What cells produce testosterone?
Leydig cells
Opening of penis
external urethral meatus
Purpose of scrotum
Keep testicular temperature 5 degrees F below core body temp
Tunica vaginalis
Smooth serosal sac with a small amount of fluid that allows free movement of the testicle
What lines seminiferous tubules
Spermatogonia
Cells that regulate sperm production
Sertoli cells
Epididymis
Place where sperm are stored and mature
Vas deferens
Narrow, stiff, heavily muscular tube that merges with duct from seminal vesicles
What does the fluid in the seminal vesicles contain
Vesiculase (causes semen to clot after ejaculation)
Semen contains
Mature sperm and fluids from seminal vesicles and prostate
Erection is mediated by
PSNS
Ejaculation is mediated by
SNS in response to stimulation as well as muscular contractions
Erectile dysfunction is from
Slow arterial inflow or fast venous drainage to the corpus cavernosum
Underlying pathology of erectile dysfunction
Atherosclerotic impairment, nerve damage controlling flow, hormonal disturbances, and therapeutic meds that interfere with erection process (2ndry to CNS, nerve, or vascular dysfunction)
Infertility
Inability to conceive for over 1 year of unprotected intercourse
Primary sperm disorders
Impaired spermatogenesis Impaired sperm emission
Impaired spermatogenesis
Low sperm count from endocrine abnormalities, infections of testis or epididymis, undescended testes, etc...
Azoospermia
No sperm at all in semen
3 primary causes of azoospermia
Testicular azoospermia, post-testicular or obstructive azoospermia, or pretesticular azoospermia
Testicular azoospermia
Testicular injury or trauma, infection, childhood illness, cancer, and cancer treatments
Post-testicular or obstructive azoospermia
Testicles produce sperm but they can't be released due to blockage or surgery (like vasectomy)
Pretesticular azoospermia
Testicles are healthy but hormone imbalance or some cancer treatments result in impairment of stimulatory signals
What causes impaired sperm/semen emission
Complete retrograde ejaculation into the bladderFailure of emission Anorgasmia
Underlying pathology of impaired sperm/semen emission
Dib neuropathy Prostatectomy Vas deferens obstructionGenetic conditions (CF)
What could also cause infertility that is its own category?
Autoimmune- antiserum antibodies
Hypospadias
Birth defect in which the opening of the urethra is not located at the tip of the penis
Epispadias
An opening on the dorsal aspect of the penis
What are hypospadias and epispadias associated with?
Incontinence InfectionObstructionUndescended testis or inguinal hernia
Phimosis
Inability to retract the foreskin over the glans
Physiologic phimosis
From adhesions between the epithelial layers of the inner prepuce and glans before puberty
Pathological phimosis
Promotes poor hygiene, infection, inflammation and scarring, and could predispose to squamous carcinoma
Paraphimosis
Acute, when a forcibly retracted prepuce becomes trapped and produces glans congestion, edema, pain and urinary obstruction.Very painful
Balanitis
Inflammation of the glan, usually in uncircumcised menUsually from fungal infection or STIsS&S: pain, redness, foul-smelling discharge under foreskin
Balanitis xerotica obliterates
Inflammatory disease with a white, sclerotic patch at tip of glans which can constrict the urethral opening
Condyloma Acuminatum
Sexually transmitted cauliflower-like growth caused by HPV
Bowen disease
Squamous carcinoma in situ & forms a grayish or reddish plaque on glans
Squamous carcinoma
Most common malignancy under foreskin, associated with poor personal hygiene and HPV infection
Peyronie disease
A noncancerous condition resulting form fibrous scar tissue of the corpus cavernosum Distorts the erect penis, causing painful erection
Priapism
Prolonged erection- usually from impaired venous outflow (lasting more than 4 hours)(Sickle cell disease = common cause)Drugs could cause this
2 types of priapism
Ischemic & nonischemic Ischemic = emergency
Urethritis
Inflammation of the urethra usually from STIUntreated is bad-could spread to the prostate or epididymis, & cause scarring/obstruction of the urethra
Inguinal hernia
Protrusion of bowel protrudes through the inguinal canal or scrotumS&S: pain when coughing, bending, lifting
Tinea cruris
Fungal infection- "jock itch"Around scrotum or inguinal skin
2 disorders of the scrotum
Varicocele & hydrocele
Varicocele
Veins become enlarged inside of scrotum (scrotal varicose veins)Many are congenital and often produce no symptoms
Hydrocele
Accumulation of fluid in the sac of the tunica vaginalis that surrounds the testes
Cryptorchidism
Undescended testes of one or both- usually one Increases risk for testicular cancer
