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Disorders of the Male Genitourinary System

Overview of Disorders and Their Effects

The male genitourinary system can be affected by a variety of disorders that impact both structure and function. These disorders may lead to problems with urine elimination, sexual function, and fertility.

• Structural Defects: Abnormalities in the anatomy of the penis, scrotum, or testes.

• Inflammation: Infection or immune responses causing swelling and pain.

• Neoplasms: Tumors or abnormal growths, which may be benign or malignant.

• Affected Functions:

  • Urine elimination

  • Sexual function

  • Fertility

Congenital and Structural Disorders of the Penis

Hypospadias and Epispadias

These are congenital malformations involving the urethral opening of the penis.

• Hypospadias: Urethra opens on the underside (ventral surface) of the penis.

  • Types: Glandular (tip), Penile (shaft), Perineoscrotal (near scrotum)

• Epispadias: Urethra opens on the top (dorsal surface) of the penis.

Phimosis and Paraphimosis

• Phimosis: Foreskin is too tight to retract over the glans penis.

• Paraphimosis: Retracted foreskin cannot return to cover the glans, causing swelling and pain. This can be a medical emergency if circulation is blocked.

Peyronie Disease

• Peyronie Disease: Scar tissue (fibrosis) forms in the tunica albuginea, leading to painful erections, a bent or curved penis, and a hard lump (plaque) under the skin.

Physiology of Erection

Components Involved in an Erection

An erection is a complex process involving neural, vascular, and muscular components.

• Autonomic Nervous System: Controls blood flow and smooth muscle relaxation.

• Neurotransmitters & Endothelial Relaxing Factors: Cause dilation of penile blood vessels.

• Vascular Smooth Muscle: In arteries and veins; relaxes to increase blood flow.

• Trabecular Smooth Muscle: In corpora cavernosa; relaxes to fill with blood, causing erection.

Erectile Dysfunction (ED)

Definition and Causes

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for sexual intercourse. Causes can be psychological or physical (organic).

• Psychological Causes:

  • Performance anxiety

  • Relationship problems

  • Depression

  • Mental health disorders (e.g., schizophrenia)

  • Overt psychotic disorders

• Physical (Organic) Causes:

  • Nerve problems (neurogenic)

  • Hormone imbalance

  • Poor blood flow (vascular)

  • Medication side effects

  • Penile structural issues

  • Aging – decreased blood flow and hormone levels

Diagnosis of Erectile Dysfunction

• Take a detailed medical, sexual, and psychosocial history

• Perform a physical exam

• Do lab tests to find or rule out possible physical (organic) causes

Priapism

Definition and Mechanisms

Priapism is a persistent, painful erection lasting more than 4 hours and not related to sexual stimulation.

• Low-flow (Ischemic) Priapism: Blood gets trapped in the penis (corpora cavernosa); venous outflow is blocked, leading to oxygen loss, pain, and swelling.

• High-flow (Nonischemic) Priapism: Too much arterial inflow due to trauma or vessel injury; usually less painful and not fully rigid.

Classifications of Priapism

• Primary Priapism: From trauma, infection, or tumor (neoplasm).

• Secondary Priapism:

  • Blood disorders: leukemia, sickle cell disease, thrombocytopenia

  • Nervous system causes: stroke, spinal cord injury, CNS lesions

  • Renal failure

Additional info:

• These disorders are not directly related to the core chapters of a college Microbiology course, but may be relevant in medical microbiology or pathology contexts, especially regarding infections and inflammation.