Chapter 36: Alterations of the Male Reproductive System

Urethral pathology encompasses infectious urethritis from sexually transmitted organisms and stricture formation resulting from scarring due to infection or iatrogenic trauma. Penile disorders span congenital conditions such as phimosis and acquired inflammatory states including balanitis, fibrotic disorders like Peyronie disease causing penile curvature and dyspareunia, vascular emergencies such as priapism, and malignancy predominantly as squamous cell carcinoma associated with human papillomavirus and chronic inflammatory states. Scrotal and testicular pathology includes vascular disorders like varicocele impairing spermatogenesis, fluid collection as hydrocele, cryptorchidism with increased malignancy risk, the surgical emergency of testicular torsion, infectious orchitis with potential sterility sequelae, and testicular cancer as the most prevalent solid malignancy in young adult males. Prostate disorders encompassing benign hyperplasia causing urinary obstruction, bacterial and nonbacterial prostatitis syndromes, and prostate cancer as the most common non-cutaneous malignancy in men with grading by Gleason scoring and hormonal influences from testosterone, dihydrotestosterone, and estrogen. Sexual dysfunction involves vascular, neurologic, endocrine, and psychosocial etiologies affecting erectile capacity, ejaculatory function, and sexual desire, with therapeutic options including phosphodiesterase-five inhibitors and prosthetic reconstruction. Male infertility results from spermatogenic impairment, endocrine imbalances, gonadal trauma, toxic exposures, immunologic factors, or motility abnormalities, with semen analysis as the diagnostic standard. Male breast pathology includes gynecomastia from estrogen-androgen imbalance and breast cancer associated with genetic mutations and endocrine alterations. The chapter concludes with sexually transmitted infections including chlamydia, gonorrhea, syphilis, human papillomavirus, herpes simplex virus, human immunodeficiency virus, and other organisms with reproductive and systemic consequences.