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The Male Reproductive System
Management of Men’s Reproductive 3 Health Problems Men’s Reproductive Health Curriculum Management of Men’s Reproductive 3 Health Problems © 2003 EngenderHealth. All rights reserved. 440 Ninth Avenue New York, NY 10001 U.S.A. Telephone: 212-561-8000 Fax: 212-561-8067 e-mail: [email protected] www.engenderhealth.org This publication was made possible, in part, through support provided by the Office of Population, U.S. Agency for International Development (USAID), under the terms of cooperative agreement HRN-A-00-98-00042-00. The opinions expressed herein are those of the publisher and do not necessarily reflect the views of USAID. Cover design: Virginia Taddoni ISBN 1-885063-45-8 Printed in the United States of America. Printed on recycled paper. Library of Congress Cataloging-in-Publication Data Men’s reproductive health curriculum : management of men’s reproductive health problems. p. ; cm. Companion v. to: Introduction to men’s reproductive health services, and: Counseling and communicating with men. Includes bibliographical references. ISBN 1-885063-45-8 1. Andrology. 2. Human reproduction. 3. Generative organs, Male--Diseases--Treatment. I. EngenderHealth (Firm) II. Counseling and communicating with men. III. Title: Introduction to men’s reproductive health services. [DNLM: 1. Genital Diseases, Male. 2. Physical Examination--methods. 3. Reproductive Health Services. WJ 700 M5483 2003] QP253.M465 2003 616.6’5--dc22 2003063056 Contents Acknowledgments v Introduction vii 1 Disorders of the Male Reproductive System 1.1 The Male -
Ultrasonography and Elastography Imaging
Jemds.com Case Report Post Traumatic Hematocele - Ultrasonography and Elastography Imaging Shivesh Pandey1, Suresh Vasant Phatak2, Gopidi Sai Nidhi Reddy3, Apoorvi Bharat Shah4 1, 2, 3, 4 Department of Radio diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra India. INTRODUCTION Hematocele with blunt scrotal trauma is an uncommon cause of the testicular pain. Corresponding Author: Elastography is the new recent advance in the field of ultrasound. USG and Dr. Suresh Vasant Phatak, elastography findings of the acute hematocele is described in this aricle. Department of Radiodiagnosis, Jawaharlal Testicular trauma is the third most common cause of acute scrotal pain,1 and Nehru Medical College, Sawangi (Meghe), high-frequency ultrasonography (USG) with a linear array transducer is the first Wardha, Maharashtra – 442001, India. E-mail: [email protected] preferred modality for testicular trauma evaluation. Extra testicular haematoceles or blood collections inside the tunica vaginalis are the most common findings in the DOI: 10.14260/jemds/2021/340 scrotum after blunt injury.2 On clinical assessment, haematocele appears as a hard mass like swelling and causes pain in the scrotum. In the majority of cases, How to Cite This Article: spontaneous resolution occurs with the support of conservative therapy,3 even if Pandey S, Phatak SV, Reddy GSN, et al. Post treated conservatively, may result in infection, discomfort, or atrophy in undiagnosed traumatic hematocele - usg and broad hematoceles and testicular hematomas over time.4 elastography imaging. J Evolution Med A testis with its coverings, epididymis, and spermatic cord are all contained in Dent Sci 2021;10(21):1636-1638, DOI: 10.14260/jemds/2021/340 each hemiscrotum. -
GERONTOLOGICAL NURSE PRACTITIONER Review and Resource M Anual
13 Male Reproductive System Disorders Vaunette Fay, PhD, RN, FNP-BC, GNP-BC GERIATRIC APPRoACH Normal Changes of Aging Male Reproductive System • Decreased testosterone level leads to increased estrogen-to-androgen ratio • Testicular atrophy • Decreased sperm motility; fertility reduced but extant • Increased incidence of gynecomastia Sexual function • Slowed arousal—increased time to achieve erection • Erection less firm, shorter lasting • Delayed ejaculation and decreased forcefulness at ejaculation • Longer interval to achieving subsequent erection Prostate • By fourth decade of life, stromal fibrous elements and glandular tissue hypertrophy, stimulated by dihydrotestosterone (DHT, the active androgen within the prostate); hyperplastic nodules enlarge in size, ultimately