00:00
In this section, we’ll take
a look at the remainder of
our male reproductive tract.
00:07
We have completed our discussion
of penile pathology here.
00:10
We’ll take a look at
pathology of testis,
epididymis, and the scrotum.
00:14
Once again, picture
what these look like.
00:17
know as to where we are,
so that you’re able
to clearly understand
the pathogenesis of each
one of these conditions.
00:25
Our topic at first
is cryptorchidism.
00:28
When I began the discussion,
we began our male reproductive
by looking at congenital
issues embryologically.
00:35
And we looked at the testis
beginning in the abdomen and
if it’s not properly pulled down by
the gubernaculum into the scrotum,
this is then called
cryptorchidism.
00:45
Let’s go into details.
00:46
One or both undescended testis.
00:49
Majority of which are located
in the inguinal canal.
00:52
Can you picture that?
Normally, they should be
resting in the scrotum.
00:56
However, it didn’t quite make it
and the testis is stuck
in the inguinal canal
Majority of them are.
01:03
Could they be back
in the abdomen?
Sure.
01:05
But go with the common.
01:07
There’s impaired spermatogenesis,
as you can imagine,
if the testis aren’t properly
located in the scrotum.
01:12
You need that optimum temperature
of 37 degrees, right?
And if you don’t have
that 37 degrees Celsius,
then it’s difficult for a male
to undergo spermatogenesis.
01:22
And so therefore –
well look for –
A different physiology
question of this would be
if you have a male that’s in different
temperatures, right?
Environments.
01:31
And so therefore, may not be the
most conducive to spermatogenesis
Even for example, bicyclists
and what do they do?
They sit on that seat for
hours and hours and hours.
01:42
And that disrupts
proper spermatogenesis.
01:45
No joke.
01:46
Meaning to say that even lifestyle
and the way that you lead it
could have serious
sequelae or consequences.
01:53
Presents in 1% of boys
at 1 year of age.
01:56
With increased occurrence in
premature or even Klinefelter.
02:00
Our topic cryptorchidism,
undescended testis,
1 in 1. 1% in 1 year of age.
02:05
Klinefelter is big.
02:07
What does your patient with
Klinefelter look like?
Picture that.
02:09
Patient, please?
Long arms, long legs,
maybe perhaps gynecomastia,
but the jaw looks like a male.
02:19
Testosterone levels are normal
in unilateral cryptorchidism
due to unaffected Leydig cells.
02:26
So you can have the other scrotum
with it’s Leydig cells in which --
You tell me as to what hormone
acts upon the Leydig cell.
02:33
Good. LH.
02:34
Responsible for
testosterone synthesis.
02:37
But descreased in
bilateral, obviously.
02:39
So here, if you have bilateral
undescended testis,
then the Leydig cells are not
able to properly perform.
02:45
So therefore, you would have
suboptimal levels of testosterone.
02:49
Is that understood?
That’s important.
02:52
Inhibin B levels are
depressed with increased
LH and FSH and there’s increased
risk of germ cell tumors.
02:59
These two bulletpoints are very,
very important for you to know.
03:02
If you don’t have proper –
I’m going to bring you back
to physiology real quick –
tell me as to where inhibin
B comes from in the male?
Good.
03:11
Sertoli cells.
03:12
So if you don’t have proper
descent of the testis,
then the sartoli cells are not able
to properly release inhibin B.
03:19
Inhibin B works on,
if you remember,
the hypothalamo–pituitary axis
and so therefore,
normally it inhibits.
03:27
So if you don’t
have the inhibin B,
you’re going to increase
your gonadotropin hormones,
increase LH and FSH.
03:33
Make sure you know the feedback.
03:35
Every little point
here has a story.
03:39
And the last little point
with cryptorchidism
is the fact that your
male is now prone to --
the most common family of testicular
tumors are germ cell tumors.
03:50
Of all the germ cell tumors,
which is the most common?
Seminoma.