Male Reproductive System.pdf

Male External Genitalia Scrotum: skin bag that covers the testes Testes: paired organs where germinal cells arise 2 types of cells: Leydig cells and Sertoli cells Leydig: production of testosterone Sertoli: in charge of spermatogenesis When FSH and LH levels are elevated: Male patte...

Male External Genitalia Scrotum: skin bag that covers the testes Testes: paired organs where germinal cells arise 2 types of cells: Leydig cells and Sertoli cells Leydig: production of testosterone Sertoli: in charge of spermatogenesis When FSH and LH levels are elevated: Male pattern of development (before birth) Enlargement of male sex organs and expression of male secondary sex characteristics (starting at puberty)  Anabolism (protein synthesis) Spermatogenesis Semen: Mixture of sperm and seminal fluid being 2.5-5 ml in each ejaculation Typical (“normal”) sperm count: 50-150 million/ml Infertile: count below 20 million/ml Vasectomy (cuts ves deferens) Penis Erection: occurs due to parasympathetic effects on penile vasculature Ejaculation: occurs through sympathetic reflex ○ Vasoconstriction = ejaculation Circumcision Surgical removal of part of prepuce (foreskin) The accumulation of fluid in the folds of skin if not circumcised (important to clean thoroughly at the head) Cryptorchidism Condition in which there is undescended testes Incidence ○ 3% full term babies ○ 30% premature ○ In 80% of the cases testes descend spontaneously during 1st year of life Implications ○ 30-50 X higher incidence for testicular cancer Puberty Gonadotropin secretion is high in newborns but decreases abruptly a few week after delivery. Secretion remains low until the beginning of puberty marked by raising levels of FSH followed by LH Inflammatory lesions Balanitis ○ Local inflammation of glans surrounding the penis head ○ Occurs in uncircumcised males in which smegma (cottage cheese material) accumulates acting as a local irritant Aggregates bacteria (secretion and redness) or fungal (wet areas and itchiness) ○ May lead into phimosis (completely closed) and paraphimosis (can retract but get too tight to go back) Carcinoma penis ○ Squamous cell carcinoma 95% Slow-growing cancer Lesion that has failed to heal Induration in the skin, a small excrescence, a papule, a pustule, a warty growth, or a reddened area A shallow erosion or a deep ulceration with rolled edges The HPV subtypes 16 and 18 is usually present in the lesions Testicular tumors Most important cause of painless mass of the testis Peak age is between 15-34 y/o 95% arise from germinal cells and are malignant  History of cryptorchidism is present in 10% of cases More common in white population History of trauma Seminoma ○ Account for 50% of primary malignant tumor of the testes ○ The lesions is firm and painless and of germ cells origin ○ Undescended testicles increase risk X 10-40 times ○ Most common testicular tumors are mixed in type (60%) Teratoma Embryonal cell carcinoma Yolk sack tumors Human chorionic gonadotropin (HCG or hCG) Alpha-fetoprotein (AFP) is a tumor marker Both are elevated during emb. Development and should not be elevated in adulthood Prostatitis Acute ○ Usually accompanied by PMN’s inflammatory infiltrate due to ascending infections of urinary tract by gram (-) as E.coli Chronic ○ Usually accompanied by lymphocytic inflammatory infiltrate due to low virulent bacteria ○ Bacteriological studies are usually negative Causes: ○ Bacterial infection ○ Due to blockage of flow ○ STD’s- chlamydia, gonorrhea ○ Nerves or muscle problems in pelvic area Symptoms: ○ Increase frequency in urination ○ Hematuria ○ Nausea or vomiting ○ Fever and chills ○ Pain in abdomen or lower back Treatment: ○ Antibiotics- Ceftriaxone IV (severe), Ciprofloxacin, Levofloxacin, TMP/SMX PO ○ Pelvic and bladder muscle relaxants- Tamsulosin (Flomax)- improve urine flow Benign Prostatic Hypertrophy Common condition affecting more than 90% of elder population Commonly associated with frequency and urinary retention Not a malignant lesion Composition: accumulation of fibrous tissue with hyperplasia of lining epithelium ○  ○ Treatment: Monitor Drug tx - alpha blockers act as vasodilators Trazosin (Hytrin) Prazosin (Minipress) Tamusolin (Flomax) Intervention - transurethral resection of the prostate TURP Prostatic Adenocarcinoma Most common visceral neoplasm in males second only to lung malignancies Originates from the prostatic secretory epithelium Peak incidence at and after 65 y/o Latent lesion is present in >50% of 80 y/o 70 -80% arise in the peripheral zone and may be palpable during rectal examination Syphilis Treponema Pallidum Sexually transmitted disease with 3 stages Primary ○ Identified by the chancre ○ 10-90 days after exposure ○ Secondary  ○ Identified by mucocutaneous lesions ○ Condyloma lata ○ Secondary uveitis ○ Tertiary ○ Cardiovascular and neurosyphilis ○ Gumma – ulcerating granulomas ○ Serologic tests VDRL (venereal diseases research laboratory) RPR (rapid plasma reagin) FTA-ABS (Fluorescent treponemal antibody absorption test) become (+) 1 – 2 weeks after infection and are (+) after 4 – 6 weeks Treatment ○ Penicillin G 2.4 million units IM once weekly for 3 weeks ○ Allergy to penicillin: Doxycycline 100 mg PO BID for 14 days Tetracycline 500 mg QID for 14 days Azithromycin 2000 mg PO single dose Gonorrhea Is clinically manifested as a purulent urethral discharge  ○ Neisseria Gonorrhoeae ○ Mucopurulent Conjunctivitis ○ Diagnose: ○ Culture ○ PCR Treatment ○