Disorders of the Male Reproductive Tract PDF

DISORDERS OF THE MALE REPRODUCTIVE TRACT Block III / 2ND Semester Author: Miguel Alejandro Dávalos Benítez, MD OBJECTIVES CONGENITAL ANOMALIES OF THE MALE REPRODUCTIVE TRACT & INFLAMMATORY DISORDERS OF THE TESTES. A. Recall the embryology and hormones inducing changes on the testes B. Enlist and und...

DISORDERS OF THE MALE REPRODUCTIVE TRACT Block III / 2ND Semester Author: Miguel Alejandro Dávalos Benítez, MD OBJECTIVES CONGENITAL ANOMALIES OF THE MALE REPRODUCTIVE TRACT & INFLAMMATORY DISORDERS OF THE TESTES. A. Recall the embryology and hormones inducing changes on the testes B. Enlist and understand the most common congenital anomalies of the male genitalia tract, its clinical features, diagnosis and prognosis Cryptorchidism. Hypospadias and epispadias Phimosis. C. Enlist and identify the most common inflammatory diseases of the male genital tract, emphasizing its clinical manifestations. Epididymitis. Testicular Torsion Embriology The development of the reproductive system includes the gonads, the genital ducts, the external genitalia, and the gonads descent. 1. Gonads develop through an indifferent stage before differentiating into the testes and the ovaries. 2. The sexual differentiation of the genital ducts is dependent on the presence or absence of testosterone and AntiMüllerian Hormone, which both influence the outcome of the mesonephric ducts and the paramesonephric ducts. 4. The sexual differentiation of the external genitalia is also dependent on hormonal secretions or lack of. 5. The descent of the gonads is mainly directed by the shortening of the gubernaculum. PENIS PENIS MALFORMATIONS The most common malformations of the penis are those in which the distal urethral orifice is abnormally located: Hypospadias: Urethral opening is found on the ventral aspect of the penis anywhere along the shaft. Occurs in 1 in 300 live male births and may be associated with other congenital anomalies. Epispadias: The abnormal urethral orifice is on the dorsal aspect of the penis. PENIS MALFORMATIONS These urethral defects may have clinical significance because the abnormal opening is often constricted, resulting in urinary tract obstruction and an increased risk of ascending infections. INFLAMMATORY PENIS LESIONS PHIMOSIS is a condition in which the prepuce cannot be retracted easily over the glans penis → favoring the development of secondary infections and increasing the risk for penile carcinoma. BALANITIS and balanoposthitis refer to local inflammation of the glans penis and of the overlying prepuce. Among the more common agents are Candida albicans, anaerobic bacteria, Gardnerella, and pyogenic bacteria. INFLAMMATORY PENIS LESIONS BALANITIS BALANOPOSTHITIS PHIMOSIS TESTIS & EPIDIDYMIS CRYPTORCHIDISM Cryptorchidism is A FAILURE OF TESTICULAR DESCENT into the scrotum. The most common site of arrest is in the inguinal canal (90%). Affects 1% of 1-year-old boys. Is Asymptomatic and comes to attention when the Scrotal Sac is discovered to be empty. Undescended testes become Atrophic → if is Bilateral = Sterility. CRYPTORCHIDISM Cryptorchidism also is associated with 3- to 5-fold increased risk for testicular cancer. Surgical placement of the undescended testis into the scrotum (Orchiopexy) is recommended by 6-12 months of age to decrease the likelihood of testicular atrophy, infertility, and testicular cancer. GERM CELL NEOPLASIA IN-SITU may be present in cryptorchid testes and is a likely precursor of subsequent GERM CELL TUMORS. INFLAMMATION OF THE TESTIS MORE COMMON IN THE EPIDIDYMIS CAUSES: Nonspecific epididymitis and orchitis: Primary urinary tract infection that spreads to the testis. Testis swollen and tender, histologic with numerous Neutrophils. AGE: Childhood: gram-negative rods. 35: E. coli and pseudomonas. INFLAMMATION OF THE TESTIS CAUSES: GRANULOMATOUS (AUTOIMMUNE) ORCHITIS: Moderately tender testicular mass of sudden onset: (MIMICKING A TESTICULAR TUMOR) Associated with Fever. Middle Age. Gonorrhea: Extension of infection from the posterior urethra to the prostate, seminal vesicles, and then to the epididymis. The infection may also spread to the testis and produce: SUPPURATIVE ORCHITIS. INFLAMMATION OF THE TESTIS CAUSES: MUMPS: School-aged children → uncommon. Post-Pubertal → 20% to 30% of cases. Develops 1 week after the onset of swelling of the parotid glands. TUBERCULOSIS: Almost invariably begins in the Epididymis -> Testis. Granulomatous Inflammation characteristic of tuberculosis elsewhere. INFLAMMATION OF THE TESTIS Causes: Syphilis: Almost invariably the Testis is involved first. Morphologic Pattern: 1. Obliterative endarteritis. 2. Granulomatous inflammation. TESTICULAR TORSION Torsion of the Spermatic Cord with Secondary Obstruction of testicular venous drainage while this leads to intense Vascular Engorgement and Infarction. The thick-walled arteries remain patent. 2 Types: Neonatal torsion (utero / shortly after birth). Adult torsion (adolescence) - Bell Clapper Abnormality. If the testis is explored surgically and the cord is manually untwisted within approximately 6 hours, the testis will likely remain viable. TORSION OF TESTIS DIAGNOSIS OF TESTICULAR TORSION https://youtu.be/01zce5o-D58 BELL CLAPPER ABNORMALITY BIBLIOGRAPHY Kumar, V., Abbas, A. K., & Aster, J. C. (2020). Robbins and Cotran Pathologic Basis of Disease (10th Edition.). Philadelphia, PA: Elsevier/Saunders, pages 963-983.