Lesson 1, Topic 1
In Progress

Male Reproductive System Disorders

April 11, 2024

Learning Objective: Differentiate among the types of male reproductive system diseases and disorders, including the etiology, signs, symptoms, diagnostic procedures, and treatments.
      Common male reproductive disorder signs and symptoms include redness, swelling, or lumps in the organs. Changes in the urinary stream or issues during sexual intercourse (copulation) can also be seen. The following sections discuss male reproductive disorders.

Cancers of the Male Reproductive System
Learning Objective: Describe cancers of the male reproductive system, including the etiology, signs, symptoms, diagnostic procedures, and treatments.
      The most common cancers of the male reproductive system include prostate and testicular cancer. Penile cancer is a rare form of cancer and is highly curable in the early stages.

Prostate Cancer
Prostate cancer is one of the most common cancers among males, and the survival rate is very high. With prostate cancer, the gland can increase in size, obstruct the urethra, and cause additional urinary complications. About 1 in 8 men will be diagnosed with prostate cancer.
      Cells in the prostate gland mutate, causing cancer. The risk for prostate cancer is increased in men over 60 years of age, African Americans, or those with a family history of the disease. Having a brother or father with the disease doubles the risk. The risk for the aggressive form of prostate cancer is increased in men who are tall, obese, lack exercise, have a family history of the disease, are African American, consume a high intake of calcium, and have been exposed to Agent Orange. Prostate cancer tends to be a silent disease in the early stages. It is not until the cancer grows large enough to obstruct the urethra that symptoms are noticeable. Advanced prostate cancer presents the following signs and symptoms:
               • Problems with urination: slow, weak stream; frequency, nocturia
               • Hematuria, blood in the semen
               • Difficulty getting an erection
               • Hip pain, back pain
               • Loss of bladder or bowel control
      The provider completes a DRE during the examination, and a PSA blood test is done. If the DRE is abnormal or the PSA blood test level has increased from the baseline, a needle biopsy of the prostate may be done. If cancer is detected, additional imaging tests will be ordered to determine the extent of the cancer. Treatment will be based on the type of prostate cancer. With nonaggressive cancers, the provider may suggest frequent checks to monitor the cancer growth. For aggressive prostate cancers, a prostatectomy and radiation may be done.

Agent Orange
Agent Orange was an herbicide used by the US military to remove dense foliage during the Vietnam War. It is presumed that any veteran who served in Vietnam was exposed to Agent Orange. The Veteran’s Administration has attributed several diseases to Agent Orange. These diseases include diabetes mellitus, Hodgkin disease, multiple myeloma, hypothyroidism, Parkinson disease, and respiratory, bladder, and prostate cancers.
Veterans exposed to Agent Orange have a higher risk of developing prostate cancer, especially the aggressive form. Screening for prostate cancer is important in veterans exposed to Agent Orange. Male children of veterans with aggressive prostate cancer are also at greater risk of developing prostate cancer.

Prostate-Specific Antigen Blood Test
The prostate-specific antigen (PSA) blood test is used as a screening tool for prostate cancer. Both normal and cancerous prostate cells make the protein PSA. Often PSA levels increase in the blood when one has prostate cancer, prostatitis, or benign prostatic hyperplasia (BPH). Males are recommended to have a baseline PSA test at the age of 40. If the patient has an increased risk, the provider may decide to get a baseline PSA test earlier than age 40. The provider then checks the PSA level over time by comparing it to the baseline level. The higher the PSA level, the more likely it is the patient has prostate cancer. However, because the PSA level can be elevated with other disorders, one abnormal screening value is not enough to diagnose cancer. The reliability of the PSA blood test is debated, but it is the only screening tool available at this time.

27.9 Critical Thinking Application
Hannah is rooming Sam Fox, a 40-year-old father of three children. He is 6 feet tall. When Hannah obtains a family history on Sam, she learns that his father, a Vietnam veteran, was just diagnosed with aggressive prostate cancer. What risk factors does Sam have for prostate cancer?

Testicular Cancer
Testicular cancer is rare and highly treatable. It is the most common cancer in males between 15 and 35 years of age. It is more common in men with abnormal testicle development, an undescended testicle, and a family history of the cancer.
      Many causes of testicular cancer are unknown. The patient usually discovers a lump or swelling in the testicle. There may also be complaints of a heavy sensation in the scrotum. The patient may also experience pain in a testicle, the scrotum, abdomen, or groin.
To determine if a lump is testicular cancer, a provider may order the following:
               • Ultrasound and CT scan
               • Biopsy of testicular tissue
               • Blood tests to check the testicular cancer markers (alpha fetoprotein [AFP], beta-human chorionic gonadotropin [beta-hCG], and lactate dehydrogenase [LDH])
Treatment consists of surgery to remove the testicle (radical inguinal orchiectomy), radiation therapy, and chemotherapy.

FIGURE 27.16  Cryptorchidism.

