Pathology of Male Reproductive System

Pathology of Male Reproductive System

• Common male reproductive organs affected by pathology: prostate, testis, and other accessory organs

Prostate Gland Disease

• Associated with urinary problems in men > 60 years old
• Causes of urinary problems: prostatitis, BPH, and prostatic carcinoma

Prostatitis

• Inflammation of the prostate
• Types:
  • Acute suppurative prostatitis: caused by coliforms, Staphylococcus, or Neisseria gonorrhoeae
  • Chronic non-specific prostatitis
  • Granulomatous prostatitis: idiopathic, tuberculous, or following transurethral resection/allergic
• Symptoms: enlarged prostate, pain during urination, and common symptoms of prostate disease

Benign Prostatic Hyperplasia (BPH)

• Non-neoplastic enlargement of the prostate
• Aetiology:
  • Hormonal imbalance: androgen decline, estrogen increase
  • DHT (dihydrotestosterone) and AR receptor
• Gross:
  • Solid nodules and cysts with yellowish necrotic areas and haemorrhagic margin
  • Nodules composed of hyperplastic glandular tissue and stromal muscle
• Histology:
  • Hyperplastic glandular tissue and stromal muscle
  • Larger glands with tall epithelium lining and papillary projections
• Clinical features:
  • Early stage: few symptoms, bladder muscles strong enough to push urine through a narrowing urethra
  • Late stage: symptoms of urine flow, weak stream, leakage after urination, unable to empty the bladder, nocturia
• Diagnosis:
  • Digital rectal examination
  • Urinalysis and urine culture
  • Prostate-specific antigen (PSA) test
• Complications:
  • Urine retention leading to recurrent urinary tract infections
  • Bladder stones and hydronephrosis
  • Gradual bladder and/or kidney damage
• Treatment:
  • Transurethral Resection of the Prostate (TURP)

Carcinoma of Prostate

• Common malignant disease in men, 2nd leading cause of male deaths
• Rare in men < 50 years old, peak incidence at 60-85 years old
• Aetiology:
  • Unknown
  • Associated with environmental factors and hormonal influences
• Pathology:
  • Gross: hard, irregular, and ill-defined gray area
  • Histology: adenocarcinomas in the glandular epithelium
• Clinical features:
  • Urinary symptoms similar to BPH but more severe
  • Hard, craggy prostate on rectal examination
  • Bone metastases, pain, pathological fracture, and anaemia
  • Lymph node metastasis
• Diagnosis:
  • Diagnostic imaging: ultrasound, skeletal X-rays, isotope bone scan
  • Cytoscopy: transurethral resection
  • Chemical pathology: serum acid and alkaline phosphatase, PSA
  • Haematology: leukoerythroblastic anaemia
  • Biopsy: transurethral resection, needle biopsy, fine-needle aspiration cytology
• Clinical Management:
  • Gonadorelin (GnRH)
  • Orchidectomy - Cyproterone (anti-androgenic effects - DHT action)
  • Radiotherapy

Testicular Lesions

• Non-neoplastic disorders:
  • Hydrocele: accumulation of fluid around the testis
  • Incidence increasing worldwide

Developmental and Cystic Lesions

• 1. Undescended testis (cryptorchidism)
• 2. Hydrocele: accumulation of serous fluid within the tunica vaginalis of the testis
• 3. Haematocele
• 4. Testicular Torsion

Orchitis

• Inflammatory condition of one or both testis
• Causes: viral or bacterial infection
• Symptoms:
  • Rapid onset of pain and swelling
  • Fever and chills
  • Nausea and malaise
  • Headache and body aches
  • Pain with urination
• Epididymo-orchitis: symptoms may come on and progress more gradually
• Diagnosis:
  • History and physical exam
  • Ultrasound
  • Rectal examination
  • Sample of discharge
  • FBC
  • Urinalysis

Testicular Tumor

• Uncommon
• Occurs in young men
• Aetiology:
  • Undescended testis
  • Other factors