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6.6: Diseases and Disorders of the Male Reproductive System

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    Benign Prostatic Hypertrophy

    Benign prostatic hyperplasia (bē-NĪN prŏs-TĂT-ĭk hī-pĕr-PLĀ-zhē-ă) (BPH) refers to enlargement of the prostate that is not cancerous. See Figure 6.4[1] for an illustration of BPH. BPH is a common condition in males aged 50 and older. The prostate presses against the urethra, causing it to narrow. Eventually, the bladder becomes weak from trying to pass urine through the narrowed urethra. It loses its ability to completely empty, leaving some urine in the bladder called urinary retention. The inability to completely empty the bladder causes many of the symptoms associated with BPH, such as a frequent and intense urge to urinate, urinating frequently at night, difficulty starting a urine stream or a weak stream, and a sensation that the bladder has not emptied completely. If urinary retention is not addressed, it can cause complications such as urinary tract infections, bladder damage, and kidney damage.[2]

    Illustrations comparing a normal prostate with an enlarged prostate
    Figure 6.4 Benign Prostatic Hypertrophy

    A health care provider may order several types of medical tests to diagnose BPH, such as urodynamic testing or a cystoscopy.[3] Review information about these tests in the “Medical Specialists, Diagnostic Testing, and Procedures Related to the Urinary System” section in the “Urinary System Terminology” chapter.

    BPH may be treated with medications or transurethral (trans-ū-RĒ-thrăl) procedures where an instrument is inserted through the urethra to widen the urethra or destroy part of the prostate with heat. Transurethral microwave thermotherapy (trans-ū-RĒ-thrăl MĪ-krō-wāv THUR-mō-THĔR-ă-pē) (TUMT) eliminates excess tissue present in benign prostatic hyperplasia by using heat generated by microwave.

    Surgery may be performed when symptoms are severe, other treatments haven’t helped, or a complication has developed such as bladder damage. Surgeries remove part or all of the prostate or make cuts in the prostate to take pressure off the urethra.[4] For example, transurethral incision of the prostate (trans-ū-RĒ-thrăl in-SIZH-ŭn ŏv thĕ PRŌS-tāt) (TUIP) is a procedure that widens the urethra by making a few small incisions in the bladder neck and the prostate gland. Transurethral resection of the prostate (trans-ū-RĒ-thrăl rĭ-SĔK-shŭn ŏv thĕ PRŌS-tāt) (TURP) is the surgical removal of pieces of the prostate gland by using an instrument inserted through the urethra.

    Cancer

    Prostate Cancer

    Prostate cancer (PROS-tāt KAN-sĕr), cancer of the prostate gland, is the second most common cancer occurring in men. Prostate cancer is most common in older men. In the U.S., about 1 out of 8 men will be diagnosed with prostate cancer. Prostate cancer usually grows very slowly, so treating it before symptoms occur may not improve men’s health or help them live longer.[5]

    Symptoms of prostate cancer are similar to benign prostatic hypertrophy (BPH), such as trouble starting a urine stream and frequent urination, especially at night, and trouble emptying the bladder. Symptoms of advanced prostate cancer that have metastasized to other areas of the body include pain in the back, hips, or pelvis that doesn’t go away, shortness of breath, fatigue, fast heartbeat, dizziness, or pale skin caused by anemia.[6]

    Diagnostic testing for prostate cancer may include the following[7]:

    • A hydrocele (HĪ-drŏ-sēl) is a type of swelling in the scrotum, the pouch of skin that holds the testicles. This swelling happens when fluid collects in the thin sac that surrounds a testicle. Hydroceles are common in newborns. They often go away without treatment by age one.[20]

      Infertility

      Nearly 1 in 7 couples is infertile, which means they haven’t been able to conceive a child even though they’ve had frequent, unprotected sexual intercourse for a year or longer. In up to half of these couples, male infertility plays a role. Male infertility can be caused by low sperm production, abnormal sperm function, or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices, and other factors may contribute to male infertility.[21]

      For a male to cause pregnancy, the following processes must occur[22]:

      • Urogenital gonorrhea can be diagnosed by testing urine, a urethral swab (for men), or endocervical or vaginal swab (for women) using nucleic acid amplification testing (no͞o-klē-ĭk ĂS-ĭd ăm-plĭ-fĭ-KĀ-shŏn tĕst-ing) (NAAT). It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.[30]

        Human Immunodeficiency Virus (HIV)

        Human immunodeficiency virus (hu-man im-yŭ-nō-dĕ-FISH-ĕn-sē VĪ-rŭs) (HIV) is a virus that attacks the T-helper cells (a type of lymphocyte or white blood cell) of the immune system. If HIV is not treated, it can lead to acquired immunodeficiency syndrome (ă-KWĪRD im-yū-nō-dĕ-FISH-ĕn-sē SĬN-drōm) (AIDS). There is currently no cure for HIV, so people who become infected with HIV have it for life. However, with proper medical care, HIV can be controlled, and people with HIV can live long, healthy lives while also preventing its spread to their partners.[32]

        Most people infected with HIV have flu-like symptoms within two to four weeks after becoming infected. Symptoms include fever, night sweats, fatigue, swollen lymph nodes, sore throat, muscle aches, and rash. If not treated, the infection becomes chronic, with or without symptoms, and can take up to ten years to develop AIDS. Without HIV treatment, people with AIDS typically only survive about three years.[33]

        HIV tests can be performed on blood or oral fluid. HIV is treated with medication called antiretroviral therapy (ăn-tē-rĕ-trō-VĪ-răl THĔR-ă-pē) that reduces the amount of virus in the body, helps maintain a healthy immune system, and prevents AIDS from developing.[34]

