared to women, risk factors including smoking and occupational exposures, genetic factors, pathogenesis, WHO and other classification systems, clinical features of non-muscle invasive and muscle invasive bladder cancers, histopathology of benign lesions and different grades of bladder tumors.
Prostate diseases are common among aging men. Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate that leads to urinary symptoms. BPH prevalence increases with age, affecting 20% of men aged 41-50 and over 80% of men aged 81-90. Treatment options for BPH include lifestyle changes, watchful waiting, medical therapy with alpha blockers or 5-alpha-reductase inhibitors, and surgical procedures like TURP. Prostate cancer is the second most common cancer in men. Screening includes a PSA test and digital rectal exam. Treatment depends on cancer risk and may include active surveillance, surgery, radiation, or hormone therapy.
This document provides guidelines for the evaluation and management of hematuria from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the classification, timing, differential diagnosis, and evaluation of hematuria. The evaluation includes history, physical exam, urinalysis, urine culture if indicated, renal function testing, cystoscopy, and imaging such as CT urogram. The goal of evaluation is to identify any underlying causes of hematuria such as infection or malignancy. Close follow up is recommended depending on the diagnosis and persistence of microscopic hematuria.
This document outlines guidelines for evaluating male infertility from the Department of Urology at GRH and KMC in Chennai, India. It discusses definitions of infertility, incidence rates, classifications of primary and secondary infertility, and pretesticular, testicular, and posttesticular causes of male infertility. The document provides details on the clinical history, physical examination, and investigations involved in evaluating male infertility, including semen analysis, endocrine evaluation, imaging, and genetic testing. Semen analysis is described as the cornerstone initial evaluation to assess the status of the germ epithelium, epididymis, and accessory sex glands. Proper collection and examination techniques for semen analysis are outlined.
This document discusses the evaluation of hematuria from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It defines hematuria and describes its classification. Potential causes of hematuria are outlined, including urinary tract infections, kidney stones, trauma, exercise, and tumors. The evaluation of hematuria involves examination of the urine, including a dipstick test and microscopic analysis to characterize the red blood cells. Further tests may include imaging like ultrasound, CT, cystoscopy and renal biopsy to identify the source and cause of the bleeding. The document distinguishes between glomerular and non-glomerular causes based on urine characteristics.
This document discusses bladder outlet obstruction (BOO) and its causes such as benign prostatic hyperplasia (BPH). It describes the primary and long term effects of BOO on the bladder, including decreased urinary flow rates and increased voiding pressures. For BPH, it notes the causes include hyperplasia of the prostate gland that typically begins in the third decade. The document outlines the diagnosis, evaluation and treatment of BOO, including medical management with medications like alpha blockers and 5-alpha reductase inhibitors, as well as surgical treatments like transurethral resection of the prostate (TURP).
This document summarizes information about lichen sclerosus, a chronic skin condition that commonly affects the genital skin. It describes the signs and symptoms, risk factors like uncircumcision, pathophysiology involving fibrosis and hypoxia, association with autoimmune diseases and rare risk of squamous cell carcinoma. Histopathology shows epidermal atrophy, dermal fibrosis and lymphocytic infiltration. The document also discusses lichen sclerosus involvement of the urethra potentially leading to strictures, with the external urinary meatus involvement posing higher risk for progressive disease.
This document discusses sepsis and septic shock and provides guidelines for management. It defines sepsis as a systemic inflammatory response to infection and outlines the sepsis spectrum from sepsis to septic shock. It describes the typical host immune response and how an uncontrolled response can lead to systemic effects. Clinical presentation, diagnosis, bacteriology, and management including initial resuscitation, antimicrobial therapy and treatment duration are covered. Treatment aims to rapidly identify and treat the infection while stabilizing the patient and preventing further progression along the sepsis spectrum.
This document discusses the clinical features, prognostic factors, investigations and guidelines for diagnosis of renal cell carcinoma (RCC). It covers the typical presentations of RCC including incidental discovery, localized symptoms like flank pain, and symptoms of advanced disease. Investigations discussed include blood tests, CT, MRI, renal angiography and PET. Guidelines from AUA, EAU, NCCN and ESMO are summarized, emphasizing use of CT for diagnosis and staging, and recommending biopsy for small lesions before treatment.
The document discusses emphysematous pyelonephritis (EPN), a severe necrotizing infection of the renal parenchyma that causes gas accumulation. EPN most often occurs in persons with uncontrolled diabetes, especially women. It requires prompt diagnosis using CT scan and treatment with IV antibiotics and percutaneous drainage to drain abscesses. Factors like altered mental status, thrombocytopenia and elevated creatinine indicate higher risk cases that may require emergency nephrectomy. With aggressive treatment, reported mortality has improved but remains at 20-25%.