leading to urethral obstruction 398 GERONTOLOGICAL NURSE PRACTITIONER Review and Resource M anual Clinical Implications History • Many men are overly sensitive about complaints of the male genitourinary system; men are often not inclined to initiate discussion, seek help; important to take active role in screening with an approach that is open, trustworthy, and nonjudgmental • Sexual function remains important to many men, even at ages over 80 • Lack of an available partner, poor health, erectile dysfunction, medication adverse effects, and lack of desire are the main reasons men do not continue to have sex • Acute and chronic alcohol use can lead to impotence in men • Nocturia is reported in 66% of patients over 65 – Due to impaired ability to concentrate urine, reduced -
Urologic Disorders
Urologic Disorders Abdulaziz Althunayan Consultant Urologist Assistant professor of Surgery Urologic Disorders Urinary tract infections Urolithiasis Benign Prostatic Hyperplasia and voiding dysfunction Urinary tract infections Urethritis Acute Pyelonephritis Epididymitis/orchitis Chronic Pyelonephritis Prostatitis Renal Abscess cystitis URETHRITIS S&S – urethral discharge – burning on urination – Asymptomatic Gonococcal vs. Nongonococcal DX: – incubation period(3-10 days vs. 1-5 wks) – Urethral swab – Serum: Chlamydia-specific ribosomal RNA URETHRITIS Epididymitis Acute : pain, swelling, of the epididymis <6wk chronic :long-standing pain in the epididymis and testicle, usu. no swelling. DX – Epididymitis vs. Torsion – U/S – Testicular scan – Younger : N. gonorrhoeae or C. trachomatis – Older : E. coli Epididymitis Prostatitis Syndrome that presents with inflammation± infection of the prostate gland including: – Dysuria, frequency – dysfunctional voiding – Perineal pain – Painful ejaculation Prostatitis Prostatitis Acute Bacterial Prostatitis : – Rare – Acute pain – Storage and voiding urinary symptoms – Fever, chills, malaise, N/V – Perineal and suprapubic pain – Tender swollen hot prostate. – Rx : Abx and urinary drainage cystitis S&S: – dysuria, frequency, urgency, voiding of small urine volumes, – Suprapubic /lower abdominal pain – ± Hematuria – DX: dip-stick urinalysis Urine culture Pyelonephritis Inflammation of the kidney and renal pelvis S&S : – Chills – Fever – Costovertebral angle tenderness (flank Pain) – GI:abdo pain, N/V, and -
Non-Certified Epididymitis DST.Pdf
Clinical Prevention Services Provincial STI Services 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel : 604.707.5600 Fax: 604.707.5604 www.bccdc.ca BCCDC Non-certified Practice Decision Support Tool Epididymitis EPIDIDYMITIS Testicular torsion is a surgical emergency and requires immediate consultation. It can mimic epididymitis and must be considered in all people presenting with sudden onset, severe testicular pain. Males less than 20 years are more likely to be diagnosed with testicular torsion, but it can occur at any age. Viability of the testis can be compromised as soon as 6-12 hours after the onset of sudden and severe testicular pain. SCOPE RNs must consult with or refer all suspect cases of epididymitis to a physician (MD) or nurse practitioner (NP) for clinical evaluation and a client-specific order for empiric treatment. ETIOLOGY Epididymitis is inflammation of the epididymis, with bacterial and non-bacterial causes: Bacterial: Chlamydia trachomatis (CT) Neisseria gonorrhoeae (GC) coliforms (e.g., E.coli) Non-bacterial: urologic conditions trauma (e.g., surgery) autoimmune conditions, mumps and cancer (not as common) EPIDEMIOLOGY Risk Factors STI-related: condomless insertive anal sex recent CT/GC infection or UTI BCCDC Clinical Prevention Services Reproductive Health Decision Support Tool – Non-certified Practice 1 Epididymitis 2020 BCCDC Non-certified Practice Decision Support Tool Epididymitis Other considerations: recent urinary tract instrumentation or surgery obstructive anatomic abnormalities (e.g., benign prostatic -
Chronic Bacterial Prostatitis Treated with Phage Therapy After Multiple Failed Antibiotic Treatments
