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Chapter 20 Human Disease: Male Reproductive Systems
Terms in this set (56)
- Kidneys: produce urine.
• Excretory duct system:
- Ureter: conveys urine into bladder by peristalsis.
- Renal pelvis: expanded upper portion of ureter.
- Major calyces: subdivisions of renal pelvis.
- Minor calyces: subdivisions of major calyces into which renal papillae discharge.
• Bladder: stores urine:
- Discharges urine into urethra during voiding.
- Anatomic configuration of bladder and ureters normally prevents reflux of urine into ureters.
• Urethra: conveys urine from the bladder for excretion.
• Paired, bean-shaped organs below diaphragm adjacent to vertebral column.
• Divided into outer cortex and inner medulla (renal pyramids and columns).
• Excretory organs, functions along with lungs in excreting waste products of food metabolism.
Three basic functions of Kidneys
1. Excrete waste products of food metabolism:
• CO2 and H2O: end-products of carbohydrate and fat metabolism.
• Urea and other acids: end-products of protein metabolism that only the kidneys can excrete.
2. Regulate mineral and H2O balance:
• Excretes excess minerals and H20 ingested and conserves them as required.
• Body's internal environment is determined not by
what a person ingests but by what the kidneys retain.
3. Produces erythropoietin and renin: specialized cells in the kidneys:
• Erythropoietin: regulates RBC production in marrow.
• Renin: helps regulate blood pressure.
• Basic structural and functional unit of the kidney.
• About 1 million nephrons in each kidney.
• Consists of glomerulus and renal tubule.
- Tuft of capillaries supplied by an afferent glomerular arteriole that recombine into an efferent glomerular
- Material is filtered by a 3-layered glomerular filter.
• Inner: fenestrated capillary endothelium.
• Middle: basement membrane.
• Outer: capillary endothelial cells (with foot processes and filtration slits).
- Mesangial cells: contractile phagocytic cells that hold the capillary tuft together; regulate caliber of capillaries affecting filtration rate.
- Part of Nephron.
- Reabsorbs most of filtrate; secretes unwanted components into tubular fluid; regulates H2O balance.
- Proximal end: Bowman's capsule.
- Distal end: empties into collecting tubules.
• Requirements for normal renal function:
- Free flow of blood through the glomerular
- Normally functioning glomerular filter that restricts passage of blood cells and protein.
- Normal outflow of urine.
Renal Regulation of Blood Pressure
• Renin: released in response to decreased blood volume, low blood pressure, low sodium.
• Angiotensin I → angiotensin II by angiotensin
converting enzyme (ACE) as blood flows through the lungs.
• Angiotensin II:
- Powerful vasoconstrictor: raises blood pressure by
causing peripheral arterioles to constrict.
- Stimulates aldosterone secretion from adrenal cortex: increases reabsorption of NaCl and H2O by kidneys.
- Net effect: higher blood pressure, increased fluid in vascular system.
• System is self-regulating.
Congenital abnormalities of Kidneys
• Renal agenesis: failure of one or both kidneys to develop.
- Bilateral: rare, associated with other congenital anomalies, incompatible with life.
- Unilateral: common, asymptomatic; other kidney enlarges to compensate.
• Duplications of urinary tract:
- Complete duplication: formation of extra ureter and renal pelvis.
- Incomplete duplication: only upper part of excretory system is duplicated.
• Malposition: one or both kidneys, associated with fusion of kidneys; horseshoe kidney; fusion of upper pole.
• Inflammation of the glomeruli caused by antigen-antibody reaction within the glomeruli.
• Immune-complex glomerulonephritis:
- Usually follows a beta-streptococcal infection.
- Circulating antigen and antibody complexes are filtered by glomeruli and incite inflammation.
- Leukocytes release lysosomal enzymes that cause injury to the glomeruli.
- Occurs in SLE; immune complexes trapped in glomeruli.
- Occurs in IgA nephropathy.
• Anti-glomerular basement membrane (anti-GBM) glomerulonephritis: autoantibodies attack glomerular basement membrane.
• Marked loss of protein in the urine:
- Urinary excretion of protein > protein production.
- Protein level in blood falls.
- Causes edema due to low plasma osmotic
• Clinical manifestations:
- Marked leg edema.
Prognosis of Nephrotic Syndrome
- In children: minimal glomerular change, complete recovery.
- In adults: a manifestation of severe progressive renal disease.
• May result from:
- Diabetes (causing glomerular changes).
- Systemic lupus erythematosus, SLE.
- Other kidney diseases.
• Complication of severe hypertension.
• Renal arterioles undergo thickening from carrying blood at a much higher pressure than normal.
• Glomeruli and tubules undergo secondary degenerative changes causing narrowing of lumen and reduction in blood flow.
- Reduced glomerular filtration.
- Kidneys shrink.
- May die of renal insufficiency.