This document provides an overview of azoospermia, which is the complete absence of sperm in semen. It classifies azoospermia as either non-obstructive or obstructive, discusses various causes such as Klinefelter's syndrome and Kallmann syndrome, and outlines examination and treatment approaches including surgical sperm retrieval techniques and IVF with ICSI. Key causes, classifications, diagnostic tests, and management strategies for azoospermia are presented.
This document discusses emphysematous pyelonephritis (EPN), a rare necrotizing infection of the renal parenchyma that causes gas formation. It provides details on the typical presentation, risk factors, diagnosis and classification of EPN. The document is authored by professors and assistant professors from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It covers epidemiology, pathogenesis, clinical features, investigations including CT findings, classification systems for EPN, treatment approaches including antibiotics and percutaneous drainage, and outcomes.
Pediatric urology Management Of Antenatal HydroureteronephrosisGovtRoyapettahHospit
This document provides information from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the professors and assistant professors in the department and provides details on fetal development of the urinary tract, grading of antenatal hydronephrosis, causes and evaluation of pediatric hydronephrosis, investigation methods, and management approaches for various prenatal urinary tract abnormalities. Key points covered include risk stratification of urinary tract dilation, indications for fetal intervention, outcomes of fetal cystoscopy versus vesicoamniotic shunting, and guidelines for management of vesicoureteral reflux and megaureter/ureterovesical junction obstruction
This document discusses the pathogenesis of benign prostatic hyperplasia (BPH). It covers several key points:
1) BPH results from an increase in epithelial and stromal cells in the prostate transition zone due to proliferation and impaired programmed cell death. While androgens are important for normal prostate development, they are not direct mitogens for BPH growth.
2) Other contributing factors include stem cell dysfunction, growth factors, inflammation, and genetic/familial components. The prostate and bladder both adapt in response to outflow obstruction through changes like smooth muscle hypertrophy, increased extracellular matrix, and altered neural control.
3) While BPH causes lower urinary tract symptoms, the symptoms are
This document discusses male infertility, including its definition, causes, evaluation, and treatment options. It notes that male factors contribute to 40% of infertility cases. Causes can be pre-testicular, testicular, or post-testicular and include genetic conditions, infections, varicocele, hormonal imbalances, and blockages. Evaluation involves history, exam, semen analysis, genetic/radiographic tests. The goal is to identify reversible causes, plan ART for irreversible conditions, and detect issues affecting offspring health. Treatment depends on the underlying cause and may involve surgery, medication, or ART like IVF/ICSI.
This document provides information about benign prostatic hyperplasia (BPH) from the Department of Urology at Government Royapettah Hospital and Kilpauk Medical College in Chennai, India. It discusses the pathology, pathophysiology, symptoms, examinations, investigations, symptom scores, and treatment options for BPH, including watchful waiting, medical therapy using various drugs, and surgical procedures like transurethral resection of the prostate. It provides details on specific drugs, procedures, risks, and indications for different treatment approaches. The moderators and their specialties are listed at the beginning.
This document discusses the diagnosis and management of posterior urethral valves. It begins by defining PUV as a congenital obstructing membrane in the urethra that causes lower urinary tract obstruction. PUV is the most common cause of urinary outflow obstruction in pediatric patients and can lead to renal failure if not treated. The document then covers the pathophysiology, prenatal diagnosis, postnatal evaluation and various treatment approaches for PUV including endoscopic valve ablation, vesicostomy, and nephroureterectomy in severe cases.
This document provides an overview of chronic pancreatitis, including its pathophysiology, etiology, clinical features, diagnosis, and management. It discusses how chronic pancreatitis represents a continuous inflammatory and fibrosing process of the pancreas resulting in permanent dysfunction. The main causes are alcohol use and genetic factors. Patients present with abdominal pain in 95% of cases and can develop weight loss, steatorrhea, and diabetes. Diagnosis involves tests of pancreatic function and imaging tests looking for features like calcification. Treatment focuses on pain control, managing maldigestion with pancreatic enzyme replacement, and addressing complications like pseudocysts and stenosis.
This document provides information on erectile dysfunction (ED) from the Department of Urology at GRH and KMC in Chennai, India. It defines ED and discusses its epidemiology, risk factors, evaluation, and management. Regarding evaluation, it describes taking a medical history, questionnaires, physical exam, and potential tests to assess vascular, neurological, and psychogenic causes of ED. The management section focuses on lifestyle changes, medication adjustments, therapies, hormonal treatment, and pharmacological options like PDE5 inhibitors and intracavernosal injections.