CASE REPORT published: 10 June 2021 doi: 10.3389/fphar.2021.692614 Case Report: Chronic Bacterial Prostatitis Treated With Phage Therapy After Multiple Failed Antibiotic Treatments Apurva Virmani Johri 1*, Pranav Johri 1, Naomi Hoyle 2, Levan Pipia 2, Lia Nadareishvili 2 and Dea Nizharadze 2 1Vitalis Phage Therapy, New Delhi, India, 2Eliava Phage Therapy Center, Tbilisi, Georgia Background: Chronic Bacterial Prostatitis (CBP) is an inflammatory condition caused by a persistent bacterial infection of the prostate gland and its surrounding areas in the male pelvic region. It is most common in men under 50 years of age. It is a long-lasting and Edited by: ’ Mayank Gangwar, debilitating condition that severely deteriorates the patient s quality of life. Anatomical Banaras Hindu University, India limitations and antimicrobial resistance limit the effectiveness of antibiotic treatment of Reviewed by: CBP. Bacteriophage therapy is proposed as a promising alternative treatment of CBP and Gianpaolo Perletti, related infections. Bacteriophage therapy is the use of lytic bacterial viruses to treat University of Insubria, Italy Sandeep Kaur, bacterial infections. Many cases of CBP are complicated by infections caused by both Mehr Chand Mahajan DAV College for nosocomial and community acquired multidrug resistant bacteria. Frequently encountered Women Chandigarh, India Tamta Tkhilaishvili, strains include Vancomycin resistant Enterococci, Extended Spectrum Beta Lactam German Heart Center Berlin, Germany resistant Escherichia coli, other gram-positive organisms such as Staphylococcus and Pooria Gill, Streptococcus, Enterobacteriaceae such as Klebsiella and Proteus, and Pseudomonas Mazandaran University of Medical Sciences, Iran aeruginosa, among others. *Correspondence: Case Presentation: We present a patient with the typical manifestations of CBP. -
Fournier's Gangrene: Challenges and Pitfalls for Genital Reconstruction from a Tertiary Hospital in South Africa
Plastic Surgery: Fournier’s gangrene: challenges and pitfalls for genital reconstruction Fournier’s gangrene: challenges and pitfalls for genital reconstruction from a tertiary hospital in South Africa G Steyn1, M G C Giaquinto-Cilliers2, H Reiner1, R Patel1, T Potgieter1 1MBChB (South Africa), Medical Officers 2MD (Brazil), Specialist Plastic Surgeon (South Africa), Head of Unit, Affiliated Lecturer of the Univer-sity of the Free State (Plastic and Reconstructive Surgery Department) Correspondence to: [email protected] Keywords: necrotising infection; necrotising fasciitis; Fournier’s gangrene; genital reconstruction; scrotal reconstruction Abstract Background: Fournier’s gangrene (FG) is an acute urological emergency described as a necrotising soft-tissue infection of the genitalia and perineum with associated polymicrobial infection, organ failure and death. The use of broad-spectrum antibiotics and immediate surgical debridementare the mainstays of treatment. The extensive debridement of all the necrotic tissue, the associated wound care and the recon- struction of the defect remain a big challenge. The prevalence in low-income countries such as South Africa seems to be higher when compared to international statistics despite the lack of published data. Patients and methods: A descriptive retrospective study was performed for the period of January 2006 up to December 2015 at Kimberley Hospital Complex, a facility which provides tertiary services to the Northern Cape Province (NCP) in South Africa. A search for all patients who underwent reconstructive procedures following the successful management of FG was performed using the Department of Plastic and Reconstructive Surgery’s database. Challenges and pitfalls for the performance of the reconstruction were analysed. Results: Sixty-four male patients underwent genital reconstruction after FG debridement. -
Epididymo- Orchitis
