Chapter 43: Disorders of the Male Reproductive System

Disorders of the Male Reproductive System thoroughly explores the structural defects, inflammatory conditions, and neoplastic diseases impacting the male genitourinary system, classifying them into disorders affecting the penis, the scrotum and testes, and the prostate. Penile disorders range from congenital malformations like hypospadias and epispadias, to acquired conditions such as Peyronie disease, which causes penile curvature due to localized and progressive fibrosis, and phimosis or paraphimosis. The physiology of erection, a neurovascular process involving the autonomic and somatic nervous systems, is detailed alongside dysfunctions like Erectile Dysfunction (ED)—often resulting from organic causes such as vascular issues like arteriosclerosis or neurological factors—and priapism, a prolonged, painful erection that constitutes a urologic emergency due to the risk of ischemia and necrosis. Testicular and scrotal disorders include cryptorchidism (undescended testes), which is the most common congenital disorder of the genitourinary system, significantly increasing the risk of infertility and malignancy, and acute issues like testicular torsion, involving twisting of the spermatic cord that necessitates immediate surgical intervention to preserve the testicle. Fluid collections such as hydrocele (fluid in the tunica vaginalis), hematocele (blood accumulation), and spermatocele (sperm-containing cyst) are described. Inflammations include epididymitis and orchitis, the latter frequently associated with viral mumps infection. The text also examines testicular cancer, which is the most common cancer in males aged 15 to 35 years and is primarily comprised of malignant germ cell tumors such as seminomas and nonseminomas. Finally, prostatic disorders encompass various prostatitis syndromes, including acute and chronic bacterial forms and chronic pelvic pain syndrome. Benign Prostatic Hyperplasia (BPH), an age-related enlargement common in older males, is influenced by high levels of dihydrotestosterone (DHT) and causes lower urinary tract symptoms due to urethral compression. Prostate cancer, the most common nonskin cancer in the United States, is often asymptomatic in early stages, increasing rapidly in incidence after age 50, and requiring screening methods like PSA testing and digital rectal examination for diagnosis and clinical staging.