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This document describes the renogram procedure. It provides details on:
- The radiopharmaceuticals used, including 99mTc-DTPA, 99mTc-MAG3, and 99mTc-DMSA
- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
- The roles of the radiopharmaceuticals in evaluating renal blood flow, glomerular filtration rate, and renal handling and excretion
- Factors that can affect the procedure such as hydration, medications, and kidney positioning
This document provides information about an X-ray KUB (kidneys, ureters, bladder) exam performed by the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the moderators and their qualifications. It then discusses the history of X-rays, how they are produced, standard views, and how to systematically read an X-ray KUB. It describes how to assess technical quality and what to look for, including renal calcifications which are most commonly due to kidney stones. It also discusses mimics of urinary calcifications like gallstones.
This document provides information about a KUB (kidney, ureter, bladder) x-ray performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides details on the history, physics, techniques, anatomical landmarks, disorders, and interpretations of renal calculi, ureter, bladder, and other findings that can be seen on a KUB x-ray.
This document describes a voiding cystourethrogram (VCUG) conducted by the Department of Urology at GRH and KMC in Chennai, India. It lists the professors and assistant professors moderating the VCUG. The document provides details on the indications, techniques, and pediatric applications of VCUGs, focusing on evaluating conditions like vesicoureteral reflux, posterior urethral valves, bladder diverticula, and ectopic ureters. It compares VCUG to nuclear cystography and voiding sonography as diagnostic tools.
This document provides information about ultrasound use in urology. It discusses the history of ultrasound in urology from 1963 onwards. It then covers basic ultrasound principles including modes, probes, imaging planes and documentation. Applications to the kidney, bladder, prostate and testes are described. Common abnormalities like hydronephrosis, cysts, masses and infections are outlined. In summary, the document is an overview of ultrasound techniques and their use in evaluating the urinary tract and common urologic conditions.
The document provides information about urodynamics testing performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the professors and assistant professors who moderate the tests. It then describes the purpose and components of urodynamics testing, which involves a series of tests to evaluate urine storage and evacuation. The key components reviewed include uroflowmetry, measurement of post-void residual urine, cystometrogram, pressure flow studies, and videourodynamics. The document provides details on performing each test and interpreting the results.
This document provides an overview of MRI in urology, with a focus on MRI of the prostate. It discusses the moderators and professors of the department of urology. It then covers the basic principles of MRI, including magnetic field strength, radiofrequency pulses, T1/T2 weighting, and contrast agents. Applications of MRI for prostate imaging and prostate cancer detection are described, including T2-weighted imaging, diffusion-weighted imaging, and magnetic resonance spectroscopy. The PIRADS scoring system and assessment of extracapsular extension on MRI are also summarized.
This document provides information about intravenous urography (IVU), including its definition, history, indications, contraindications, technique, phases, and what is evaluated. Some key points:
- IVU involves injecting iodine contrast intravenously and taking x-ray images as it passes through the kidneys, ureters, and bladder. It was introduced in 1929 by American urologist Moses Swick.
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- The technique involves injecting contrast as a rapid bolus,
This patient presented with anterior urethral stricture and multiple abnormal connections (fistulas) between the prostate gland/urethra and the skin, resulting in urine leakage to the skin. Treatment will require surgical repair of the strictures and closure of all abnormal connections to restore normal urinary flow and continence.
This document provides information about intravenous urography (IVU), including:
- IVU involves injecting contrast media intravenously and imaging the kidneys, ureters, and bladder.
- It has indications like evaluating suspected obstruction, assessing integrity after trauma, and investigating hematuria or infection.
- Contraindications include contrast allergy and renal failure. Advantages include clearly outlining the urinary system, while disadvantages include need for contrast and radiation exposure.
- The document describes the IVU technique, expected timing of images, and what should be evaluated on the images.
- It also covers normal anatomy, types of contrast media, and abnormal findings that could be
This document discusses urinary extravasation, which is when urine leaks out of the urinary tract into other body cavities. It defines two types - superficial and deep extravasation. Superficial extravasation occurs above the perineal membrane and is usually caused by injuries to the penile urethra during instrumentation. Deep extravasation occurs below the perineal membrane due to injuries of the membranous urethra or extraperitoneal bladder from pelvic trauma. Management involves pain relief, antibiotics, suprapubic catheterization, and sometimes surgical exploration and drainage of collections.
