Clinical Aspects of the Male Reproductive System

Infection

Most infections of the male reproductive tract are sexually transmitted diseases (STDs), listed in Display 14-1. The most common STD in the United States is caused by the bacterium Chlamydia trachomatis, which, in males, mainly causes urethritis. This same organism also causes lymphogranuloma venereum, an STD associated with lymphadenopathy, which is rare in the United States. Both forms of these chlamydial infections respond to treatment with antibiotics.

Gonorrhea is caused by Neisseria gonorrhoeae, the gonococcus (GC). Infection usually centers in the urethra, causing urethritis with burning, a purulent discharge, and dysuria. Untreated, the disease can spread through the reproductive system. Gonorrhea is treated with antibiotics, but there has been rapid development of resistance to these drugs by gonococci.

Another common STD is herpes infection, caused by a virus. Other STDs are discussed in Chapter 15. Mumps is a non-sexually transmitted viral disease that can infect the testes and lead to sterility. Other microorganisms can infect the reproductive tract as well, causing urethritis, prostatitis, orchitis, or epididymitis.

Benign Prostatic Hyperplasia

As men age, the prostate gland commonly enlarges, a condition known as benign prostatic hyperplasia (BPH). Although not cancerous, this overgrown tissue can press on the urethra near the bladder and interfere with urination. Urinary retention, infection, and other complications may follow if an obstruction is not corrected.

Medications for increasing urinary flow rate by relaxing smooth muscle in the prostate and bladder neck are used to treat the symptoms of BPH. Drugs that interfere with testosterone activity in the prostate may slow

DISPLAY 14-1

Sexually Transmitted Diseases

DISEASE

ORGANISM

chlamydial infection

Chlamydia trachomatis types D to K

Ascending infection of reproductive and urinary tracts. May spread to pelvis in women, causing pelvic inflammatory disease (PID).

lymphogranuloma venereum

Chlamydia trachomatis type L

General infection with swelling of inguinal lymph nodes; scarring of genital tissue

gonorrhea

Neisseria gonorrhoeae; gonococcus (GC)

Inflammation of reproductive and urinary tracts. Urethritis in men. Vaginal discharge and inflammation of the cervix (cervicitis) in women, leading to pelvic inflammatory disease (PID). Possible systemic infection. May spread to newborns. Treated with antibiotics.

bacterial vaginosis

Gardnerella vaginalis

Vaginal infection with foul-smelling discharge

DISPLAY 14-1 Sexually Transmitted Diseases, continued

DISEASE

ORGANISM

DESCRIPTION

syphilis

Treponema pallidum (a spirochete)

Primary stage: chancre (lesion); secondary stage: systemic infection and syphilitic warts; tertiary stage: degeneration of other systems. Cause of abortions, stillbirths, and fetal deformities. Treated with antibiotics.

VIRAL

acquired immune deficiency syndrome (AIDS)

human immunodeficiency virus (HIV)

An often fatal disease that infects T cells of the immune system, weakening the host and leading to other diseases

genital herpes

Herpes simplex

Painful lesions of the genitalia. In women, may be a risk factor in cervical carcinoma. Often fatal infections of newborns. No cure at present.

hepatitis B

hepatitis B virus (HBV)

Causes inflammation of the liver, which may be acute or may develop into a chronic carrier state. Linked to liver cancer.

condyloma acuminatum (genital warts)

human papilloma virus (HPV)

Benign genital warts. In women, predisposes to cervical dysplasia and carcinoma.

PROTOZOAL

trichomoniasis

Trichomonas vaginalis

Vaginitis. Green, frothy discharge with itching; pain on intercourse (dyspareu-nia); and painful urination (dysuria).

progress of the disorder. An herbal remedy that seems to act in this same manner is an extract of the berries of the saw palmetto, a low-growing palm tree. Saw palmetto has been found to delay the need for surgery in some cases of BPH.

In advanced cases of BPH, removal of the prostate, or prostatectomy, may be required. When this is performed through the urethra, the procedure is called a transurethral resection of the prostate (TURP) (Fig. 14-3). The prostate may also be cut in a transurethral incision of the prostate (TUIP) to reduce pressure on the urethra (see Fig. 14-3). Other forms of energy, such as a laser beam or heat, have also been used to destroy prostatic tissue. BPH is diagnosed by digital rectal examination (DRE) or imaging studies.

Cancer of the Prostate

Cancer of the prostate is the most common malignancy in men in the United States. Only lung cancer and colon cancer cause more cancer-related deaths in men who are past middle age. Prostatic cancer may metas-tasize rapidly and is difficult to remove surgically. Other methods of treatment include radiation; measures to reduce male hormones (androgens), which stimulate prostatic growth; and chemotherapy. In cases of prostatic cancer, a protein produced by prostate cells increases in the blood. This prostate-specific antigen (PSA) is used, along with rectal examinations, to screen for prostate cancer and to assess the results of treatment.

