1. Prostate
1.1. Usual disease symptoms: urethral obstruction, irritation.
1.2. Inflammation
1.2.1. Acute Prostatitis
1.2.1.1. PMN inflammation
1.2.1.2. Most common: E. coli, S. aureus
1.2.1.3. Can be iatrogenic: catheter
1.2.2. Chronic Prostatitis
1.2.2.1. Symptoms more non-specific
1.2.2.1.1. Dysuria: painful, frequent urination
1.2.2.1.2. Low back pain
1.2.2.2. Cause: recurrent acute?
1.2.2.3. Inflammatory cells: Lymphocytes, plasma cells
1.3. Hyperplasia
1.3.1. BPH: proliferation of glandular and fibrous elements
1.3.1.1. Extremely common: 90% men over 80
1.3.1.2. BPH doesn't lead to Prostate cancer
1.3.1.3. Likely hormonally stimulated
1.3.1.4. Gross: nodular hyperplasia in periurethral region
1.3.1.5. Lower UT sypmtoms
1.3.1.5.1. Voiding
1.3.1.5.2. Storage
1.3.1.6. Management
1.3.1.6.1. Medicine: Alpha 1 blockers relax muscle
1.3.1.6.2. Surgical: TURP chips
1.3.1.6.3. Microwave thermotherapy
1.4. Neoplasia
1.4.1. Prostatic Adrenocarcinoma
1.4.1.1. Prevalence
1.4.1.1.1. Most common non-skin cancer of adult males 20%
1.4.1.1.2. Second leading cause of male cancer deaths: This is because it is so common
1.4.1.1.3. 300k new cases
1.4.1.1.4. More men die with prostate cancer than of it
1.4.1.1.5. 70% prevalence at age 70
1.4.1.2. Risk factors
1.4.1.2.1. Age, Race, Genetics
1.4.1.2.2. Androgens likely have a role
1.4.1.3. Effects: Peripheral/Transition zone
1.4.1.4. Screening: controversial
1.4.1.4.1. Serum prostate specific antigen PSA
1.4.1.4.2. No improvement in mortality rates due to PSA
1.4.1.4.3. Gold standard diagnosis: Blind ramdom biopsies
1.4.1.5. Low stage 5yr survival 50-80%
1.4.1.6. Disseminated 5yr survival 10-40%
1.4.1.7. Gleason Grading: Determines prognosis
1.4.1.7.1. Assigns 1-5 grade based on morphologic resemblance to normal prostate.
2. Genital
2.1. Testis
2.1.1. Cells
2.1.1.1. Spermatogonia
2.1.1.2. Leydig
2.1.1.3. Spermatocytes
2.1.1.4. Spermatids
2.1.1.5. Sertoli cells: nurse maid cells
2.1.2. Testis Congenital Anomalies
2.1.2.1. Maldescent
2.1.2.1.1. Testis should descend from abdomen during final 2 mos.
2.1.2.1.2. Cryptorchidism: unfound testis
2.1.2.1.3. Unilateral 75%
2.1.2.1.4. Majority idiopathic
2.1.2.1.5. Complications
2.1.2.2. Absence
2.1.2.3. Fusion
2.1.2.4. Cysts
2.1.3. Inflammation
2.1.3.1. Epididymis: gonorrhea, Tb
2.1.3.2. Orchitis (testis): syphilis
2.1.3.3. Bacterial infections -> acute inflammation -> fibrous scarring and infertility.
2.1.3.4. Children: epididymitis, is secondary to UT malformation->Gram neg. rods
2.1.3.5. Men under 35: STI, Chlamydia, trachomatis, N. gonorrhea
2.1.3.6. Men over 35: UTI, E. coli and Pseudomonas
2.1.4. Mumps Orchitis
2.1.4.1. 1 wk after parotid involvement
2.1.4.2. Unilater 70%
2.1.4.3. Infertility uncommon
2.1.5. Testicular tumors
2.1.5.1. Most important cause of firm, painless enlargement of testis.
2.1.5.2. Ages 15-34
2.1.5.3. Cryptorchidism, testicular dysgenesis (testicular feminization and Klinefelter syndrome), isochromosome 12.
2.1.5.4. Non-germ cell
2.1.5.4.1. Usually benign
2.1.5.4.2. Arise from Leydig, Sertoli cells
2.1.5.5. Germ cell 95%
2.1.5.5.1. Seminomatous
2.1.5.5.2. Non-seminomatous
2.1.5.5.3. 60% Germ cell tumors are mixed
3. Penile
3.1. Penile Malformations
3.1.1. Hypospadias - Ventral Opening
3.1.1.1. (1/300 male births)
3.1.2. Epispadias - Dorsal Opening
3.1.3. These can lead to UT obstruction --> UTI
3.2. Inflammatory Penile Diseases
3.2.1. Balanitis
3.2.1.1. Common cause: debris in uncircumcised
3.2.1.2. Can lead to Phimosis: scarring of prepuce
3.2.2. Genital Candidiasis
3.2.2.1. Skin infection in warm, moist area
3.2.2.2. More common in diabetics
3.2.2.3. Painful, itchy lesion
3.2.2.4. Penis, scrotum, intertriginous (two skin areas rub together)
3.3. Penile Tumors
3.3.1. Condyloma acuminatum
3.3.1.1. Not pre-malignant
3.3.1.2. HPV 6, 11
3.3.1.3. Coronal sulcus, inner surface of prepuce (Head, foreskin)
3.3.1.4. Red papillary excrescences (distinct outgrowth)
3.3.1.5. Hist: thickened, strat squam covers branching CT
3.3.2. Pre-malignant lesions
3.3.2.1. Have capacity to become invasive carcinomas
3.3.2.2. High Risk HPV 16, 18
3.3.2.3. Bowen's and Erythroplasia of Queryrat are same disease: difference is location and gross appearance
3.3.2.3.1. Bowen's Disease - Shaft and scrotum
3.3.2.3.2. Erythroplasia of Queyrat - glans and prepuce, erythematous patch
3.3.3. Penile Malignancies
3.3.3.1. Most common: Epithelial (Squamous cell carcinoma) 95%
3.3.3.2. Rare in USA <1%
3.3.3.3. Ages 40-70
3.3.3.4. Risk Factors: Poor hygiene, High Risk HPV, phimosis, smoking, immunosuppression.
3.3.3.5. Slow growing
3.3.3.6. Gross: crusted exophytic (outward projecting), distal penis.