tunica vaginalis
smooth serosal sac with small amount of fluid allowing free movement of testicle
testes
gonad composed of seminiferous tubules and interstitial tissue
epididymis
posterior testis after seminiferous tubules, long coiled tube connecting to vas deferens, where sperm mature and are stored
vas deferens
narrow, stiff, heavily muscled tube over pelvic brim to merge with seminal vesicle duct
seminal vesicle
glands beside prostate and bladder, excrete nutrient fluid into semen, fluid with vesiculase to clot sperm
spermatic cord
vas deferens, blood vessels, nerves, tissues
ejaculation
sympathetic nervous system activated ejection of semen, mediated by muscular contractions
erectile dysfunction
inability to attain or sustain an erection firm enough for satisfactory intercourse, from slow arteries or fast veins of corpus cavernosum or from problem with any step/hormone/organ involved in erection; psych and anxiety hurt tooTx: testosterone, phosphodiesterase inhibitors, vein constrictors, intracavernous vasodilators, extenral vacuum pump
infertility
inability to contribute to conception, inability to conceive 1 year after trying; 35% from sperm disorders of impaired spermatogenesis, sperm emission; need semen analysis with specific parameters and endocrine evaluationClomiphene can increase sperm count
impaired spermatogenesis
low sperm count under 15 mil/mL; from hypothyroidism or endocrine abnormalities, testis or epididymis infection, varicocele, drugs
azoospermia
no sperm at all in the semen
testicular azoospermia
from testicular injury/trauma, infection, illness, cancer, cancer treatment
post-testicular or obstructive azoospermia
testicles produce sperm but sperm can't be released from blockage or surgery
pretesticular azoospermia
healthy testicles but hormone imbalance or some cancer treatments result in impairment of stimulatory signals
impaires sperm emission
spectrum of dysfunction from mild to complete lack of ejaculation; from retrograde ejaculation into bladder, emission failure, anorgasmia, diabetic neuropathy, prostatectomy, obstruction
hypospadias
congenital defect where urethral opening is not at tip of penis; elongated opening on distal ventrum of penis, 3 degreesassociate with incontinence, infection, obstruction, hernia
epispadias
urethral opening on dorsum of penis
phimosis
in uncircumcised males, inability to retract foreskin over the glans, cause erectile pain
physiologic phimosis
often younger males, result from adhesion between epithelial layers of inner prepuce and glans before puberty; spontaneously dissolve with intermittent retraction and erections
pathologic phimosis
phimosis in adults promoting poor hygiene, infection, inflammation, scarring, may predispose to carcinoma
paraphimosis
most acute complication of pathological phimosis, when forcibly retracted prepuce is trapped and cause glans congestion, edema, pain, obstruction, can be emergent is persist
balanitis
glans inflammation in uncircumcised men, from fungal or bacterial infection, can be STI; cause pain, redness, foul discharge under foreskin
balanitis xerotica obliterans
inflammatory disease with white, sclerotic patch at tip of glans with can constrict the urethral opening
condyloma acuminatum
sexually transmitted cauliflower like growth from HPV
Bowen disease
squamous carcinoma in situ in basement membrane; form gray-red patch on glans, can progress to invasive carcinoma
squamous carcinoma
most common invasive malignancy on or under foreskin; invade glans in uncircumcised adults, risk from poor hygiene or HPV
Peyronie disease
noncancerous condition from fibrous scar tissue of corpus cavernosum; distort erect penis causing pain and difficult intercourse; from repeated penile injury; surgery can worsen with more scar tissue
priapism
prolonged erection of the penis, not sexually stimulated or last a really long time; often impaired venous blood flow from inflammation or drug therapy; ischemic or nonischemic; tender/painful penis
urethritis
inflammation of urethra primarily caused by infection, often STI (N. gonorrhoeae, Chlamydia, Trichomonas, Ureaplasma), Tx with antibiotics, may spread to sperm tract, cause urethral scarring
inguinal hernia
protrusion of bowel into inguinal canal or scrotum through weak spot in abdominal muscles; cause pain with increased abdominal pressure; surgical treatment
tinea cruris
fungal infection causing red and itchy rash in warm, moist areas of the body; can inflame scrotum or inguinal skin; Tx with antifungals
varicocele
when veins are enlarged in scrotum, often congenital and present in puberty, often asymptomatic and cause low sperm count and quality and infertility, scrotal enlargement