What about my partner? If you have been diagnosed with an STI, it is important that all of the people you have recently been in sexual contact with are given the option to be tested and treated. Your doctor or nurse will discuss this with you. When can I have sex again? You will have to wait until you have finished the antibiotics and have had a check-up by your A guide to doctor before having sex again, even sex with a condom or oral sex. Epididymo- If you were diagnosed with an STI, it is really orchitis important that you don’t have sex with your partner before they are tested and treated as you could become infected again. What happens if my epididymo-orchitis is left untreated? If you do not get treatment, the testicular pain and swelling will last much longer. Untreated infection is more likely to lead to complications such as long term testicular pain or an abscess. In rare cases, untreated infection can lead to shrinkage of the testicle and loss of fertility. You can order more copies of this leaflet free of charge from www.healthpromotion.ie October 2017 What is epididymo-orchitis? How do I get epididymo-orchitis? How can I be tested for epididymo-orchitis? Epidiymo-orchitis is a condition that affects men In most men under the age of 35, epididymo- Epididymo-orchitis is diagnosed based on your and is characterised by pain and swelling inside orchitis is caused by a sexually transmitted symptoms and what the doctor or nurse finds the scrotum (ball bag). -
Sexually Transmitted Infections and Increased Risk of Co-Infection with Human Immunodeficiency Virus
REVIEW ARTICLE Sexually Transmitted Infections and Increased Risk of Co-infection with Human Immunodeficiency Virus Margaret R.H. Nusbaum, DO, MPH; Robin R. Wallace, MD; Lisa M. Slatt, MEd; Elin C. Kondrad, MD The incidence of trichomoniasis (Trichomonas vaginalis) Clinical Presentation in the United States is estimated at 5 million cases annu- Urethritis, Epididymitis, and Proctitis ally; chlamydia (Chlamydia trachomatis) at 3 million; gon- In men, STIs usually remain confined to the urethra. Symptoms orrhea (Neisseria gonorrhoeae), 650,000; and syphilis (Tre- of urethritis include urethral discharge, dysuria, or urethral ponema pallidum), 70,000. However, most sexually itching. The discharge of nongonococcal urethritis (NGU) is transmitted infections (STIs) are asymptomatic—con- often slight, and may not be apparent without massaging the tributing to underdiagnosis estimated at 50% or more. urethra. Discharge of NGU is usually minimal and gray, white, Diagnosis of an STI signals sexual health risk because an or mucoid rather than yellow. Discharge that is yellow and pre- STI facilitates the transmission and acquisition of other sent in greater volume most often signals infection with N STIs, including human immunodeficiency virus (HIV). gonorrhoeae. In fact, comorbid STIs increase patients’ susceptibility of Epididymitis presents as acute unilateral testicular pain acquiring and transmitting HIV by two- to fivefold. Sev- and swelling. Clinical findings include tenderness of the epi- eral studies have shown that aggressive STI prevention, didymis and ductus deferens, erythema and edema of the testing, and treatment reduces the transmission of HIV. overlying scrotal skin, urethral discharge, and dysuria. Swelling The authors discuss common clinical presentations, and tenderness may be localized or may extend to the entire screening, diagnosis, and treatment for trichomoniasis, epididymis and surrounding areas, making the epididymis less chlamydia, gonorrhea, syphilis, and herpes simplex virus. -
The Management of Acute Testicular Pain in Children and Adolescents
BMJ 2015;350:h1563 doi: 10.1136/bmj.h1563 (Published 2 April 2015) Page 1 of 8 Clinical Review CLINICAL REVIEW The management of acute testicular pain in children and adolescents 1 2 1 Matthew T Jefferies specialist registrar in urology , Adam C Cox specialist registrar in urology , 1 3 Ameet Gupta specialist registrar in urology , Andrew Proctor general practitioner 1Department of Urology, University Hospital of Wales, Cardiff, UK; 2Institute of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK; 3Roath House Surgery, Cardiff, UK Sudden onset testicular pain with or without swelling, often aspect of the testes to the tunica vaginalis. Consequently the referred to as the “acute scrotum,” is a common presentation in testis is free to swing and rotate within the tunica vaginalis of children and adolescents, and such patients are seen by the scrotum. This defect is referred to as the “bell-clapper urologists, paediatricians, general practitioners, emergency deformity,” occurring in 12% of all males; of those, 40% of doctors, and general surgeons. Of the many causes of acute cases are bilateral 7 (figure⇓). This type of abnormality mainly