Male Reproductive Disorders

Testicular Disorders

Infections of the Testes (Orchitis)

1. Acute bacterial epididymo-orchitis; from sexual transmission or gram -ve bacteria. Infection spreads from urethra/LUT > enlarge tender tests

2. Viral orchitis; unilateral infection from mumps during puberty

3. Tuberculous epididymo-orchitis; Bloodstream spread to epididymis from active TB > caseous granulomas in testes

Intrascrotal Lesions

1. Hydrocoele; increased serous fluid in tunica vaginalis (becomes distended) > testes atrophy

2. Haematocoele; blood within tunica vaginalis > testes atrophy

3. Spermatocoele; semen accumulation within spermatic cord (due to epididymal cysts/dilation)

4. Chylocoele; lymph in the tunica albuginea (due to lymphatic obstruction) > increase scrotum size but testes atrophy

5. Varicocoele; Varicose pampiniform venous plexus in spermatic cord (presents as "Bag of Worms" = sluggishness of veins) > increased intrascrotal pressure

6. Inguinal Hernia; herniation where loop of intestine enters inguinal canal (due to intra-abdominal pressure, heavy weights etc)

Germ cell tumours (95%)

1. Seminoma (classic); carcinoma of the seminefereous epithelium (potatoe tumours) > appear with clear cytoplasm & large nucleus

2. Spermatocytic seminoma (best prognosis); benign classic seminoma (>60 y/o males) > clear cytoplasm/large nucleus & clear pattern

3. Teratoma; mature - occur in young, behavour in benign manner, good prognosis. Immature - highly malignant, little differentiation, poor prognosis

4. Yolk sac tumour (most common); good prognosis = chemosensitive, diagnosed when a-fetoprotein (only present in pregnancy)

5. Choriocarcinoma; trophoblastic tissue, highly malignant (rare), diagnosed by HcG levels (present in pregnancy), poor prognosis

6. Embyronal carcinoma; pleomorphic cells, highly malignant, responds well to cytotoxic chemotherapy, good prognosis (w/ early detection)

Sex cord & Stromal Tumours (5%)

1. Interstitial cell tumour; involves Leydig cells, premature puberty onset, associated w/ increased testosterone levels

2. Sertoli cell tumour; well circumscribed, benign, sertoli cell = nourish spermazoa

Prostate Gland Disorders

Prostatitis

Acute Prostatitis; due to infection of bladder/urethra > suppuration & abscess formation > detected by DRE > tender/soft upon palp

Chronic Prostatitis; progressive acute protatitis or TB > harden prostate upon palp

Benign Prostatic Hyperplasia

Aetiology; hormonal imbalances

Symptoms; micturition difficulty, nocturia, dysuria > UTI & prostatitis

Diagnosis; DRE, biopsy

Treatment; TURP (transurethral resection of prostate) or laser

Prognosis; good (does not predispose)

Carcinoma of the Prostate

Aetiology; genetics, cadium exposure, elevated testosterone levels, reduced immunity

Symptoms; late - back pain, weight loos, anaemia

Diagnosis; palpable, DRE, raised prostate specific antigens (PSA)

Treatment; surgery, radiotherapy, hormonal therapy

Prognosis; Stage A (80% 5yr), stage B (50% 5yr), stage C (35% 5 yr), stage D (20% 5yr)

Penile Disorders

Hypospadias (most common)

Ventral (underside) opening of urethra

Epispadias

Dorsal (upperside) opening of urethra

Urethritis

Penile urethra infection > pain & purulent discharge > may lead to Reiter's syndrome (arthritis/urethritis/conjunctivitis

Balanitis

Bacterial infection of glands/foreskin

Phimosis

Abnormal foreskin > non-retractable/tight prepuce = increased risk of infection

SCC of Penis

Due to inadequate hygiene/presence of foreskin > warty/fungating mass (cauliflower like growth) > ulceration, deformity, fistula formation

Sex cord & Stromal Tumours