Congenital Male Reproductive System Diseases and Disorders
Learning Objective: Describe congenital male reproductive system diseases and disorders.
Several types of congenital conditions can affect the male reproductive system:
                • Anorchism: The absence of one or both testes at birth
                • Chordee: Downward curve of the penis due to a congenital condition such as hypospadias
                • Cryptorchidism: Also called undescended testicle, or the testicle fails to descend into the scrotum (FIGURE 27.16); the testicle develops in the abdomen and starts its descent into the scrotum in utero around the seventh month; treatment for this condition consists of gonadotropic hormones and surgery (orchiopexy)
                • Epispadias: Congenital malformation causing the urethra to open on top of the penis
                • Hypospadias: Congenital malformation causing the urethra to open on the underside of the penis
                • Hydrocele: Fluid-filled sac in the scrotum, common in newborn infants and may go away in a few months (FIGURE 27.17); often caused by an inguinal hernia
                • Phimosis: Tightening of the penile foreskin that may result in the closure of the urethra opening, and the foreskin may not retract

Inflammatory Male Reproductive System Diseases and Disorders
Learning Objective: Describe inflammatory male reproductive system diseases disorders.
Several types of inflammatory conditions can affect the male reproductive system:
                • Balanitis: Inflammation of the head and foreskin of the penis
                • Epididymitis: Inflammation of the epididymis; often caused by a bacterial infection that starts in the bladder, prostate, or urethra
                • Orchitis: Inflammation of one or both testicles, usually caused by bacteria or viruses (e.g., mumps)
                • Prostatitis: Inflammation of the prostate that can obstruct urinary flow

FIGURE 27.17  Hydrocele

Structural and Functional Male Reproductive System Diseases and Disorders
Learning Objective: Describe structural and functional male reproductive diseases and disorders, including the etiology, signs, symptoms, diagnostic procedures, and treatments.
      Benign prostatic hyperplasia, erectile dysfunction, and male infertility are the most common structural and functional male reproductive disorders. The following sections describe these conditions along with additional disorders.

Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is a nonmalignant condition seen in about half of men over the age of 50 and more than 90% of men in their 70s and 80s.
      As men age, the cells of the prostate gland surrounding the urethra can start to reproduce more rapidly, causing the organ to enlarge (hyperplasia). The enlarged prostate compresses the urethra, causing urgency, frequency, difficulty starting urination, urine retention, dribbling, hematuria, and repeated UTIs.
      During the physical exam, the provider will do a digital rectal exam (DRE) by inserting a gloved finger in the rectum to palpate the prostate (FIGURE 27.18). Blood tests (e.g., prostate-specific antigen [PSA], tests of kidney function), urinalysis, transrectal biopsy, urodynamic tests, and cystoscopy may also be done. Treatments include the following:
                 • Lifestyle changes: Bladder training, avoiding caffeine and alcohol, and preventing constipation.
                 • Medications: Used independently or combined with other medications:
                                 • Alpha-blockers: Relax the smooth muscles of the prostate and the bladder neck to improve urine flow and reduce the blockage. Examples include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo).
                                 • 5-Alpha reductase inhibitors: Prevent growth of or shrinks the prostate. Examples include finasteride (Proscar, Propecia) and dutasteride (Avodart).
                 • Transurethral resection of the prostate (TURP) surgery: A lighted scope is inserted into the urethra, and all but the outer part of the prostate is removed.
                 • Laser therapy: A high-energy laser is used to destroy the overgrown prostate tissue.

FIGURE 27.18  Digital rectal exam (DRE).

27.10 Critical Thinking Application
Hannah is working with Mr. Endl, who has BPH. He asks Hannah why the BPH impacts his urine flow. How should Hannah respond to Mr. Endl?

Erectile Dysfunction
Erectile dysfunction (ED), also called impotence, occurs when a male has trouble keeping or getting an erection. ED is an ongoing issue that impacts relationships, affects males’ self-confidence, and can cause stress.
      Common conditions that lead to ED include heart disease, hypertension, tobacco use, alcoholism, diabetes, metabolic syndrome, Parkinson disease, prior pelvic surgeries and treatments, obesity, depression, and stress. Male arousal involves hormones, emotions, muscles, blood vessels, nerves, and the brain; thus any change in these may lead to ED. The sign of ED is trouble keeping or getting an erection firm enough for intercourse.
      After the physical exam, the provider may order tests to identify the cause of ED. Treatment consists of a healthy lifestyle and oral erectile dysfunction medications, including avanafil (Stendra), sildenafil (Viagra, Revatio), tadalafil (Adcirca, Cialis), and vardenafil (Levitra, Staxyn).

Male Infertility
Infertility is defined as not getting pregnant after 1 year or longer of unprotected sex. In about one-third of couples dealing with infertility issues, the cause is male infertility.
      In about half of the male infertility cases, the cause is unknown. Known causes of infertility include infections, undescended testicles, inherited disorders, dilated veins around the testicle (varicocele), hormone imbalances, and blockages preventing sperm movement. Sperm production can be affected by heat, chemicals, and toxins (e.g., heavy metals, industrial chemicals). Stress, depression, and using drugs, alcohol, and nicotine can also cause infertility.
      The main sign is not being able to conceive a child. Other signs and symptoms can include problems with sexual function, testicular swelling or pain, recurring respiratory infections, an inability to smell, low sperm counts, and decreased body and facial hair.
      The provider will do a complete medical history and physical exam. Additional diagnostic testing includes a semen analysis, hormone testing, testicular biopsy, and scrotal and transrectal ultrasounds. Treatments depend on the cause of infertility. Treatments may include surgery, antibiotics to treat an infection, hormone treatments, and assisted reproductive technology (ART), such as in vitro fertilization.

Additional Structural and Functional Male Reproductive Disorders
Additional structural and functional male reproductive disorders include the following:
                • Peyronie disease: Thick scar tissue develops in the penis, causing it to bend
                • Priapism: Painful erection that does not go away
                • Gynecomastia: Enlargement of breast tissue in males caused by an estrogen and testosterone imbalance
                • Spermatocele: A cyst-like mass filled with fluid and dead sperm cells; located in the epididymis
                • Testicular torsion: Twisting of the spermatic cord, causing the blood supply to be blocked off from the testicles; may occur after an injury to the area
                • Varicocele: Enlargement of the veins in the scrotum; may cause low sperm production and quality, leading to infertility