Urinary bladder

Transurethral Incision The Prostate

FIGURE 14-3. Prostate surgery procedures. (A) Transurethral resection of the prostate (TURP). Portions of the prostate are removed at the bladder opening. (B) Transurethral incision of the prostate (TUIP). One or two incisions are made in the prostate to reduce pressure on the urethra.

Enlarged prostate being cut

Site for incision into prostate

FIGURE 14-3. Prostate surgery procedures. (A) Transurethral resection of the prostate (TURP). Portions of the prostate are removed at the bladder opening. (B) Transurethral incision of the prostate (TUIP). One or two incisions are made in the prostate to reduce pressure on the urethra.

Cryptorchidism

It is fairly common that one or both testes will fail to descend into the scrotum by the time of birth. This condition is termed cryptorchidism, literally hidden (crypt/o) testis (orchid/o). The condition usually corrects itself within the first year of life. If not, it must be corrected surgically to avoid sterility and an increased risk of cancer.

Infertility

An inability or a diminished ability to reproduce is termed infertility. Its causes may be hereditary, hormonal, disease-related, or the result of exposure to chemical or physical agents. The most common causes of infertility are STDs. A total inability to produce offspring may be termed sterility. Men may be voluntarily sterilized by cutting and sealing the vas deferens on both sides in a vasectomy (see Fig. 15-4).

ERECTILE DYSFUNCTION

Erectile dysfunction, also called impotence, is the male lack of ability to perform intercourse because of failure to initiate or maintain an erection until ejaculation. The disorder may be broadly characterized as psy-chogenic, in which case it is caused by emotional factors, or organic, caused by some physical problem such as an anatomic defect or circulatory problem. More specifically, neurogenic impotence results from a disorder of the nervous system, such as a central nervous system lesion, paralysis, or neurologic damage complicating diabetes. Erectile dysfunction may also be a side effect of drug treatment.

Drugs that are used to treat erectile dysfunction work by dilating arteries in the penis to increase blood flow to that organ. One highly prescribed drug of this sort is sildenafil (trade name, Viagra). Penile vacuum pumps and penile prostheses are nondrug approaches to therapy for erectile dysfunction.

Vagina Vacuum Pump

FIGURE 14-4. Inguinal hernia. The hernial sac is a continuation of the peritoneum. The intestine or other abdominal contents can protrude into the hernial sac.

Normal Hernia

FIGURE 14-4. Inguinal hernia. The hernial sac is a continuation of the peritoneum. The intestine or other abdominal contents can protrude into the hernial sac.

Inguinal Hernia

The inguinal canal, through which the testis descends, may represent a weakness in the abdominal wall that can lead to a hernia. In the most common form of inguinal hernia (Fig. 14-4), an abdominal organ, usually the intestine, enters the inguinal canal and may extend into the scrotum. This is an indirect or external inguinal hernia. In a direct or internal inguinal hernia, the organ protrudes through the abdominal wall into the scrotum. If blood supply to the organ is cut off, the hernia is said to be strangulated. Surgery to correct a hernia is a herniorrhaphy.

adrenal

Key Clinical Terms

DISORDERS

benign prostatic hyperplasia (BPH)

Nonmalignant enlargement of the prostate; frequently develops with age; also called benign prostatic hypertrophy

cryptorchidism krip-TOR-kid-izm

Failure of the testis to descend into the scrotum

epididymiti_s ep-i-did-i-MI-tis

Inflammation of the epididymis. Common causes are UTIs and STDs.

erectile_dysfunction e-REK-til dis-FUNK-shun

A lack of ability to perform intercourse in the man because of failure to initiate or maintain an erection until ejaculation; impotence

Disorders, continued

IM-po-tens

Erectile dysfunction

infertility in-fer-TIL-i-te

Decreased capacity to produce offspring

inguinal hernia

ING-gwin-al

Protrusion of the intestine or other abdominal organ through the inguinal canal (see Fig. 14-3) or through the wall of the abdomen into the scrotum

orchitis or-KI-tis

Inflammation of a testis. May be caused by injury, mumps virus, or other infections.

prostatit_is pros-ta-TI-tis

Inflammation of the prostate gland. Often appears with UTI, STD, and a variety of other stresses.

sexually transmitted disease (STD)

Disease spread through sexual activity (see Display 14-1)

sterility

Complete inability to produce offspring

ure thritis u-rl-THRI-tis

Inflammation of the urethra; often caused by gonorrhea and chlamy-dial infections

SURGERY

herni orrhaphy her-ne-OR-a-fe

Surgical repair of a hernia

prostatectomy pros-ta-TEK-to-me

Surgical removal of the prostate

vasectom_y va-SEK-to-me

Excision of the vas deferens. Usually done bilaterally to produce sterility (see Fig. 15-4). May be accomplished through the urethra (transurethral resection).

r SEP-tum

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Responses

  • PRISCA
    Are std's common in the male reproductive system?
    5 years ago

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