        Herpes Simplex Virus

        Genital herpes (JEN-ĭt-ăl HĔRP-ēz) is an STI caused by the herpes simplex virus (HUR-pēz SĬM-pleks VĪ-rŭs) (HSV) that is characterized by blisters in the genital area. There are two types of herpes simplex viruses: HSV-1 and HSV-2. HSV-1 (oral herpes) causes mouth ulcers, commonly called “cold sores.” HSV-2 causes genital herpes when a person has genital contact with someone who has a genital HSV-2 infection. Additionally, a genital HSV-1 infection can occur when a person receives oral sex from a person with an HSV-1 oral ulcer. Herpes infection can also be passed from mother to child during pregnancy or childbirth, which can result in a potentially fatal neonatal herpes infection.[35]

        Herpes lesions typically appear as one or more vesicles (i.e., small blisters), on or around the genitals, rectum, or mouth. The vesicles break and leave painful ulcers that may take two to four weeks to heal after the initial herpes infection. Once a patient is infected with HSV, the virus remains in their body even after the symptoms are gone and can cause recurring outbreaks related to fever, stress, or other triggering factors.[36] See Figure 6.5[37] for an image of a mouth ulcer caused by HSV-1. Although this is not considered an STI, herpes lesions that occur on the genitals have a similar appearance.

        Image showing a mouth ulcer caused by H S V 1
        Figure 6.5 Mouth Ulcer Caused by HSV-1

        HSV nucleic acid amplification tests (NAAT) are the best test for diagnosing herpes, but in some settings, a viral culture is the only test available. There is no cure for herpes. Antiviral medications can shorten outbreaks, and daily suppressive therapy can prevent outbreaks and transmission of the infection to partners.[38]

        Human Papillomavirus

        Human papillomavirus (hu-man PAP-ĭ-LŌ-mă-VĪ-rŭs) (HPV) is a common STI. Almost three quarters of sexually active individuals have been exposed to HPV during their lifetime. HPV spreads through sexual activity and skin-to-skin contact in the genital area with an infected person. Because some types of HPV are asymptomatic, people don’t know they have the virus and, consequently, pass the virus to their sexual partners.[39]

        There are over 100 strains of HPV, and some strains of HPV can cause visible genital warts. Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Some strains of HPV cause genital, anal, throat, and cervical cancers. For this reason, routine PAP smears for women can help prevent cervical cancer from HPV.[40]

        Treatments are available for genital warts, but there is no cure for HPV. The HPV vaccine can protect against diseases (including cancers) caused by HPV. The HPV vaccine is recommended for all preteens (including boys and girls) at age 11 or 12 years and through age 26 years. Most sexually active adults have already been exposed to HPV, so vaccination is not recommended. People who are in a long-term, mutually monogamous relationship are not likely to get a new HPV infection.[41]

        Syphilis

        Syphilis (SIF-ĭ-lĭs) is an STI that can cause serious health problems without treatment. Infection develops in stages called primary, secondary, latent, and tertiary. Each stage can have different signs and symptoms. Syphilis is spread by direct contact with a syphilis sore during vaginal, anal, or oral sex. Syphilis can also be spread from a mother with syphilis to her unborn baby.[42]

        During the first (primary) stage of syphilis, a single sore or multiple sores appear in the location where syphilis entered the body. See Figure 6.6[43] for an image of a sore caused by syphilis, referred to as a chancre. Sores are typically firm, round, and painless. The sore usually lasts three to six weeks and heals regardless of whether treatment is received.

        Image showing a syphilis chancre on the index finger
        Figure 6.6 Syphilis Chancre

        During the secondary stage, skin rashes and/or sores in the mouth, vagina, or anus appear. The rash can show up when the primary sore is healing or several weeks after the sore has healed. The rash can also be on the palms of the hands and/or the bottoms of the feet and look rough, red, or reddish-brown. Without treatment, syphilis can spread to the brain and nervous system (neurosyphilis), the eye (ocular syphilis), or the ear (otosyphilis). This can happen during any of the stages. Syphilis is treated with antibiotics, but antibiotics do not reverse any damages that occurred prior to treatment.[44]

        Trichomoniasis

        Trichomoniasis (trĭk-ō-mō-NĪ-ă-sĭs) is a common STI caused by infection with Trichomonas vaginalis, a protozoan (tiny, single-celled) parasite. Although symptoms vary, most people who have trichomoniasis cannot tell they have it. Men with trichomoniasis may notice itching or irritation inside the penis, burning after urinating or ejaculating, or discharge from the penis. Women with trichomoniasis may notice itching; burning; redness or soreness of the genitals; dysuria; or a clear, white, yellowish, or greenish vaginal discharge with a fishy smell. Trichomoniasis is diagnosed with a swab specimen evaluated in a laboratory. It is treated with antibiotics taken by mouth.[45]

        Spermatocele

        A spermatocele (spĕr-MĂT-ō-sēl) is an abnormal sac (cyst) that develops in the epididymis, the small, coiled tube located on the upper testicle that collects and transports sperm. The cause of spermatoceles is unknown but could be due to a blockage in one of the tubes that transport sperm. If a spermatocele grows large enough to cause discomfort, surgery may be required.[46]

        Testicular Torsion

        Testicular torsion (tĕs-TĬK-ū-lăr TOR-shŏn) occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden, severe pain and swelling. Testicular torsion commonly occurs between ages 12 and 18 and usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.[47]

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