This document provides information about urodynamic evaluation of voiding dysfunction. It discusses the history of urodynamics, aims, equipment used including catheters, flowmeters and EMG equipment. It describes how to conduct urodynamic evaluations including uroflowmetry, cystometrogram, and considerations for filling rate and medium. Key points covered are the indications for urodynamics, preparation of patients, types of equipment and how to interpret uroflow curves and cystometrogram measurements.
This document provides information about various tumor markers used in urology, including prostate-specific antigen (PSA) markers for prostate cancer screening and diagnosis, tumor markers for testicular cancer such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), and urine-based markers for bladder cancer screening like NMP22 and BTA. It also discusses guidelines for PSA screening and interpretation, as well as clinical applications of different tumor markers for diagnosis, prognosis, monitoring treatment response, and detecting recurrence of urological cancers.
This document discusses transitional urology, which involves the planned movement of adolescents and young adults with chronic urological conditions from pediatric to adult-centered care. It provides an overview of common urological conditions seen in transitional urology, including spina bifida, bladder exstrophy, hypospadias, posterior urethral valves, vesicoureteral reflux, and pediatric genitourinary cancers. It also discusses specific issues in transitional urology like urinary tract infections in neurogenic/reconstructed bladders, troubleshooting continent catheterizable channels, risks of malignancy with augmentation cystoplasty, and presentation of BPH and pelvic organ prolapse in patients with neurogenic
This document provides information about retroperitoneal fibrosis (RPF), including its pathogenesis, clinical presentations, investigations, and management. RPF is characterized by extensive fibrosis in the retroperitoneum that can encase the aorta, vena cava, and ureters. Patients typically present with nonspecific symptoms like back pain, but late presentations can include urinary obstruction and vascular complications. Diagnosis is often made using CT or MRI imaging showing soft tissue surrounding retroperitoneal structures. Treatment involves medications like corticosteroids to reduce inflammation or surgical procedures to decompress the urinary system if obstructed.
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This document describes uroflowmetry - a noninvasive test used to evaluate urine flow. It discusses the normal and abnormal flow patterns seen in uroflowmetry and their clinical significance. Uroflowmetry provides parameters like maximum flow rate, average flow rate and voided volume. It can detect bladder outlet obstruction, detrusor underactivity or overactivity. However, pressure-flow studies are needed to precisely define lower urinary tract function. Uroflowmetry is useful for screening and monitoring treatment response, though invasive therapy should not be based on uroflowmetry alone per AUA guidelines.
Pathophysiology of pneumoperitoneum and complications of laproscopic surgeryGovtRoyapettahHospit
This document provides information about the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the professors and assistant professors in the department and provides an introduction to laparoscopy. The rest of the document discusses the history of laparoscopy, choices of insufflation gas, physiological effects of pneumoperitoneum, and potential complications of laparoscopy procedures. It provides details on cardiovascular, respiratory, renal, and other organ system effects of increased abdominal pressure during laparoscopy. The document also outlines potential complications from veress needle placement, trocar insertion, insufflation, and electrosurgery and their management.
This document discusses the history and types of endoscopes used in urology. It describes rigid endoscopes which use a series of lenses to transmit images and how the rod lens system improved image quality. Flexible endoscopes transmit images using fiber optic bundles and have the advantage of being able to flex and access different areas. Newer digital endoscopes replace lenses with CCD chips to provide superior quality images electronically. The document outlines the benefits of different endoscope technologies and future trends including 3D imaging and wireless capabilities.
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1. TREATMENT CATEGORIES OF
MALE INFERTILITY
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai
1
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2
3. Distribution of Etiology of Male
Infertility
• Varicocele
• Idiopathic
• Obstruction
• Female factor
• Cryptorchidism
• Immunologic
• Ejaculatory dysfunction
• Testicular failure
• Drug/radiation
• Endocrinopathy
• Others - <1%
3
Dept of Urology, GRH and KMC, Chennai.
4. Varicocele
• Abnormal dilation and tortuosity of the internal
spermatic veins within the pampiniform plexus of
the spermatic cord.
• Incidence -
15% --- general population,
35% -- men with primary infertility
75% to 81% - men with secondary infertility.
4
Dept of Urology, GRH and KMC, Chennai.
5. Etiology
• Anatomic variance
• Increased pressure in the left renal vein
• Incompetent or congenitally absent valves
5
Dept of Urology, GRH and KMC, Chennai.
