testosterone:produced by ________ in response to stimulation by ____ from the _________________ stimulates testicular germ cells to mature into functional sperm
Leydig cells; LH; anterior pituitary; FSH
penis:opening is the ___________-______ is a retractable collar of skin that folds over the glanscontains two dorsal ___________ and one centerline ventral ____________
external urethral meatus; prepuce; corpus cavernosum; corpus spongiosum
smooth serosal sac with a small amount of fluid that allows free movement of the testicle
tunica vaginalis
testes:a ______ composed of -__________ (90%) where sperm are produced________ (10%) that produces testosterone
gonad; seminiferous tubules; interstitial tissue
seminiferous tubules are lined by __________ which divide to form sperm
spermatogonia
________ regulate sperm production
sertoli cells
on the posterior side of the testis where the seminiferous tubules emptylong coiled tube that connects the testis to the vas deferensplace where sperm mature and are stored
epididymis
narrow, stiff, heavily muscled tube that travels over the pelvic brim into the pelvis where it merges with the duct from the seminal vesicles
vas deferens
glands that lie beside the prostate and bladder that excrete nutrient fluid into semenfluid contains _________ that causes semen to clot after ejaculation
seminal vesicles; vesiculase
vas deferens, blood vessels, nerves, and tissue
spermatic cord
formed of mature sperm from the epididymis with fluids from the seminal vesicles and prostate
semen
enlargement and stiffening of the penis in response to sensory signals mediated by the parasympathetic nervous system
erection
ejection of semen mediated by the sympathetic nervous system in response to stimulationmediated by muscular contractions of the epididymis, vas deferens, seminal vesicles, and prostate
ejaculation
inability to attain or sustain an erection firm enough for satisfactory intercoursecaused by either slow arterial inflow or fast venous drainage to the corpus cavernosumtypical underlying pathology:atherosclerotic impairmentnerve damage controlling flowhormonal disturbancestherapeutic meds that interfere w/ erection process
erectile dysfunction
inability to contribute to conception - inability of a couple to conceive after 1 year of unprotected regular intercourse
infertility
results in low sperm count (<15 million sperm per mL semen)can be caused by: hypothyroid (or other endocrine abnormalities), infections of the testis or epididymis, undescended testes, varicocele, or drugs
impaired spermatogenesis
presence of no sperm at all in the semen (~15% of male infertility cases)three primary causes=testicular azoospermiapost-testicular or obstruction azoospermiapretesticular azoospermia
azoospermia
infertility caused by testicular injury/trauma, infection, childhood illness, cancer, and cancer treatments
testicular azoospermia
infertility where testicles produce sperm but they can't be released due to a blockage or surgery (i.e. vasectomy)
post-testicular or obstructive azoospermia
infertility where testicles are healthy but hormone imbalance or some cancer treatments result in impairment of stimulatory signals
pretesticular azoospermia
spectrum of dysfunction from mild impairment to complete absence of ejaculationcan be due to: complete retrograde ejaculation into the bladderfailure of emissionanorgasmiaunderlying pathology:diabetic neuropathy/other neuro condition impeding peristalsisprostatectomyvas deferens obstructiongenetic conditions (cystic fibrosis)
impaired semen/semen emission
birth defect where the opening of the urethra is not located at the tip of the penis________ is an opening on the dorsumeither can be associated with:incontinenceinfectionobstructionundescended testis/inguinal hernia
hypospadias; epispadias
a condition of the penis that occurs in some adults and children who aren't circumcised:inability to retract the foreskin over the glans
phimosis
results from adhesions between the epithelial layers of the inner prepuce and glans before pubertyspontaneously dissolve w/ intermittent foreskin retraction and erections, so resolves with age
physiologic phimosis
promotes poor hygiene, infection, inflammation, and scarringmay predispose to squamous carcinoma
pathological phimosis
most acute complication of pathological phimosisoccurs when a forcibly retracted prepuce becomes trapped which produces glans congestion, edema, pain, and urinary obstructionif persists for several hours - should be treated as medical emergency, may result in tissue necrosis
paraphimosis
inflammation of the glans, most common in uncircumcised menmost often caused by fungal infection, but may be bacterial or STI
balanitis
inflammatory disease with a white sclerotic patch at tip of glans which can constrict the urethral opening
balanitis xerotica obliterans
sexually transmitted cauliflower-like growth caused by HPV
condyloma acuminatum
squamous carcinoma in situ, which remains contained to the basement membraneforms a grayish or reddish plaque on glans10% progress to invasive carcinoma
Bowen disease
most common invasive malignancy which usually forms on or under the foreskinbecomes invasion on glans in uncircumcised males >40yo or in the penile urethrarisk factors: poor personal hygiene, HPV infx
squamous carcinoma
noncancerous condition resulting from fibrous scar tissue of the corpus cavernosum (or tunica albuginea)distorts the erect penis, causing painful erection and/or difficult intercoursecaused by repeated penile injury, typically during sex or physical activity
peyronie disease
