Chapter 44 - Disorders of the Male GU System

• erectile dysfunction could be classified as psychogenic, organic, or mixed
• after 50 years of age, the overall prevalence of erectile dysfunction is reported to be greater than 50%
• organic etiologies are the most common in erectile dysfunction
• in hypertension, erectile dysfunction is impaired not so much by the increased BP as by the associated stenotic arterial lesions
• a report of pain radiating to the inguinal area points to a tentative diagnosis of testicular torsion
• testicular torsion is a twisting of the spermatic cord that suspends the testes
• testicular torsion is the most common acute scrotal disorder in the pediatric and young adult population
• PSA is a glycoprotein that is secreted into the cytoplasm of benign and malignant prostatic cells that is not found in other normal tissues or tumours
• a positive PSA test indicates only the possible presence of testicular cancer
• a PSA test can often be positive in cases of BPH and prostatitis
• cancer of the prostate is treated by surgery, radiation therapy, and hormonal manipulation
• metastatic disease often is treated with androgen deprivation therapy
• androgen deprivation may be induced at several levels along the pituitary-gonadal axis using a variety of methods or agents
• orchiectomy often is effective in reducing symptoms of prostate cancer and extending survival
• ultimately, treatment decisions for prostate cancer are based on tumour grade and stage and health of the man affected
• cryptorchidism = undescended testes
• the testes develop intra-abdominally in the fetus and usually descend into the scrotum through the inguinal canal at 7 to 9 months of gestation
• hydrocele is fluid accumulation in the layers around the scrotum
• hematocele is blood in the layers around the scrotum
• spermatocele is a cyst in the epididymis
• varicocele is an enlargement of the veins of the scrotum
• orchitis is an infection of the testes
• undescended testes increases the risk of testicular torsion by 10 times
• the mumps virus can be spread to the testes through the bloodstream or the lymphatics and cause orchitis
• orchitis has a sudden onset and is characterized by painful enlargement of the testes
• urinary symptoms are absent in orchitis
• atrophy of the testes may occur in orchitis, impacting spermatogenesis (permanent sterility is rare)
• a patient with orchitis is usually symptomatic for 7 to 10 days
• testicular cancer is relatively rare but is most common between the ages of 15 to 29
• testicular cancer requires surgical removal of the testes and spermatic cord plus radiation
• risk factors for testicular cancer include:

  • cryptorchidism
  • family history
  • personal history
• stage I testicular cancer is characterized by a tumour that is confined to the testes, epididymis, or spermatic cord
• stage II testicular cancer is characterized by a tumour that spreads to the retroperitoneal lymph nodes below the diaphragm
• stage III testicular cancer is characterized by metastases outside the retroperitoneal nodes or above the diaphragm
• the most common etiology for acute bacterial prostatitis is an ascending urethral infection (E. coli)
• manifestations of acute bacterial prostatitis include:

  • fever
  • malaise
  • frequent/urgent urination
  • urethral discharge
• treatment for acute bacterial prostatitis includes antibiotics, reduced activity, hydration, and pain management
• chronic bacterial prostatitis is characterized by recurrent UTIs and is persistent in prostatic fluid and urine
• chronic bacterial prostatitis has similar manifestations to acute bacterial prostatitis
• treatment for chronic bacterial prostatitis is more difficult as antibacterial drugs are less effective in penetrating the chronically inflamed prostate