In benign prostatic hyperplasia (BPH) the prostate gland enlarges sufficiently to compress the urethra and cause some overt urinary obstruction. BPH begins with changes in periurethral glandular tissue. As the prostate enlarges, it may extend into the bladder and obstruct urine outflow by compressing or distorting the prostatic urethra. BPH may also cause a diverticulum musculature that retains urine when the rest of the bladder empties.

Recent evidence suggests a link between BPH and hormonal activity. As men age, production of androgenic hormones decreases, causing an imbalance in androgen and estrogen levels and high levels of dihydrotestosterone, the main prostatic intracellular androgen. Other theoretical causes include neoplasm, arteriosclerosis, inflammation, and metabolic or nutritional disturbances.

Epididymitis, infection of the epididymis (the cordlike excretory duct of the testis), is one of the most common infections of the male reproductive tract. It usually affects adults and is rare before puberty.

Epididymitis usually results from pyogenic organisms, such as staphylococci, Escherichia coli, streptococci, chlamydia, Neisseria gonorrhoeae, and Treponema pallidum. Infection usually results from established urinary tract infection and sexually transmitted disease (STD) or prostatitis extending to the epididymis through the lumen of the vas deferens. Rarely, epididymitis is secondary to a distant infection, such as pharyngitis or tuberculosis that spreads through the lymphatic system or, less commonly, the bloodstream.

Trauma may reactivate a dormant infection or initiate a new one. In addition, epididymitis is a complication of prostatectomy and may result from chemical irritation by extravasation of urine through the vas deferens.

Erectile dysfunction (ED) refers to the inability to attain or maintain penile erection long enough to complete intercourse. ED is characterized as primary or secondary. The patient with primary ED has never achieved sufficient erection. Secondary ED, which is more common and less serious than the primary form, implies that, despite the current inability, the patient has succeeded in completing intercourse in the past. Transient periods of ED aren’t considered dysfunctional and probably occur in 50% of males.

Three types of secondary ED occur:

ED affects all age-groups but becomes more common with age. The prognosis depends on the severity and duration of ED and on the underlying cause.

A hydrocele is a collection of fluid between the visceral and parietal layer of the tunica vaginalis of the testicle or along the spermatic cord. It’s the most common cause of scrotal swelling. It may be caused by an infection or trauma to the testes or epididymis or a testicular tumor.

Congenital hydrocele occurs when an opening between the scrotal sac and the peritoneal cavity allows peritoneal fluid to collect in the scrotum. The exact mechanism is unknown.

Prostate cancer is the most common neoplasm in males older than age 50; it’s a leading cause of male cancer death. Adenocarcinoma is the most common form; only seldom does prostate cancer occur as a sarcoma. Most prostate cancers originate in the posterior prostate gland, with the rest growing near the urethra. Malignant prostatic tumors seldom result from the benign hyperplastic enlargement that commonly develops around the prostatic urethra in older males.

Slow-growing prostate cancer seldom produces signs and symptoms until it’s well advanced. Typically, when primary prostatic lesions spread beyond the prostate gland, they invade the prostatic capsule and then spread along the ejaculatory ducts in the space between the seminal vesicles or perivesicular fascia. When prostate cancer is fatal, there is usually widespread bone metastasis.

Risk factors for prostate cancer include age (the cancer seldom develops in males younger than age 40), race (higher incidence in Blacks), and genetic factors. Men who have a first-degree relative with prostate cancer have twice the risk of developing it. Endocrine factors may also have a role, leading researchers to suspect that androgens speed tumor growth.