Male Reproductive System Disorders

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• QWhat should I ask the urologist if I have a swollen testicle?

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  A Dr. Sangtae Park, MD , Urology, answered on behalf of NorthShore University HealthSystem

  1.  Is this an infection?
  2.  Do I need an ultrasound?
  3.  Do I need any blood tests?
  4.  Do I need to cryopreserve sperm?
  5.  Will I need surgery?
  6.  Will this affect my fertility or sexual function?
  7.  Do I need any other xrays or CT scans?

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• QWhat is the treatment for an epididymal cyst?

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  A Dr. Arthur R. Crowley, MD , Urology, answered

  An epididymal cyst is a sperm-filled cyst in the collecting tubes located just behind the testicle. This is often (medically) referred to as a spermatocele. Most times there are no symptoms and a spermatocele is diagnosed by self-examination or by a physician on routine physical examination. Symptoms, if present, can include, pain, swelling, and heaviness in the scrotum or redness of the scrotum. Treatment (surgical removal) is usually indicated when there are complaints of increase swelling, pain or discomfort, or embarrassment secondary to enlarged size.
• QHow is gynecomastia treated?

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  A Dr. Stuart A. Linder, MD , Plastic Surgery, answered

  Gynecomastia can be defined as excessive breast and glandular tissue in a male. Treament options depend on the severity of the diagnosis. The Tanner classification is used by the American Board of Plastic Surgery in staging the degree of gynecomastia. For mild cases liposuction alone may be used. For more severe cases that include thick glandular tissue behind the nipple areolar complex, a combination of liposuction and partial subcutaneous mastectomy should be perfomed through a periareolar approach.

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• QWhat are the treatment options for acute bacterial prostatitis?

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  A Dr. Farzanna S. Haffizulla, MD , Internal Medicine, answered on behalf of MDLIVE

  Acute Bacterial Prostatitis can be caused by bacterial infection of either gram negative, gram positive or both types of bacteria. If predominantly gram negative bacteria are involved, medicines such as Bactrim or Quinolones can be used effectively. For Gram positive bacteria, penicillin or cephalosporins can be used. There are a wide variety of these antibiotic combinations that can be used to provide broad coverage of these bacterial types. If any signs of sepsis are present or if the patient is unable to tolerate oral medicines, then IV antibiotics need to be used. Anti-inflammatory medicines can also be used to reduce pain and inflammation concurrent with antibiotic treatment.

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• QWhat is prostatitis?

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  A Dr. Madeleine M. Castellanos, MD , Psychiatry, answered on behalf of Good In Bed

  In younger and middle-aged men, prostatitis is often the culprit when there are difficulties. Prostatitis refers to an infection of the prostate which results in swelling of the tissues, thereby producing symptoms. Infections of the prostate can be either acute (short duration and quick onset) or chronic (long-standing and pervasive). In addition to the symptoms listed above, prostatitis can present with: 
   

  • Pain behind the testicles or in the pelvis or lower back (especially when seated for long periods)
  • Discomfort or pain in the penis or testicles
  • Pain or burning when urinating
  • Sense of heaviness in or behind the testicles

  
  In more severe cases, a man may also have fever, chills, nausea, or vomiting.  Bacterial or parasitic prostatitis can be sexually transmitted or due to improper hygiene.  These types of prostatitis are treated with medications, but can often be difficult to resolve and it's not uncommon to be on treatment for several weeks to months.  Although prostatitis is often caused by infection, there are cases of prostatitis where no bacteria or parasites are found.

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• QWhy should acute prostatitis be treated immediately?

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  A Dr. Harry Fisch, MD , Urology, answered

  Acute prostatitis (inflammation of the prostate, usually caused by a relatively fast-developing bacterial infection in the male urinary tract) should be treated immediately because the scarring that can develop from the infection can block the ejaculatory ducts, which are the tiny "ports" that allow sperm to mix with semen during ejaculation.
  
  But here's the thing: a lot of guys have mild, chronic infections that produce only subtle symptoms, such as occasional urinary frequency, mild but chronic fatigue, a dull aching in the lower back, testicles or bladder region, or no symptoms at all. A study of guys who did not complain of urinary symptoms, found that 32% showed evidence of low-grade infection or prostatitis. That's a pretty staggering figure -- and it's got some important implications. For one thing, we know that prostatitis can raise the level of prostate-specific antigen (PSA) in the blood. PSA is what doctors measure as an indication of prostate health and, specifically, prostate cancer.
  
  If a third of men have unrecognized chronic prostatitis, this means their PSA levels may be higher than normal and they may be shunted into additional tests for prostate cancer when the real problem is a low-grade infection or inflammation that could be easily cleared up with antibiotics or anti-inflammatory medication.
  
  In addition, the low-grade infections may be hurting the men's fertility. This is why one of the first things I look for if there's a question about a guy's fertility is low-grade prostatitis.
• QWhat is hematospermia?

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  A Dr. Harry Fisch, MD , Urology, answered

  Semen is normally milky white. If it's some shade of pink that means blood is mixing with the semen. The medical name for the condition is hematospermia. We believe the condition is common, but the prevalence of hematospermia is very difficult to calculate for the simple reason that many men ejaculate while inside their partner and, hence, they don't actually take a look at their semen. Many cases, therefore, undoubtedly go unreported. 
  
  Most patients have more than one episode of hematospermia, occurring over weeks to months.
  
  If blood in the semen persists for more than 10 ejaculations or for longer than 2 months, it should be formally evaluated.