hydrocele
accumulation of fluid in sac of tunica vaginalis around testis, can develop after scrotal injury, often painless
cryptorchidism
where testes not descend from abdomen, most common congenital abnormality, usually unilateral; if remain have high risk of malignancy; abdomen heat atrophy testes; Tx with surgery
orchitis
swelling from inflammation of the testes from infection or STI, mumps; supportive treatment
epididymitis
epididymis inflammation from retrograde infection from cystitis, urethritis, prostatitis; STI or urinary pathogen; cause swollen, red scrotum, pain/tenderness with gradual onset, severe pain and swelling; treat with antibiotic
spermatocele
cysts of epididymis containing sperm, when sperm builds up somewhere in epididymis from blockage or inflammation; enlarges with continues sperm production; noncancerous, painless with milky fluid; often small with few symptoms
testicular torsion
rotation of testicle resulting in twisting of spermatic cord; interrupt venous drainage causing congestion and hemorrhagic infarction; often associate with congenital abnormality; cause pain, swelling, nausea, vomiting; need immediate orchiplexy of both testicles-- 6 hour window before lose testicle
germ cell tumor
most common neoplasm between 15 and 40 years; risks with cryptorchidism; totipotent cells cause wide variety of tumors at any stage; contraindicate biopsy; need to remove entire testis to examine; testes inherently prevent malignancy, if breached have worse prognosisTx with surgery, radiation, chemo, hormones
teratoma
benign germ cell tumor of differentiated tissues like hair, skin, brain, thyroid tissue, causing mass of disorganized tissues associated together
seminoma
germ cell neoplasm retain features of primitive spermatocytes, most common testicular tumor; slow growing, late metastasis, limited by immune system; treat with surgery and radiation
sex chord/stromal tumors
arise from primitive embryologic sex chord stromal tumor; origin in supporting tissue, usually benign; painless mass but can have hormone production symptoms; Leydig in testicular stroma or Sertoli cell tumors in seminiferous tubules; Tx with surgery
prostate gland
encircle urethra with layer of fibromuscular tissue with 4 zones; produce seminal fluid to feed and transport sperm; contain prostate specific antigen
peripheral zone of prostate
70% glandular tissue, form posterior part of superior half, surround distal prostatic urethra
central zone of prostate
25% of glands and ducts sitting high in gland
transitional zone of prostate
surround proximal half of prostatic urethra with 5% tissue
anterior zone of prostate
fibromuscular stroma without glandular tissue
prostate specific antigen
enzyme in prostate gland that dissolves clotted semen to allow sperm to migrate upward into female genital tract
acute bacterial prostatitis
from E. coli or other fecal bacteria infecting through urine reflux or instrumentation; cause fever, chills, dysuria, pelvic discomfort, pain, swollen gland; Tx with antibiotics
digital rectal exam
routine procedure to examine lower rectum and other internal organs, can examine size of prostate
chronic bacterial prostatitis
may be asymptomatic or with low back pain, pelvic pain, discomfort, afebrile, positive urine culture, inflammatory cells in prostatic secretion; Tx with antibiotic, often reoccur
chronic nonbacterial prostatitis
chronic pelvic pain syndrome, common, similar to bacterial prostatitis with negative urine cultures with inflammatory cells in prostatic secretions; long term pain and urinary symptoms, no specific treatment
benign prostatic hyperplasia
from nodular hyperplasia of gland and supporting tissue, very common with age; unclear cause but associate with abnormal testosterone metabolism causing dysregulation of glandular and stromal tissue; enlarged, tense rubbery gland; obstruct urinary emptying, require catheterization, urinary symptoms, stasis, infection, pyelonephritisTx: fluid restriction, alpha blockers, block testosterone metabolism, surgery
prostatic carcinoma
prostate gland malignancy; most common malignancy, not as lethal; often asymptomatic; often androgen dependent; local spread cause obstructive symptoms, hematuria, lower urinary complaints, distant metastases to bone; use Gleason scaleTx depend on severity, often cause more damage, usually wait and observe
prostatic intraepithelial neoplasia
atypical cells contain some molecular changes in carcinoma, neoplastic growth of epithelial cells with preexisting benign prostatic acini or ducts; high grade is carcinoma in situ