• Complication of long-standing diabetes.
• Nodular and diffuse thickening of glomerular basement membranes (glomerulosclerosis), usually with coexisting nephrosclerosis.
- Progressive impairment of renal function.
- Protein loss may lead to nephrotic syndrome.
- No specific treatment can arrest progression of
- Progressive impairment of renal function may lead to renal failure.
- Elevated blood uric acid levels lead to increased uric acid in tubular filtrate.
- Urate may precipitate in Henle's loops and
- Tubular obstruction causes damage.
- Impaired renal function.
- May lead to renal failure.
- Common in poorly-controlled gout.
Urinary Tract Infections
• Very common; maybe acute or chronic.
• Most infections are caused by gram-negative bacteria.
• Organisms contaminate perianal and genital areas and ascend urethra.
• Conditions protective against infection:
- Free urine flow.
- Large urine volume.
- Complete bladder emptying.
- Acid urine: most bacteria grow poorly in an acidic
Predisposing factors of Urinary tract infections
- Any condition that impairs free drainage of urine.
- Stagnation of urine favors bacterial growth.
- Injury to mucosa by kidney stone disrupts protective epithelium allowing bacteria to invade deeper tissue.
- Introduction of catheter or instruments into bladder may carry bacteria.
• Affects only the bladder
- More common in women than men; shorter female urethra, and, in young sexually active women, sexual intercourse promotes transfer of bacteria from urethra to bladder
- Common in older men, because enlarged prostate interferes with complete bladder emptying
Cystitis Clinical Manifestations
- Burning pain on urination.
- Desire to urinate frequently.
- Urine contains many bacteria and leukocytes.
-Responds well to antibiotics.
- May spread upward into renal pelvis and kidneys.
• Involvement of upper urinary tract from:
- Ascending infection from the bladder (ascending pyelonephritis).
- Carried to the kidneys from the bloodstream (hematogenous pyelonephritis).
Clinical Manifestations of Polynephritis
- Similar with an acute infection.
- Localized pain and tenderness over affected kidney.
- Responds well to antibiotics.
- Cystitis and pyelonephritis are frequently associated.
- Some cases become chronic and lead to kidney failure.
• Urine normally prevented from flowing back into the ureters during urination.
• Failure of mechanisms allows bladder urine to reflux into ureter during voiding:
- Predisposes to urinary tract infection.
- Predisposes to pyelonephritis.
• Stones may form anywhere in the urinary tract.
• Predisposing factors:
- High concentration of salts in urine saturates urine causing salts to precipitate and form calculi.
• Uric acid in gout.
• Calcium salts in hyperparathyroidism.
- Urinary tract infections reduce solubility of salts in urine; clusters of bacteria are sites where urinary salts may crystallize to form stone.
- Urinary tract obstruction causes urine stagnation, promotes stasis and infection, further increasing stone formation.
Urinary Calculi 2
- Staghorn calculus: urinary stones that increase in size to form large branching structures that adopt to the contour of the pelvis and calyces.
• Small stones may pass through ureters causing renal colic.
• Some become impacted in the ureter and need to be removed.
- Renal colic associated with passage of stone.
- Obstruction of urinary tract causes hydronephrosis-hydroureter proximal to obstruction.
Treatment of Urinary Calculi
- Cystoscopy: snares and removes stones lodged in distal ureter.
- Shock wave lithotripsy: stones lodged in proximal ureter are broken into fragments that are readily excreted.
• Blockage of urine outflow leads to progressive dilatation of urinary tract proximal to obstruction, eventually causes compression atrophy of kidneys.
- Hydroureter: dilatation of ureter.
- Hydronephrosis: dilatation of pelvis and calyces.
- Bilateral: obstruction of bladder neck by enlarged prostate or urethral stricture.
- Unilateral: ureteral stricture, calculus, tumor.
• Complications: stone formation; infections.
• Diagnosis and treatment: pyelogram, CT scan.
Foreign Bodies in Urinary Tract
• Usually inserted by patient • May injure bladder • Predispose to infection • Treatment
- Usually removed by cystoscopy
- Occasionally necessary to open bladder surgically
Renal Tubular Injury
- Impaired renal blood flow.
- Tubular necrosis caused by toxic drugs or chemicals.
• Clinical manifestation:
- Acute renal failure: oliguria, anuria.
- Tubular function gradually recovers.
- Treated by dialysis until function return.
• Solitary cysts common; not associated with impairment of renal function.
• Multiple cysts:
- Congenital polycystic kidney disease.
- Most common cause of multiple cysts.
- Mendelian dominant transmission.
- Cysts enlarge and destroy renal tissue and function.
- Onset of renal failure by late middle age.
- Suspected by physical examination that reveals greatly enlarged kidneys.
- Some form cysts in liver or cerebral aneurysm.