6. • Varicocele -
more common in left testicle than right
Because of several anatomic factors
- right angle at which left testicular vein enters left
renal vein
- Long left testicular vein (8 - 10 cm)
- lack of effective antireflux valves at juncture of
testicular vein and renal vein
- increased renal vein pressure due to its
compression between the superior mesenteric artery and
the aorta
Nutcracker PHENOMENON
6
Dept of Urology, GRH and KMC, Chennai.
7. • Secondary varicocele - due to compression of
the venous drainage of the testicle.
• Pelvic or abdominal malignancy suspects -
when a right-sided varicocele is newly diagnosed
in a patient older than 40 years of age
• Most common cause - Renal cell carcinoma
Others -- retroperitoneal fibrosis or adhesions.
7
Dept of Urology, GRH and KMC, Chennai.
8. Pathologic effects of varicocele
• Abnormal spermatogenesis, and infertility
Semen analysis shows
- Decreased motility,
- Decreased sperm density
- Increased number of pathologic sperm
forms
8
Dept of Urology, GRH and KMC, Chennai.
9. • Histologic studies shows
- Leydig cell hyperplasia,
- Decreased number of spermatogonia per
tubule
- Decreased spermatogenesis and
maturation arrest,
- Sloughing of germinal epithelium
interstitial fibrosis
9
Dept of Urology, GRH and KMC, Chennai.
10. Mechanism of varicocele-induced
IMPAIRMENT OF SPERMATOGENESIS
• Lead theory postulates - that testicular
cellular processes are temperature
dependent.
• Venous pooling from a varicocele produces
- Elevated intrascrotal temperature
resulting in reductions in testosterone
- Injury to germinal cell membranes,
- Altered protein metabolism, and
reduced Sertoli cell function
10
Dept of Urology, GRH and KMC, Chennai.
11. • Free reflux of renal and adrenal metabolites
from the left renal vein - directly
gonadotoxic.
• Spermatic cord blood catecholamine and
prostaglandin levels - appear elevated in
varicocele
11
Dept of Urology, GRH and KMC, Chennai.
12. • Other proposed mechanisms for
Varicocele induced subfertility
Include impaired venous drainage
with results - hypoxia
Poor clearance of gonadotoxins
Elevated levels of oxidative stress.
• Mechanism of varicocele damage -
Multifactorial
12
Dept of Urology, GRH and KMC, Chennai.
13. Indications
• Current guidelines in 2008 by the Best Practice
Committee of American Society for
Reproductive Medicine
• Recommend treatment of a varicocele in the
infertile patient
Varicocele - palpable on physical examination
Couple has known infertility
13
Dept of Urology, GRH and KMC, Chennai.
14. Female partner has normal fertility or a
potentially treatable cause of infertility;
Male partner has abnormal semen
parameters or abnormal results from sperm
function tests
• Sense of heaviness or hemiscrotal discomfort
• Clinical varicoceles with testicular
hypotrophy
14
Dept of Urology, GRH and KMC, Chennai.
15. • Patients with subclinical varicoceles are
not candidates - varicocele treatment
Prophylactic surgery - not advisable
15
Dept of Urology, GRH and KMC, Chennai.
16. OUTCOMES
• Significant improvement
Semen analysis - 60% to 80% of men.
Mean increases in sperm density - 9.7million/mL
Motility increases - 9.9%
Sperm morphology improvement - 3%
Semen quality - improve in 51% to 78%
16
Dept of Urology, GRH and KMC, Chennai.
17. • Spontaneous pregnancy rates after varicocele
treatment have reported - between 30% and
50%
• Microsurgical varicocelectomy results -return
of sperm ejaculate - up to 60% of
azoospermic men with palpable varicoceles
• Repair of bilateral varicoceles - increased
benefit over unilateral varicoceles
17
Dept of Urology, GRH and KMC, Chennai.
18. • Repair of large varicoceles results in - greater
improvement semen quality than repair of
small varicoceles
• Infertile men with low serum testosterone
levels, microsurgical varicocelectomy results
substantial improvement in serum
testosterone levels
18
Dept of Urology, GRH and KMC, Chennai.
19. Cryptorchidism
• Relatively common condition -2.7% -newborns
0.8% -1 year
• Well -known etiology for subfertility
• Associated with reduced testicular size and
sperm concentration
• Reductions in serum inhibin
Elevations in serum FSH levels
19
Dept of Urology, GRH and KMC, Chennai.
20. • Reductions in semen quality
• Suggested mechanisms for cryptorchidism-
induced subfertility
Testicular dysgenesis
Impaired endocrine axis
Immunologic damage
Obstruction
20
Dept of Urology, GRH and KMC, Chennai.
