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Chapter 39 Disorders of the Male Genitourinary System

Chapter 39 Disorders of the Male Genitourinary System. Male Reproductive Anatomy. Androgens. Testosterone Main testicular hormone Dihydrotestosterone Formed from testosterone in peripheral tissues Produced by the enzyme 5-alpha reductase. Hypothalamus. Negative. GnRH. feedback.

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Chapter 39 Disorders of the Male Genitourinary System

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  1. Chapter39Disorders 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 Spermatogenesis Testosterone 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

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