scrotum, testicular torsion is a medical emergency; it is the one occurs in adolescents. In contrast, extravaginal torsion occurs diagnosis that must be made accurately and rapidly to prevent more often in neonates (figure), occurring in utero or around loss of testicular function. the time of birth before the testis is fixed in the scrotum by the This review aims to cover the salient points in the history and gubernaculum. Consequently, both the spermatic cord and the clinical examination of acute scrotum to facilitate accurate tunica vaginalis undergo torsion together, typically in or just diagnosis and prompt treatment of the most common below the inguinal canal. -
EAU Guidelines on Male Infertility$ W
European Urology European Urology 42 (2002) 313±322 EAU Guidelines on Male Infertility$ W. Weidnera,*, G.M. Colpib, T.B. Hargreavec, G.K. Pappd, J.M. Pomerole, The EAU Working Group on Male Infertility aKlinik und Poliklinik fuÈr Urologie und Kinderurologie, Giessen, Germany bOspedale San Paolo, Polo Universitario, Milan, Italy cWestern General Hospital, Edinburgh, Scotland, UK dSemmelweis University Budapest, Budapest, Hungary eFundacio Puigvert, Barcelona, Spain Accepted 3 July 2002 Keywords: Male infertility; Azoospermia; Oligozoospermia; Vasectomy; Refertilisation; Varicocele; Hypogo- nadism; Urogenital infections; Genetic disorders 1. Andrological investigations and 2.1. Treatment spermatology A wide variety of empiric drug approaches have been tried (Table 1). Assisted reproductive techniques, Ejaculate analysis and the assessment of andrological such as intrauterine insemination, in vitro fertilisation status have been standardised by the World Health (IVF) and intracytoplasmic sperm injection (ICSI) are Organisation (WHO). Advanced diagnostic spermato- also used. However, the effect of any infertility treat- logical tests (computer-assisted sperm analysis (CASA), ment must be weighed against the likelihood of spon- acrosome reaction tests, zona-free hamster egg penetra- taneous conception. In untreated infertile couples, the tion tests, sperm-zona pellucida bindings tests) may be prediction scores for live births are 62% to 76%. necessary in certain diagnostic situations [1,2]. Furthermore, the scienti®c evidence for empirical approaches is low. Criteria for the analysis of all therapeutic trials have been re-evaluated. There is 2. Idiopathic oligoasthenoteratozoospermia consensus that only randomised controlled trials, with `pregnancy' as the outcome parameter, can accepted Most men presenting with infertility are found to for ef®cacy analysis. have idiopathic oligoasthenoteratozoospermia (OAT). -
1 KEY WORDS: Testis, Epididymis, Torsion, Epididymitis, Ischemia
THE ACUTE SCROTUM KEY WORDS: Testis, epididymis, torsion, epididymitis, ischemia, tumor, infection, hernia LEARNING OBJECTIVES: At the end of medical school, the student should be able to: 1. Describe 6 conditions that may produce acute scrotal pain or swelling. 2. Distinguish, through the history, physical examination and laboratory testing, testicular torsion, torsion of testicular appendices, epididymitis, testicular tumor, scrotal trauma and hernia. 3. Appropriately order imaging studies to make the diagnosis of the acute scrotum. 4. Determine which acute scrotal conditions require emergent surgery and which may be handled less emergently or electively. INTRODUCTION: The “acute scrotum” may be viewed as the urologist’s equivalent to the general surgeon’s “acute abdomen.” Both conditions are guided by similar management principles: - The patient history and physical examination are key to the diagnosis and often guide decision making regarding whether or not surgical intervention is appropriate. - Imaging studies should complement, but not replace, sound clinical judgment. - When making a decision for conservative, non-surgical care, the provider must balance the potential morbidity of surgical exploration against the potential cost of missing a surgical diagnosis. - A small but real, negative exploration rate is acceptable to minimize the risk of missing a critical surgical diagnosis. DIFFERENTIAL DIAGNOSIS OF THE ACUTE SCROTUM A list of potential medical conditions that can present as acute pain or swelling of the scrotum are found