21. • Studies shows significant detrimental effects
on semen parameters with even unilateral
cryptorchidism
• Studies suggested that orchiopexy younger
than 4 years of age - associated with
improved fertility outcomes
21
Dept of Urology, GRH and KMC, Chennai.
22. Endocrinopathies
• Occur at hypothalamic, pituitary, or gonadal levels.
• Primary hypogonadism (primary testicular failure)
Hypergonadotrophic hypogonadism
- defined as low serum testosterone and elevated
gonadotropin level consistent with organ function
failure at the level of the testes.
• Secondary hypogonadism (hypogonadotropic
hypogonadism)
low testosterone levels in conjunction
low gonadotropin levels
22
Dept of Urology, GRH and KMC, Chennai.
23. Hypogonadotropic Hypogonadism
• Relatively rare cause of subfertility <1%
• May be congenital or acquired
Acquired Causes of Hypogonadotropic Hypogonadism
• Central nervous system (CNS)
CNS developmental abnormalities
Head trauma
Pituitary tumors
• Autoimmune disease
• Parasitic diseases
• Crohn disease
• Beta-thalassemia/hemoglobinopathy
• Hemochromatosis
• Disorders of lipid metabolism 23
Dept of Urology, GRH and KMC, Chennai.
24. Congenital Hypogonadotropic
Hypogonadism
• Congenital idiopathic hypogonadism
Anosmic (Kallman syndrome)
Nonanosmic
• Congenital adrenal hypoplasia
• Fertile eunuch syndrome
• Genetic defects of the gonadotropin subunits
Follicle-stimulating hormone–β mutations
Luteinizing hormone–β mutations
Mutations in leptin and leptin receptor genes
• Syndromes associated with hypogonadotropic hypogonadism
Prader-Willi syndrome
Congenital spherocytosis
Moebius syndrome
Cerebellar ataxia
Retinitis pigmentosa
24
Dept of Urology, GRH and KMC, Chennai.
25. Androgen Excess
• Excess systemic levels of androgen paradoxically
inhibit spermatogenesis
• Due to direct feedback inhibition of
gonadotropin secretion at the level of the
hypothalamus and pituitary.
• Results in low intratesticular levels of
testosterone, inadequate for the maintenance of
spermatogenesis
25
Dept of Urology, GRH and KMC, Chennai.
26. • Excess states may result from either endogenous
production or exogenous administration of androgens
• Congenital adrenal hyperplasia (CAH) most common
endogenous etiology of androgen excess
specific enzyme defects in cortisol and aldosterone
synthesis.
Inadequate systemic cortisol levels result in excessive
pituitary release of ACTH leading to hyperstimulation
of the adrenal gland
subsequent release of adrenal androgens and
suppression of pituitary gonadotropin release.
26
Dept of Urology, GRH and KMC, Chennai.
27. • Deficiency in the 21-hydroxylase enzyme
accounts - 90% of cases of CAH
• Present neonatal period with salt wasting, milder
deficiencies with phallic enlargement, precocious
puberty, and advanced skeletal maturation
• Elevated levels of serum 17-
hydroxyprogesterone and urinary pregnanetriol
- diagnosis of 21-hydroxylase deficiency
• Treatment – glucocorticoid replacement, reduces
ACTH levels and adrenal androgen production
27
Dept of Urology, GRH and KMC, Chennai.
28. Hyperprolactinemia
• Hyperprolactinemia - associated with medications,
physiologic stress, and pituitary tumors
• Elevated prolactin levels – confirmed
(>18 ng/dL),
• Anatomic imaging of the sella turcica - required,
usually with magnetic resonance imaging with
gadolinium contrast.
• Macroadenomas - require surgical excision,
Microadenomas - usually responsive to dopamine
agonist therapy with bromocriptine or cabergoline.
28
Dept of Urology, GRH and KMC, Chennai.
29. Disorders of Internal Ductal
Development
• Congenital Bilateral Absence of the Vas
Deferens
- Mildest presentation of cystic fibrosis
transmembrane conductance regulator (CFTR)
dysfunction
- One CF allele - mutated, patient present
with CBAVD without the pulmonary and
pancreatic manifestations
29
Dept of Urology, GRH and KMC, Chennai.
30. Congenital Bilateral Absence of the
Vas Deferens
• 6% cases of obstructive azoospermia
• Associated anomalies - prominent caput with
absence of the distal two thirds of the
epididymis, atrophy, or hypoplasia of the
seminal vesicles.
