1. Chapter 39 Disorders of the Male Genitourinary System

2. Male Reproductive Anatomy

3. Androgens Testosterone Main testicular hormone Dihydrotestosterone
Formed from testosterone in peripheral tissues
Produced by the enzyme 5-alpha reductase

4. Hypothalamus
Negative
GnRH
feedback
Pituitary LH
FSH
Inhibin
Sertoli
Interstitial cells
cells
of Leydig
Testosterone
Spermatogenesis
Maturation
of sperm

5. Question Tell whether the following statement is true or false:
Male reproductive hormones are regulated by the HPA axis.

6. Answer
False
The regulation of reproductive hormones is accomplished by the HPG axis (hypothalamic-pituitary-gonadal). Gonads are sex organs.

7. Erection—Vasodilation Fills Spongy Tissue with Blood

8. Penile Disorders Inflammations Balanitis Balanoposthitis
Peyronie disease
Penile cancer

9. Embryonic Development and Descent of Testes
Testes develop from embryonic kidneys
Descend into scrotum through inguinal canal

10. Hernia

11. Testicular Disorders Varicocele Hydrocele Testicular torsion
Inflammations
Epididymitis
Orchitis

12. Scenario
An 8-year-old boy is in the emergency room. His babysitter says the boy has a GI bug because he has been throwing up and complains of severe abdominal pain…
When alone with you, he admits the pain is in his testes
He presents with HR 115 bpm; RR 29 breaths/min; BP 135/95 mm Hg; pale, cold skin; no bowel sounds; severe pain in right testis; and slight swelling on the right side of the scrotum.
His uncle recently had the mumps
Question
What problems might this boy have? What has caused his symptoms?

13. Question
Which testicular disorder would be the most likely to result from trauma to the scrotum?
Varicocele
Hematocele
Spermatocele
Testicular torsion

14. Answer
Hematocele
Hematocele is characterized by the accumulation of blood in the tunica vaginalis, and may be caused by scrotal trauma.
Varicoceles are varicosities in veins supporting the testes. A spermatocele is a cyst at the end of the epididymis. Testicular torsion is caused by the twisting of the spermatic cord.

15. Testicular Cancers Usually arise from germ cells
These cells have the potential to contribute to a new body
Therefore, they have the potential to do everything that a new body will do: multipotent
Alpha fetoprotein
Human chorionic gonadotropin
Lactate dehydrogenase

16. Prostate Surrounds Urethra
Prostate enlargement compresses urethra
Causes alterations in urination
Weak stream
Urgency
Dysuria
Discharge

17. Kinds of Prostatitis Asymptomatic inflammatory Acute bacterial
Chronic bacterial
Chronic prostatitis/pelvic pain syndrome
Inflammatory
Noninflammatory

18. Benign Prostatic Hyperplasia (BPH)
Nodules have compressed the urethra to a narrow slit
Decreasing testosterone levels can decrease the prostate growth

19. Question Which type of prostatitis is the most common?
Asymptomatic bacterial
Acute bacterial
Chronic bacterial
Pelvic pain syndrome

20. Answer Pelvic pain syndrome
Pelvic pain syndrome (aka chronic prostatitis) is the most common prostatic syndrome. It can be inflammatory or noninflammatory, and is treated with antibiotics, anti- inflammatories, anticholinergics, or alpha-adrenergic antagonists.

21. Scenario
An elderly man has problems with night urgency and joint pain.
Blood tests show:
Elevated plasma creatinine
Elevated BUN
Elevated calcium
Prostate-specific antigen
Question
What do you suspect is causing his symptoms?

22. Childhood Disorders Hypospadias Epispadias Phimosis Paraphimosis
Cryptorchidism