• Cortical tumors: arise from epithelium of renal tubules:
- Adenomas: usually small and asymptomatic.
- Carcinomas more common.
- Hematuria often first manifestation.
- Invades renal vein and metastasizes into bloodstream.
- Treated by nephrectomy.
• Transitional cell tumor: Arise from transitional epithelium lining urinary tract:
- Most arise from bladder epithelium.
- Hematuria: common first manifestation.
- Low grade malignancy; good prognosis.
• Nephroblastoma (Wilms Tumor):
- Uncommon; highly malignant; affects infants and children.
Renal Failure (Uremia)
• Retention of excessive byproducts of protein metabolism in the blood.
• Acute renal failure:
- Causes: tubular necrosis from impaired blood flow to kidneys or effects of toxic drugs.
- Renal function usually returns.
• Chronic renal failure:
- From progressive, chronic kidney disease; > 50% from chronic glomerulonephritis.
- Others include congenital polycystic kidney disease, nephrosclerosis, diabetic nephropathy.
Clinical Manifestations and Treatment of Renal Failure (Uremia)
• Clinical manifestations:
- Weakness, loss of appetite, nausea, vomiting.
- Toxic manifestations from retained waste
- Edema: retention of salt and water.
• Substitutes for the functions of the kidneys by
removing waste products from patient's blood.
• Waste products in patient's blood diffuse across a
semipermeable membrane into a solution (dialysate) into the other side of the membrane.
• Two types:
- Extracorporeal dialysis (more common): patient's
circulation connected to an artificial kidney machine.
- Peritoneal dialysis (less common): patient's own
peritoneum is used as the dialyzing membrane.
• Attempted when kidneys fail.
• Kidney is from a close relative donor or cadaver.
• Survival of transplant depends on similarity of HLA antigens between donor and recipient.
- Only identical twins have identical HLA antigens in their tissues; others invariably contain foreign
- Consequently, patient's immunologic defenses
will respond to the foreign antigens and attempt to destroy (reject) foreign kidney.
Renal Transplantation 2
• Patient's immune system must be
suppressed by drugs.
• Kidney is placed in the iliac area, outside the peritoneal cavity.
- >90% of transplanted kidneys survive for 5 years
when donor's HLA antigens resemble the patient's.
- Survival rate of cadaver transplants has improved in recent years.
Male Reproductive System: Anatomy
• Components of the male reproductive system.
• Accessory glands.
• Duct system to transport sperm from testes to
- Starts at epididymis.
- Continues on as vasa deferentia.
- Vasa deferentia extend upward in spermatic cords.
- Enter prostatic urethra as ejaculatory ducts.
- Urethra divided into long penile urethra and a short
segment traversing the prostate (prostatic urethra).
• Spherical gland that surrounds urethra just below the base of the bladder.
• Secretes thin alkaline fluid with a high concentration of an enzyme from prostatic epithelial cells.
• Prostatic secretions are discharged into the urethra during ejaculation.
• Secretions mix with sperm and secretions from seminal vesicles to form seminal fluid.
• Composed of numerous branched glands intermixed with masses of smooth muscle and fibrous tissue
• Inner group of glands
- Surround urethra as it passes through the prostate
- May give rise to benign hyperplasia
• Outer or main group of glands
- Makes up bulk of prostatic glandular tissue - May give rise to prostatic carcinoma
Benign Prostatic Hyperplasia
• Moderate enlargement of the prostate gland is relatively common in elderly men.
• Usually involves inner group of glands
surrounding the urethra.
• Obstructs the outflow of urine.
• Enlargement is significant if it obstructs
neck of the bladder, leading to incomplete emptying, or causes complete urinary tract obstruction.
Complications of Benign Prostatic Hyperplasia
- Cystitis: inflammation of urinary bladder.
- Pyelonephritis: inflammation of kidneys and pelvis.
- Calculi formation: stones.
- Hydronephrosis: distention of renal pelvis and calyces with urine due to obstruction.
• Gold standard: transurethral resection.
- Acute inflammation of the prostate.
• Spread of infection from bladder or urethra.
• May be secondary to gonococcal infection of posterior urethra.
- Mild inflammation.
- Causes few symptoms.
Gonorrhea and Chlamydia
• A common sexually transmitted disease:
- Initially, acute inflammation of anterior urethra.
- Inflammation may spread to posterior urethra and transport ducts.
- May also cause an acute inflammation of the rectal mucosa.
- Obstruction of vasa may block sperm transport and cause sterility.
• Nongonococcal urethritis:
- Caused by Chlamydia.
- Causes an acute urethritis.
- Clinically very similar to gonorrhea.
Carcinoma of the Prostate
• Usually originates in outer group of glands of the prostate.
- Common in elderly men; early case may be asymptomatic.
- Urinary obstruction from encroachment of bladder neck.
- Infiltration of tissues surrounding prostate.
