Male Reproductive System: Testicular System PDF

Male Reproductive System: Testicular System Pathophysiology Terrel Master, PhD Male Reproductive System Anatomy Review Cancers Congenital Disorders Penile Epispadia/Hypospadia Prostate Cryptorchidism Testicular Disorders of the...

Male Reproductive System: Testicular System Pathophysiology Terrel Master, PhD Male Reproductive System Anatomy Review Cancers Congenital Disorders Penile Epispadia/Hypospadia Prostate Cryptorchidism Testicular Disorders of the Testes Sexually Transmitted and Scrotum Infections Chlamydia Hydrocele Gonorrhea Spermatocele Syphilis Varicocele Herpes Torsion Trichomoniasis Anatomy Review Spermatogenesis: generates and transports sperm Produces sex hormones Aids in urination Includes penis, scrotum, testes, duct system, and accessory glands Testosterone Testosterone Gives males their secondary sex characteristics and sex drive Regulates metabolism and protein anabolism Inhibits pituitary secretion of the gonadotropins Promotes potassium excretion and renal sodium reabsorption Contributes to male pattern baldness and acne 10 weeks Glans Urogenital Glans Groove Urethral Folds (partial Anus fusion) Anus 4 weeks Fully Developed Glans Genital Tubercle Body (Indifferent Stage) Glans Body Raphe Labium Minora Urethral (Penis) & Vaginal Orifices (complete fusion) ScrotumLabium Majora Perineal Raphe Anus Anus Congenital Penile Variations Hypospadia Urethral meatus located on the ventral surface of the penis Risk increases with maternal factors like age >35 years, obesity, use of fertility treatments, and hormone therapy Most common penile variation Congenital Penile Variations Epispadia Urethral meatus occurs on the dorsal surface of the penis and may extend the entire length of the penis; Can cause urination problems increased risk for urinary tract infections Usually develops during the first month of gestation; urinary defects often also present Congenital Testicular Disorders Cryptorchidism Undescended testicle One or both testes do not descend from abdomen to scrotum; undescended testes usually remain along the path of descent Disorders of the Testes Hydrocele Fluid accumulation between the layers of the tunica vaginalis or along the spermatic cord Can affect one or both testes Causes: congenital defect, inflammation, infection, trauma, and tumors Diagnosis: painless scrotal enlargement that transilluminates and scrotal heaviness Disorders of the Testes Varicocele Manifestations: “bag of Dilated vein in the spermatic worms” feeling to the cord scrotum and scrotal Results from valve issues that allow blood to pool in the veins heaviness Causes: congenital defects and obstructions Most common cause for low sperm counts and decreased sperm quality because of testicular ischemia More common in left testicle because of anatomic factors Disorders of the Testes Testicular Torsion Abnormal rotation of the testes on the spermatic cord Causes: trauma, but can also occur spontaneously Manifestations: sudden scrotal edema and pain Diagnosis: history, physical examination, and scrotal ultrasound Treatment: manual manipulation and surgery Male Reproductive Cancers Penile Cancer Testicular Cancer Rare malignancy Uncommon but curable (even if The exact cause is unknown metastatic) cancer most common in 15–35 year olds Risk factors: smegma, being uncircumcised, Affecting one or both testicles poor hygiene, phimosis, and HPV infections Appears as a thick, grey-white lesion (Bowen Risk factors: family history, infection, lesion) or a red, shiny lesion (erythroplasia of trauma, and cryptorchidism Queyrat) Manifestations: asymptomatic; a hard, Risk factors: being uncircumcised, poor painless, palpable mass that does not hygiene, phimosis, and HPV infections transilluminate; testicular discomfort Prognosis is good with early diagnosis and or pain; enlargement of the testicle treatment Diagnosis: monthly self-testicular Treatment: penectomy, chemotherapy, examinations radiation, and surgical excision Treatment: orchiectomy, chemotherapy, and radiation Male Reproductive Cancers Prostate Cancer Most common cancer in men Slow-growing tumor with an unknown cause; as it grows, it obstructs urethra Second leading cause of cancer deaths Risk factors: history of STIs, family history, high-fat diets, and androgen hormone replacement Manifestations: urinary difficulties, erectile dysfunctions, bloody semen, and hematuria Diagnosis: biopsy, the prostate-specific antigen test, and prostatic acid phosphatase test Treatment: radical prostatectomy, radiation, orchiectomy, and antitestosterone drugs For cancers diagnosed in early stage, active surveillance is appropriate Sexually Transmitted Infections STI Sexually Transmitted Infections Infections that can be contracted through sexual contact More than 30 different sexually transmissible bacteria, viruses, and parasites have been identified Some can also be transmitted from mother to child during pregnancy and childbirth as well as through blood contact Some of these are easily eradicated with appropriate treatment, whereas others remain for a lifetime Three are reportable to the Centers for Disease Control and Prevention—chlamydia, gonorrhea, and syphilis Bacterial STIs Chlamydia Gonorrhea Chlamydia trachomatis: intracellular Caused by Neisseria gonorrhoeae, an parasite that requires a host cell to aerobic bacterium with many drug- reproduce