• Absence of seminal vesicle contributions
- ejaculate will be azoospermic with
- low volume (typically <0.5 mL)
- acidic pH (6.5) unbuffered scant prostatic
secretions
30
Dept of Urology, GRH and KMC, Chennai.
31. • TRUS - confirm the seminal vesicle anomalies
• Diagnosis of CBAVD - basis of clinical and
semen findings
• Spermatogenesis - usually normal,
• TREATMENT
- Sperm retrieval techniques via a
percutaneous or open surgical route from
either the caput epididymis or testis
31
Dept of Urology, GRH and KMC, Chennai.
32. Ultrastructural Sperm Anomalies
• Primary Ciliary Dyskinesia.
immotile cilia syndrome
- encompasses a spectrum disorders
involving ultrastructural abnormalities of the
flagellum affecting all ciliated cells including
the lining of the respiratory and sinus tracts,
as well as sperm motility.
32
Dept of Urology, GRH and KMC, Chennai.
33. • Electron microscopy demonstrated
abnormalities in PCD - absence of outer and
inner dynein arms, radial spokes, and central
doublet.
• Affected patients - rarely present with
infertility, initially present in childhood with
chronic bronchiectasis and sinusitis
33
Dept of Urology, GRH and KMC, Chennai.
34. • Kartagener syndrome - variant of PCD with
chronic sinusitis and bronchiectasis, situs
inversus, and infertility manifested by low or
absent sperm motility
• No cure for the ultrastructural defects,
• Sperm have been used successfully for ICSI
with resulting normal births
• Genetic counseling - highly recommended
before pursuing ICSI
34
Dept of Urology, GRH and KMC, Chennai.
35. Globozoospermia
• Round headed sperm syndrome
• 0.1% of infertile males
• Sperm concentration and motility – normal,
spermatozoa have a characteristic circular head
due to the absence of the acrosomal cap and
enzyme package including acrosin
• This deficiency prevents the sperm from
penetrating the zona pellucida and outer
investment of the oocyte and from obtaining
fertilization.
• ICSI - Treatment
35
Dept of Urology, GRH and KMC, Chennai.
37. Functional Ejaculatory Dysfunction
• Include premature and delayed ejaculation.
• Premature ejaculation - common form of male
sexual dysfunction,
• Occurs in more than 30% of men between ages
18 and 60
• Cause significant emotional distress in couples
• If ejaculation- consistently occurring before
intromission, semen may be collected by the
couple and used for intravaginal insemination
37
Dept of Urology, GRH and KMC, Chennai.
38. • Delayed ejaculation - defined as persistent
difficulty or inability to ejaculate despite the
presence of sexual desire and erection
• Believed to be psychogenic issue
• Benefit from sex therapy or vibratory
stimulation , electroejaculation or surgical
sperm retrieval
38
Dept of Urology, GRH and KMC, Chennai.
39. Neurogenic Anejaculation
• Usually the result of a spinal cord injury
• Also have erectile dysfunction and deficiencies
in spermatogenesis, & stasis of spermatozoa
• Most require penile vibratory stimulation
(PVS), electroejaculation (EEJ)
• Surgical sperm retrieval via either
percutaneous or open biopsy of the
epididymis or testis - remains an effective
option for management
39
Dept of Urology, GRH and KMC, Chennai.
40. Retrograde Ejaculation
• Occurs when seminal fluid preferentially flows into
the bladder, instead of the normal antegrade direction
due to failure of the bladder neck to close
Causes
• Incompetence of the bladder neck from prior surgery
such as transurethral resection of the prostate gland,
• Medications such as α blockers and antidepressants,
• Neurologic pathology such as diabetes and multiple
sclerosis.
Diagnosis - confirmed by identification of
10 to 15 sperm per HPF in a centrifuged specimen of
postejaculation urine
40
Dept of Urology, GRH and KMC, Chennai.
41. Treatment
• Reversible etiologies such as medications should be
removed
• Trial of sympathomimetic medication therapy useful
in increasing sympathetic tone of the bladder neck and
vas deferens
Phenylpropanolamine Ephedrine
Pseudoephedrine Imipramine
• Who do not respond to medical therapy - sperm
recovered from the bladder for use in intrauterine
insemination
41
Dept of Urology, GRH and KMC, Chennai.