Why is there a higher risk for a pt that has Cryptorchidism to develop cancer
Whatever is causing the Cryptorchidism is what is creating the higher risk of testicular cancer
Orchitis
Swelling from inflammation of the testes From STIs but also the mumps virus
Epididymitis
Inflammation of epididymitis Cause: bacterial or non- (autoimmune)S&S: severe pain
Spermatocele
Cyst of the epididymis that contains sperm Usually from blockage of epididymal tubule Enlarges slowly with sperm production Most remain small in size and usually painless
Testicular torsion
Rotation of the testicles resulting in the twisting of the spermatic cordIntensely painful and treated with orchipexy of both testicles
Testicular neoplasm
Majority are malignant
2 groups of testicular neoplasms
Tumors of germ cells (more common)Tumors of sex-chord/stroma cells
What makes germ cell tumors malignant
Germs cells are totipotent and can arise at any age in development
What is a benign teratoma composed of
Differentiated tissue like: hair, skin, brain, or thyroid tissue
Most common neoplasm of germ cell tumors
Seminoma- grow slowly and metastasize later
Other types of germ cell tumors
Embryonal carcinomaYolk sac carcinomaChoriocarcinoma
Embryonal carcinoma
Composed of primitive cells
Yolk sac carcinoma
Contains yolk sac cells and occurs in young boys
Choriocarcinoma
Contains placental chorionic-type cells
Mixed tumors
Contain more than one type of cell and occur in half of tumors (common mixture = carcinoma & teratoma)
Why do you not want to biopsy a testes?
If you breach the tunica albuginea with a needle it could cause the cancer to spread
Sex chord/stormal tumors
Arise from primitive embryologic sex cord-stormal tumors
Leding cell tumors
Arise in testicular stroma
Sertoli cell tumors
Arise in seminiferous tubules
Prostate gland 4 zones
PeripheralCentralTransitional Anterior
Prostate gland function
Produce the fluid that nourishes and transports sperm
Peripheral zone of prostate gland
Contains 70% glandular tissue, forms the posterior part of the superior half and surrounds the distal prostatic urethra
Central zone of prostate gland
Contains 25% of glands and ducts and sits high in the gland
Transitional zone of prostate gland
Surrounds the proximal half of the prostatic urethra
Anterior zone of prostate gland
Composed of fibromuscular stroma w/o glandular tissue
What does the normal function of the prostate gland depend on?
Depends on androgens, mainly testosterone
PSA
Prostate specific antigen-An enzyme that dissolves clotted semen & allows sperm to migrate upward into the female genital tract
Acute bacterial prostatitis
Caused by E. Coli from urine or catheterization Gland is tender and swollen on DRE
Digital rectal exam
DRE- Routine procedure used to examine the lower rectum and other internal organs
Where does the prostate lay in comparison to the rectum?
Immediately anterior
Where does prostate cancer usually develop in the prostate
Posterior and peripheral parts (this is why it is palpable during a DRE)
Chronic bacterial prostatitis
Asymptomatic or presents with low back pain, pelvic pain or discomfort Positive urine culture
Problem with using ABX for chronic bacterial prostatitis
ABX does not penetrate tissue that well- so could cause recurrence
Chronic nonbacterial prostatitis
Similar to chronic bacterial prostatitis but urine cultures are negative
BPH
Benign prostatic hyperplasia Most men will have this From Nodular hyperplasia of the gland and supporting tissueResults in enlarged gland (gland could be tense and rubbery on DRE)
What is that problem with BPH?
Causes complete emptying of the bladder, difficulty starting stream, interruption of stream, and dribbling & narrow stream
What does retention of urine cause?
Stasis, dribbling, & narrow stream
Prostatic carcinoma (prostatic adenocarcinoma)
Malignancy of prostate gland epithelial cells High incidence Most are androgen-dependent
PIN
Prostatic intraepithelial neoplasia -Atypical cells that contain some molecular changes found in carcinoma
Can adenocarcinoma develop in a pt w/o PIN?
Yes
S&S of Prostatic carcinoma
Almost always metastasis to bone, discovered by an increase in PSA levels, and are rarely obstructive
Prostatic carcinoma screening
Does not save lives- this test is prostate specific but not sensitive or specific for prostate cancer
Prostatic carcinoma grading
Standardized- usually uses Gleason scale (1-5)1 is well differentiated and 5 is poorly differentiated
Does T4 staging in the TNM system have a good prognosis?
No its the worst! (1 is the best)
What findings of prostate cancer have a very poor prognosis
Lymph node involvement, distant metastases, high PSA, & high Gleason score