15.2 Disorders of the Male Reproductive System

Prostate and testicular disorders can significantly impact men's health and quality of life. From benign prostatic hyperplasia to prostate cancer, these conditions often cause urinary symptoms and may lead to more serious complications if left untreated.

Testicular conditions like cryptorchidism, varicocele, and torsion can affect fertility and overall well-being. Understanding the causes, symptoms, and potential complications of these disorders is crucial for early detection and effective management.

Prostate and Testicular Disorders

Pathophysiology of prostate disorders

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• Benign Prostatic Hyperplasia (BPH)
  • Pathophysiology
    • Non-cancerous enlargement of prostate gland occurs due to hormonal changes and cell growth in transition zone
    • Compression of urethra leads to urinary symptoms impacting quality of life
    • Androgen dihydrotestosterone (DHT) stimulates prostate cell growth and proliferation
  • Signs and symptoms
    • Frequent urination disrupts sleep patterns especially at night (nocturia)
    • Weak urine stream or difficulty initiating urination (hesitancy) frustrates patients
    • Incomplete bladder emptying increases risk of urinary tract infections
    • Urinary urgency causes sudden, strong desire to urinate
    • Dribbling at end of urination wets clothing and causes embarrassment
• Prostate Cancer
  • Pathophysiology
    • Uncontrolled growth of cells in prostate gland begins often in peripheral zone
    • Spread to nearby tissues and metastasis to bones, lymph nodes, and other organs occurs
    • Genetic mutations (BRCA1, BRCA2) and hormonal factors contribute to development
  • Signs and symptoms
    • Often asymptomatic in early stages making regular screening crucial
    • Difficulty urinating or weak urine flow develops as tumor grows
    • Blood in urine (hematuria) or semen (hematospermia) alarms patients
    • Pelvic or back pain indicates possible bone metastasis
    • Erectile dysfunction may occur due to tumor invasion or treatment side effects

Causes of testicular conditions

• Cryptorchidism
  • Causes and risk factors
    • Failure of testicular descent during fetal development linked to hormonal imbalances
    • Genetic factors such as mutations in INSL3 or RXFP2 genes increase risk
    • Maternal exposure to endocrine disruptors (pesticides, plasticizers) during pregnancy affects development
  • Complications
    • Increased risk of testicular cancer necessitates lifelong monitoring
    • Infertility due to impaired spermatogenesis in undescended testicle
    • Inguinal hernia may develop alongside cryptorchidism
• Varicocele
  • Causes and risk factors
    • Abnormal dilation of pampiniform plexus veins in scrotum occurs
    • More common on left side due to anatomy of left testicular vein
    • Obesity or heavy lifting may exacerbate condition by increasing intra-abdominal pressure
  • Complications
    • Testicular atrophy results from impaired blood flow and increased temperature
    • Reduced sperm production and quality affects fertility
    • Infertility may occur in severe or bilateral cases
• Testicular Torsion
  • Causes and risk factors
    • Abnormal attachment of testicle within scrotum (bell clapper deformity) predisposes to torsion
    • More common in adolescents and young adults due to rapid growth
    • Physical activity or trauma can trigger twisting of spermatic cord
  • Complications
    • Testicular ischemia and necrosis occur if not treated within 6 hours
    • Infertility may result from damage to affected testicle
    • Loss of affected testicle necessitates removal (orchiectomy) in severe cases

Erectile Dysfunction and Reproductive Cancers

Erectile dysfunction: mechanisms and management

• Pathophysiology

  • Inability to achieve or maintain erection sufficient for sexual intercourse affects men's quality of life
  • Vascular (atherosclerosis), neurological (nerve damage), hormonal (low testosterone), or psychological factors contribute
  • Often multifactorial involving interplay of physical and psychological components

• Diagnosis

  • Medical history and physical examination reveal risk factors and comorbidities
  • Blood tests check hormone levels (testosterone, thyroid) and screen for diabetes, hyperlipidemia
  • Nocturnal penile tumescence test assesses nighttime erections
  • Duplex ultrasound evaluates penile blood flow and vascular abnormalities

• Management

  1. Lifestyle modifications: weight loss, regular exercise, smoking cessation improve overall vascular health
  2. Oral medications: PDE5 inhibitors (sildenafil, tadalafil) enhance nitric oxide-mediated vasodilation
  3. Intracavernosal injections: alprostadil directly induces erection when oral medications fail
  4. Vacuum erection devices: create negative pressure to draw blood into penis
  5. Penile implants: surgical option for severe cases unresponsive to other treatments

• Potential underlying causes

  • Cardiovascular disease restricts blood flow to penis (atherosclerosis)
  • Diabetes mellitus damages nerves and blood vessels affecting erectile function
  • Hormonal imbalances (low testosterone) reduce libido and erectile capacity
  • Neurological disorders (multiple sclerosis, Parkinson's disease) disrupt nerve signaling
  • Psychological factors (depression, anxiety, stress) interfere with arousal and performance

Male reproductive cancers

• Types of male reproductive system cancers
  • Prostate cancer: most common, develops in prostate gland
  • Testicular cancer: relatively rare, affects young adults
  • Penile cancer: uncommon, develops on penis surface or in tissues
• Risk factors
  • Age increases prostate cancer risk significantly after 50
  • Family history of reproductive cancers suggests genetic predisposition
  • Race plays role: African American men have higher prostate cancer risk
  • Undescended testicle (cryptorchidism) increases testicular cancer risk
  • Human papillomavirus (HPV) infection linked to penile cancer development
• Importance of early detection and treatment
  • Improved survival rates and treatment outcomes when caught early
  • Preservation of sexual and reproductive function possible with targeted therapies
  • Reduced risk of metastasis and complications through prompt intervention
  • Better quality of life for patients achieved with less aggressive treatments
• Screening methods
  • Prostate-specific antigen (PSA) test detects elevated levels indicating potential prostate issues
  • Digital rectal examination (DRE) allows palpation of prostate for abnormalities
  • Testicular self-examination encourages regular checking for lumps or changes
  • Regular physical exams and health check-ups facilitate early detection of various cancers