prolonged erection - continues hours beyond or is not caused by sexual stimulationmost cases d/t impaired venous outflow from inflammation or drug therapy (sickle cell, leukemia, etc.)ischemic can be medical emergency - can lead to tissue necrosis
priapism
inflammation of the urethra primarily caused by an infectionmost commonly d/t STI
urethritis
protrusion of the bowel into the inguinal canal or scrotum through a weak spot in the abdominal muscles
inguinal hernia
fungal infection that causes red and itchy rash in warm and moist areas of the bodyinflammation of the scrotum or inguinal skin
tinea cruris
enlarged veins inside the scrotummany cases are congenital and do not become apparent until pubertyoften produce no sx - but can cause low sperm production or decreased sperm quality -> infertility
varicocele
accumulation of fluid in the sac of the tunica vaginalis that surrounds the testiscan develop d/t inflammation or injury within the scrotumusually painless, often not a serious concern
hydrocele
condition in which one or both of the testes fail to descend from the abdomen into the scrotummost common congenital abnormalityrarely bilateraltestis that remain in the abdomen confer a 10x risk for testicular malignancy
cryptorchidism
swelling from inflammation of the testiscan be caused by bacterial/viral infections, but often cause is unknownmost common: bacterial/STIsome: mumps
orchitis
inflammation of the epididymismost occur from retrograde infection d/t cystitis/urethritis/prostatitisin men <35: suspect STIin men >35: suspect urinary pathogen
epididymitis
cysts of the epididymis that contain spermhappen when sperm builds up somewhere in the epididymis - often related to a blockage/inflammation in the epididymal duct noncancerous, generally painless most remain small in size and cause few or no sx
spermatocele
rotation of the testicles resulting in twisting of the spermatic cordinterrupts venous drainage but not arterial inflowmost cases occur in teenagers with a congenital abnormality of the testis
testicular torsion
surgery to move and/or permanently fix a testicle into the scrotumtypical treatment for testicular torsion
orchipexy
majority are malignantoccur most commonly between ages 15-40
testicular neoplasms
two major groups of testicular neoplasms:tumors of _______ (95%, virtually all malignant)tumors of _________ (5%, almost all benign)
germ cells; sex-chord/stroma cells
a benign _______ is composed of differentiated tissues i.e. hair, skin, brain, thyroid tissue
teratoma
germ cells are ________ so a wide variety of tumors can arise at any stage in development
totipotent
germ cell tumors:retains features of primitive spermatocytes and are most commongrow more slowly and metastasize later than other germ cell malignanciesslow growing bc they are limited by the immune system (incites an immune response w/ dense accumulations of lymphocytes)
seminoma
germ cell tumors:composed of very primitive cells
embryonal carcinoma
germ cell tumors:contains yolk sac cells, occurs in young boys
yolk sac carcinoma
germ cell tumors:contains placental chorionic-type cells
choriocarcinoma
germ cell tumors:contain more than one type of celloccur in half of tumorscommon: embryonal carcinoma + teratoma
mixed tumors
have origin in supporting tissue of testicles, including Leydig/Sertoli cells and granulosa cellsalmost always benign
sex chord/stromal tumors
sex chord/stromal tumors:arise in testicular stroma
leydig cell tumors
sex chord/stromal tumors:arise in seminiferous tubules
sertoli cell tumors
encircles the urethra at the neck of the bladderwrapped in thin layer of fibromuscular tissue composed of glands, ducts, and stroma
prostate
4 zones of prostate
peripheral, central, transitional, anterior
primary function of prostate
produce fluid that nourishes and transports sperm (seminal fluid)
prostate gland:contains 70% of glandular tissue, forms the posterior part of the superior half and surrounds the distal prostatic urethra
peripheral zone
prostate gland:contains 25% of glands and ducts and sits high in the gland
central zone
prostate gland:surround the proximal half of the prostatic urethra and contains 5% of tissue
transitional zone
prostate gland:composed of fibromuscular stroma without glandular tissue
anterior zone
normal function of prostate depends upon ________, mainly ________
androgens; testosterone
an enzyme that dissolves clotted semen and allows sperm to migrate upward into the female genital tract
prostate specific antigen (PSA)
usually caused by E.coli or other fecal bacteriad/t reflux of infected urine or following instrumentization/catheterization
acute bacterial prostatitis
may be nearly asymptomatic or present with low back pain, suprapubic/pelvic/perineal pain or discomfortmay have hx prior UTI/but do have positive urine culture and inflammatory cells in prostatic secretion
chronic bacterial prostatitis
chronic pelvic pain syndrome"10-15% of menclinically similar to bacterial, but urine cultures are negative (does include inflammatory cells in prostatic secretions)
chronic nonbacterial prostatitis
caused by nodular hyperplasia of the prostate gland and supporting tissuenearly all men will develop w/ advancing agecause is unclear - but abnormal testosterone metabolism plays a major role in dysregulation of glandular and stromal tissue
benign prostatic hyperplasia (BPH)
malignancy of prostate gland epithelial cellsmost common malignancy: more frequent than breast or lung CA, but is far less lethalmost are androgen-dependentusually not symptomatic - discovered by increase in PSA levels
prostatic carcinoma (prostatic adenocarcinoma)
prostatic carcinoma grading:commonly used _________ based on histological grading
Gleason scale