42. Immunologic Infertility
• Antisperm antibodies (ASA) results from a
variety of conditions cause disruption of the
blood-testis immune barrier, results in exposure
of sperm antigens to the systemic immune
system
• Elevated levels of ASA - associated with gonadal
trauma, testicular torsion, cryptorchidism,
varicocele, genital infections, and prior testicular
biopsy
• Prior vasectomy - leading cause of clinically
significant immunologic infertility
vasectomized men - 34% to 74%
42
Dept of Urology, GRH and KMC, Chennai.
43. • Effects of ASA -
Impaired sperm motility,
Reduced binding & penetration of the zona
pellucida,
Inhibition of the acrosome reaction, and
Reduced sperm survival in the female
reproductive tract.
43
Dept of Urology, GRH and KMC, Chennai.
44. • Current treatment strategies
Immunosuppression using corticosteroid
therapy
Assisted reproduction
IUI & Intracytoplasmic sperm injection -
an effective treatment for ASA -mediated
infertility
44
Dept of Urology, GRH and KMC, Chennai.
45. Idiopathic Infertility
• > 30% of patients - still have no discernible
cause for abnormal semen analysis
• At present they are considered idiopathic
disorders
• In absence of other causes, therapy involves
employment of empiric medical therapy or
assisted reproductive techniques
45
Dept of Urology, GRH and KMC, Chennai.
47. Gonadotropin-Releasing Hormone Agonists
• Effective for treatment of hypogonadotropic
hypogonadism
• Stimulation of FSH elevation may be
beneficial even in the absence of known
deficiency
47
Dept of Urology, GRH and KMC, Chennai.
48. Antiestrogens
• Most commonly employed medical therapy for
idiopathic male infertility.
• Clomiphene citrate and tamoxifen citrate -
nonsteroidal selective estrogen receptor
modulators.
By blocking the estrogen receptors at the
hypothalamus and pituitary levels,minimizes the
estrogenic-mediated inhibition of gonadotropin
release, results in - elevation of gonadotropin
levels.
48
Dept of Urology, GRH and KMC, Chennai.
49. • More recent study shows combination
therapy with tamoxifen (20 mg/day) and
testosterone replacement (120 mg/day) for
patients with idiopathic oligoteratospermia -
noting improvements in semen parameters
and pregnancy rates
49
Dept of Urology, GRH and KMC, Chennai.
50. Aromatase Inhibitors
• Suppress the activity of aromatase, a
cytochrome P-450 enzyme concentrated in
the testes, liver, brain, and adipose tissue.
• Aromatase - responsible for the conversion
of testosterone to estradiol, so blockade
produces functional effects similar to the
antiestrogen class of medications
50
Dept of Urology, GRH and KMC, Chennai.
51. • Testolactone and anastrozole - two main
agents used for the treatment of idiopathic
infertility.
• Study shows noted improvement in semen
parameters in men with severe idiopathic
oligospermia
51
Dept of Urology, GRH and KMC, Chennai.
52. Antioxidant Therapy
• Antioxidant supplementation - common form
of empiric therapy.
• Antioxidant vitamins
α-tocopherol(vitamin E), ascorbic acid(vitaminC)
retinoids (vitamin A), L-carnitine,
amino acid - important for mitochondrial
metabolism, shows therapeutic benefit for
male subfertility
52
Dept of Urology, GRH and KMC, Chennai.
53. • Various studies shows - antioxidant vitamin
supplementation L-carnitine have shown
improvement
semen parameter and pregnancy rate results
53
Dept of Urology, GRH and KMC, Chennai.
55. Anatomy
• Testicular veins form highly anastomotic
channels that surround the testicular artery
forms pampiniform plexus.
• Arrangement allows countercurrent heat
exchange, which cools the blood in the testicular
artery.
• Testicular veins may anastomose with the
external pudendal, cremasteric, and vasal veins
55
Dept of Urology, GRH and KMC, Chennai.
56. • At the level of the
inguinal canal, veins join
to form two or three
channels
• Then a single vein that
drains into
Right - Inferior vena cava
Left - Renal vein
56
Dept of Urology, GRH and KMC, Chennai.
57. • Examined in a warm room -standing and supine
positions, with and without a Valsalva
maneuver.
• Grade I - detectable only during the
Valsalva maneuver
• Grade II - can be palpated without Valsalva
• Grade III - visible through the scrotal skin
classically described as feeling like a “bag
of worms”
57
Dept of Urology, GRH and KMC, Chennai.
58. Physical examination - Testis
• Assess - testicular consistency & volume.
• Simultaneous comparison of both testes
• Several methods are available to measure the
size of testis
- visual comparison
- calipers like Prader orchidometer
Takahi orchidometer
- Ultrasound.
58
Dept of Urology, GRH and KMC, Chennai.