resistant strains The most commonly reported STI in the Second most common STI United States; Complications: PID, epididymitis, Complications: PID, epididymitis, prostatitis, infertility, ectopic pregnancy, arthritis, dermatitis, and prostatitis, infertility, and ectopic endocarditis pregnancy, Increases the risk for contracting other STIs Manifestations: if present, include dysuria; penile, vaginal, or rectal Manifestations: if present, include discharge; redness/edema at urinary dysuria; penile, vaginal, or rectal meatus (in men); testicular discharge; testicular tenderness or pain; tenderness; rectal pain; painful rectal pain; and painful sexual intercourse; white blisters that darken intercourse and disappear Both Treated with antibiotics Bacterial STIs Syphilis 3 Phases of Disease Ulcerative infection caused by Progressive symptoms Treponema pallidum, a spirochete that requires a warm, moist environment to survive Transmitted from skin or mucous membrane and from the mother to child through the placental barrier In utero, fetuses are protected by Langhans layer for the first four months, so screening and treating the mother prior can decrease likelihood of fetus contracting the infection Untreated, may lead to fetal demise or defect affecting the bone, liver, lungs, and nerves  Syphilis Stages Stage one: Primary syphilis 1+ painless chancres form at site 2–3 weeks after infection no other symptoms are present Often go unnoticed and disappear about 4–6 weeks later, even without treatment Bacteria become dormant, and Contagious, but may not test positive, so testing should be repeated at a later date Stage two: Secondary syphilis Stage three: Latent or tertiary syphilis Occurs about 2–8 weeks after the first chancres form Begins when the secondary Treatment in the primary stage can decrease the likelihood symptoms disappear and lasts 1–4 of developing this stage years Manifestations: generalized, brown-red rash; malaise; Can last for years; infection spreads fever; Symptoms will often go away without treatment, and to the brain, nervous system, heart, again, the bacteria become dormant skin, and bones Will test positive (if untreated) and is contagious, Complications: blindness, paralysis, especially with direct contact with the rash dementia, cardiovascular disease, and death Will test positive (if untreated) and is Viral STIs Herpes simplex virus (HSV) Recurrent episodes of lesions, sores Two forms HSV type 1 typically occurs above the waist and manifests as a cold sore HSV type 2 typically occurs below the waist Each type can affect the mouth or the genitals through oral-genital contact Transmitted through sexual, direct The virus causes an initial skin-to-skin contact, and from mother to fetus infection at the entry site Risk of transmission is the greatest then the virus travels when lesions are present along the nerve root where it remains dormant Genital Herpes Outbreaks begin with a tingling or burning sensation at the site just before the lesion appears (prodrome) The lesions first appear as a vesicle surrounded by erythema Vesicles rupture, leaving a painful ulcerative lesion with watery exudate Crust forms over the ulcer, and it heals spontaneously in 3–4 weeks Treatment: antiviral medications, avoiding reoccurrence triggers, proper hygiene, avoiding sexual activity during outbreaks, and safe sex practices Human papillomaviruses (HPVs) Benign growths on external Diagnosis: history, genitals, cervix, and anus examination, Pap smear, caused by a group of viruses biopsy, and PCR test Incubation period can last up to 6 Prevention: vaccine and months; can lead to safe sex practices reproductive/anal cancers Treatment: removal using Manifestations: asymptomatic; chemicals, cryosurgery, growths that can be raised, flat, electrocautery, laser rough, smooth, flesh-colored, therapy, or excision; white, grey, pink, cauliflower- treating sexual partners; like, large, or barely visible, with and cesarean section abnormal bleeding, discharge, deliveries and itching Trichomoniasis Caused by Trichomonas vaginalis (a parasite), a one-celled anaerobic organism that can burrow under the mucosal lining In men, the organism primarily resides in the urethra and causes no symptoms In women, the organism resides in the vagina The organism cannot survive in the mouth or the rectum Complications: cervical cancer Manifestations: excessive odorous, frothy, white or yellow-green vaginal discharge; vagina and vulva irritation; itching; painful intercourse; and dysuria Diagnosis: history, physical examination, and Pap smear Treatment: antibiotic therapy, specifically metronidazole (Flagyl), and screening and treating sexual partners Fetal Sex Determination Female gonad (ovary) is default Male gonad (testis) only develops in the presence of SRY gene found on the ‘sex determining region’ of the Y chromosome XX – Female gonad  develops female phenotype XY - Male gonad  testosterone  male phenotype “The type of sex chromosome complex established at fertilization of the oocyte determines the type of gonad that differentiates from the indifferent gonad. The type of gonad then determines the type of sexual differentiation that occurs in the genital ducts and external genitalia” Androgen Insensitivity – XY chromosome complex, but tissues do not respond to testosterone, Testis develop but do not descend, external genitalia does not form