• Metastasizes to bones of spine and pelvis.
• Acid phosphatase: secreted by normal prostatic cells and tumor cells; leaks into bloodstream; high levels in prostate cancer.
Carcinoma of the Prostate (2 of 3)
• Prostate-specific antigen, PSA.
- Secreted by prostatic epithelial cells.
• Tumor often grows slowly; may take ≥ 10
before it obstructs bladder or metastasizes to the bones.
- Digital rectal exam: irregularity or nodularity.
Carcinoma of the Prostate (3 of 3)
• Radical prostatectomy and radiation: seems to improve survival; controversy on effectiveness in elderly men.
• Radical prostatectomy.
- For small, localized tumor; may cause impotence due to disruption of nerve supply to penis.
• If with metastasis:
- Surgical removal of testes to eliminate source of testosterone that stimulate tumor growth.
- Drugs that suppress gonadotropic hormones to inhibit testicular testosterone secretion.
• Testis does not descend normally into scrotum:
- Usually retained in abdominal cavity; sometimes in
- Germ cells require a temperature lower than the normal body temperature.
- Interstitial cells function normally at body temperature.
- Germ cells are destroyed at higher intra-abdominal temperature.
- Interstitial cells of Leydig function normally and produce testosterone.
- Undescended testis more prone to developing testicular cancer; treat by surgically replacing testis in scrotum.
Cryptorchidism (2 of 2)
• In some newborns, testes may not have descended yet into scrotum but usually descend within 6 months after birth
• If descent has not occurred by 12 months, an ectopic testis that is not in the scrotum should be surgically brought into the scrotum
• Abnormal attachment of testis in scrotum:
- Predisposes to rotary twisting of testis and spermatic cord within scrotum.
- Shuts blood supply to testes.
• Manifestations and treatment:
- Acute onset of testicular pain and swelling.
- Leads to hemorrhagic infarction unless promptly untwisted.
- Untwist the torsion, firmly anchor affected testis within scrotum.
- Other testis also anchored in scrotum to prevent possible torsion.
- Excess fluid accumulates in tunica vaginalis.
- Treated by aspiration or resection of tunica vaginalis.
- Varicose veins in spermatic cord.
- Usually involves left side of scrotum.
- May impair fertility.
- Treatment required only if varicocele causes discomfort or impairs infertility.
• Consists of 3 cavernous bodies or cylinders of extremely vascular erectile tissue:
- Two lateral: corpora cavernosa.
- Midline: corpora spongiosum that surrounds penile urethra.
- Surrounded by thick fibrous connective tissue capsule (spongy meshwork of endothelium-lined blood sinuses).
- Supported by connective tissue and smooth muscle.
• Inability to achieve and maintain a penile erection.
• Common problem and frequency increases with age.
- Low testosterone level inhibits sexual desire and arousal.
- Damage to nerves supplying penis (prostate surgery;
- Impaired blood supply to penis: arteriosclerosis, diabetes.
- Certain anti-hypertensive drugs that target autonomic
- Stress, emotional factors, chronic diseases.
• Treatment: depends on cause of dysfunction.
- Use of drugs that inhibit phosphodiesterase to promote blood flow to penis.
Physiology of Penile Erection factors
• Complex process.
- Sexual desire: initiates physiologic events that increase blood flow to penis.
- Arteries supplying cavernous bodies must dilate to deliver a large volume of blood to penis.
- Pressure of blood in cavernous bodies must be high to compress draining veins.
- Blood must flow into penis faster than it drains out or erection cannot be maintained.
Physiology of Penile Erection
• Penile arteries are normally constricted:
- Little blood flows into cavernous bodies.
- Vascular sinuses are collapsed.
• In sexual arousal:
- Parasympathetic nerve impulses from sacral part of spinal cord cause release of nitric oxide.
- Nitric oxide causes relaxation of smooth muscle walls of penile arteries and trabeculae.
- Penile arteries dilate and sinuses in cavernous bodies expand.
Physiology of Penile Erection in Sexual Arousal
• In sexual arousal:
- Blood pours under high pressure into the sinuses.
- Increased blood pressure compresses veins retarding outflow of blood from penis.
- Engorgement of sinuses with results in rigidity and erection.
Carcinoma of the Testis
• Seminoma: malignant neoplasm of semen-producing epithelium.
• Malignant teratoma: composed of several types of malignant tissues.
• Choriocarcinoma: resembles the tumor that arises from uterine trophoblastic tissue.
- Resection of testicle and associated structures.
• Methods for monitoring response to therapy:
- Chorionic gonadotropin (HCG) test.
- Alpha fetoprotein (AFP) test.
Carcinoma of the Penis 2
• Rare in circumcised males.
• Caused by Papilloma virus.
• Treatment: partial or complete amputation of
penis; removal of inguinal lymph nodes.
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