Kliniczne aspekty chorób układu płciowego męskiego: część 1 i 2 | Clinical Aspects of Male Reproductive System Diseases: part 1 and 2

Tooltip .tooltip { position: relative; cursor: pointer; text-decoration: none; border-bottom: 1px dashed rgba(0, 0, 0, 0.6); } .tooltip::before { content: attr(data-tooltip); position: absolute; top: -40px; /* Trochę niżej nad słowem */ left: 50%; /* Wyśrodkowanie */ transform: translateX(-50%); background-color: rgba(255, 255, 255, 0.9); color: #333; padding: 6px 12px; border-radius: 8px; white-space: nowrap; opacity: 0; visibility: hidden; transition: opacity 0.3s ease, visibility 0.3s ease; font-family: ‘Arial’, sans-serif; font-size: 14px; box-shadow: 0px 4px 8px rgba(0, 0, 0, 0.1); z-index: 10; } .tooltip:hover::before { opacity: 1; visibility: visible; } document.addEventListener(‘DOMContentLoaded’, function () { const wordsToTooltip = { “Testicular cancer”: “Rak jądra”, “Most common cancer”: “Najczęstszy nowotwór”, “Highly treatable”: “Wysoce uleczalny”, “Germ cells”: “Komórki rozrodcze”, “Testes”: “Jądra”, “Seminomas”: “Nasieniaki”, “Non-seminomas”: “Nienasieniaki”, “Genetics”: “Genetyka”, “Family history of testicular cancer”: “Historia rodzinna raka jądra”, “Cryptorchidism”: “Wnętrostwo”, “Undescended testes”: “Niezstąpione jądra”, “Caucasian men”: “Mężczyźni rasy białej”, “African American men”: “Mężczyźni rasy czarnej”, “Asian men”: “Mężczyźni rasy azjatyckiej”, “Malignant transformation”: “Przemiana złośliwa”, “Uncontrolled proliferation”: “Niekontrolowane namnażanie”, “Radiation therapy”: “Radioterapia”, “Chemotherapy”: “Chemioterapia”, “Painless testicular mass”: “Bezbolesny guz jądra”, “Self-examination”: “Samobadanie”, “Testicular discomfort”: “Dyskomfort w jądrze”, “Dull ache”: “Tępy ból”, “Heaviness in the scrotum”: “Uczucie ciężkości w mosznie”, “Gynecomastia”: “Ginekomastia”, “Hormone-producing tumors”: “Guzy produkujące hormony”, “Back pain”: “Ból pleców”, “Chest pain”: “Ból w klatce piersiowej”, “Respiratory symptoms”: “Objawy oddechowe”, “Physical examination”: “Badanie fizykalne”, “Ultrasound”: “Ultrasonografia”, “Tumor markers”: “Markery nowotworowe”, “Alpha-fetoprotein”: “Alfa-fetoproteina”, “Human chorionic gonadotropin”: “Ludzka gonadotropina kosmówkowa”, “Lactate dehydrogenase”: “Dehydrogenaza mleczanowa”, “CT scan”: “Tomografia komputerowa”, “Metastatic disease”: “Choroba przerzutowa”, “Orchiectomy”: “Orchidektomia”, “Surgical removal”: “Usunięcie chirurgiczne”, “Surveillance”: “Obserwacja”, “Five-year survival rate”: “Pięcioletni wskaźnik przeżycia”, “Benign prostatic hyperplasia”: “Łagodny rozrost gruczołu krokowego”, “Non-cancerous enlargement”: “Nienowotworowe powiększenie”, “Prostate gland”: “Gruczoł krokowy”, “Urinary symptoms”: “Objawy ze strony układu moczowego”, “Aging men”: “Starzejący się mężczyźni”, “Dihydrotestosterone”: “Dihydrotestosteron”, “Hyperplasia”: “Przerost”, “Stromal cells”: “Komórki zrębowe”, “Epithelial cells”: “Komórki nabłonkowe”, “Transition zone”: “Strefa przejściowa”, “Urinary frequency”: “Częste oddawanie moczu”, “Weak urine stream”: “Słaby strumień moczu”, “Incomplete bladder emptying”: “Niepełne opróżnianie pęcherza”, “Digital rectal exam”: “Badanie per rectum”, “Prostate-specific antigen test”: “Test na PSA”, “Urinalysis”: “Analiza moczu”, “Uroflowmetry”: “Uroflowmetria”, “Bladder ultrasound”: “USG pęcherza moczowego”, “Alpha-blockers”: “Alfablokery”, “5-alpha reductase inhibitors”: “Inhibitory 5-alfa reduktazy”, “Transurethral microwave thermotherapy”: “Przezcewkowa terapia mikrofalowa”, “Transurethral needle ablation”: “Przezcewkowa ablacja igłowa”, “Transurethral resection of the prostate”: “Przezcewkowa resekcja prostaty”, “Laser therapy”: “Terapia laserowa”, “Urinary retention”: “Zatrzymanie moczu”, “Prostatitis”: “Zapalenie prostaty”, “Inflammation of the prostate gland”: “Zapalenie gruczołu krokowego”, “Acute bacterial prostatitis”: “Ostre bakteryjne zapalenie prostaty”, “Chronic bacterial prostatitis”: “Przewlekłe bakteryjne zapalenie prostaty”, “Chronic prostatitis”: “Przewlekłe zapalenie prostaty”, “Chronic pelvic pain syndrome”: “Zespół przewlekłego bólu miednicy”, “Asymptomatic inflammatory prostatitis”: “Bezobjawowe zapalenie stercza”, “Gram-negative bacteria”: “Bakterie Gram-ujemne”, “Escherichia coli”: “Escherichia coli”, “Urinary tract infections”: “Infekcje dróg moczowych”, “Pelvic floor dysfunction”: “Dysfunkcja dna miednicy”, “High fever”: “Wysoka gorączka”, “Pelvic pain”: “Ból miednicy”, “Dysuria”: “Bolesne oddawanie moczu”, “Painful ejaculation”: “Bolesny wytrysk”, “Recurrent urinary tract infections”: “Nawracające infekcje dróg moczowych”, “Erectile dysfunction”: “Zaburzenia erekcji”, “Prostate fluid analysis”: “Analiza płynu sterczowego”, “Prostatic massage”: “Masaż prostaty”, “Broad-spectrum antibiotics”: “Antybiotyki o szerokim spektrum działania”, “Fluoroquinolones”: “Fluorochinolony”, “Trimethoprim-sulfamethoxazole”: “Trimetoprim-sulfametoksazol”, “NSAIDs”: “Niesteroidowe leki przeciwzapalne”, “Multimodal therapy”: “Terapia wielomodalna”, “Pain management”: “Zarządzanie bólem”, “Lifestyle modifications”: “Zmiana stylu życia”, “Abscess formation”: “Powstawanie ropnia”, “Biofilm formation”: “Tworzenie biofilmu”, “Hormonal changes”: “Zmiany hormonalne”, “Obesity”: “Otyłość”, “Physical activity”: “Aktywność fizyczna”, “Surgical procedures”: “Procedury chirurgiczne”, “Infertility”: “Niepłodność”, “Urethra”: “Cewka moczowa”, “Perineal discomfort”: “Dyskomfort w okolicy krocza”, “Intravenous antibiotics”: “Antybiotyki dożylne” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses normalizedWordsToTooltip[cleanedKey.toLowerCase()] = value; } function processNode(node) { if (node.nodeType === Node.TEXT_NODE && node.nodeValue.trim()) { let content = node.nodeValue; // Regex to match only the main words (ignores parentheses) const regex = new RegExp( `b(${Object.keys(normalizedWordsToTooltip).join(‘|’)})b`, ‘gi’ ); if (regex.test(content)) { const wrapper = document.createElement(‘span’); wrapper.innerHTML = content.replace(regex, (match) => { const tooltip = normalizedWordsToTooltip[match.toLowerCase().trim()]; return `${match}`; }); node.replaceWith(wrapper); } } else if (node.nodeType === Node.ELEMENT_NODE) { Array.from(node.childNodes).forEach(processNode); } } document.querySelectorAll(‘body *:not(script):not(style)’).forEach((element) => { Array.from(element.childNodes).forEach(processNode); }); });Podświetlanie tekstu z notatkami body { margin: 0; padding: 0; font-family: Arial, sans-serif; } .highlight { background-color: #cce7ff; /* Highlight color without notes */ position: relative; display: inline; } .highlight.with-note { background-color: #ffeb3b; /* Highlight color with notes */ } .note-box { position: absolute; background-color: #f9f9f9; color: #333; font-size: 14px; line-height: 1.6; padding: 10px 15px; border: 1px solid #ddd; border-radius: 5px; box-shadow: 0 2px 5px rgba(0, 0, 0, 0.2); max-width: 250px; z-index: 1000; white-space: normal; text-align: left; display: none; /* Hidden by default */ } .note-controls { position: absolute; top: -30px; right: -30px; display: flex; gap: 10px; z-index: 10; opacity: 0; pointer-events: none; transition: opacity 0.3s; } .note-controls.visible { opacity: 1; pointer-events: all; } .note-controls span { cursor: pointer; background-color: gray; color: white; padding: 5px 10px; border-radius: 5px; font-size: 16px; font-weight: bold; } .note-controls span:hover { background-color: darkgray; } document.addEventListener(“DOMContentLoaded”, () => { /** * Checks if an element is a header. */ const isHeaderElement = (node) => { while (node) { if (node.nodeType === 1 && node.tagName.match(/^H[1-5]$/)) { return true; } node = node.parentNode; } return false; }; /** * Checks if an element is inside a table cell. */ const isInsideTable = (node) => { while (node) { if (node.tagName === “TD” || node.tagName === “TH”) { return node; } node = node.parentNode; } return null; }; /** * Checks if an element belongs to the same list item. */ const isWithinSameListItem = (selection) => { if (selection.rangeCount === 0) return false; const range = selection.getRangeAt(0); const startContainer = range.startContainer; const endContainer = range.endContainer; const getClosestListItem = (node) => { while (node) { if (node.nodeType === 1 && node.tagName === “LI”) { return node; } node = node.parentNode; } return null; }; const startListItem = getClosestListItem(startContainer); const endListItem = getClosestListItem(endContainer); // Ensure selection is within the same list item return startListItem === endListItem; }; /** * Validates the selection. * Ensures the selection is within a single header, table cell, or list item. */ const isSelectionValid = (selection) => { if (selection.rangeCount === 0) return false; const range = selection.getRangeAt(0); const startContainer = range.startContainer; const endContainer = range.endContainer; const startInHeader = isHeaderElement(startContainer); const endInHeader = isHeaderElement(endContainer); // Block selection spanning headers if (startInHeader !== endInHeader) { return false; } const startCell = isInsideTable(startContainer); const endCell = isInsideTable(endContainer); // Block selection spanning table cells if (startCell && endCell && startCell !== endCell) { return false; } // Block selection spanning multiple list items if (!isWithinSameListItem(selection)) { return false; } return true; }; /** * Highlights the selected text. */ const wrapTextWithHighlight = (range) => { const fragment = range.extractContents(); const highlight = document.createElement(“span”); highlight.className = “highlight”; highlight.appendChild(fragment); range.insertNode(highlight); const noteControls = document.createElement(“div”); noteControls.className = “note-controls visible”; const editNote = document.createElement(“span”); editNote.textContent = “✎”; editNote.title = “Edit note”; noteControls.appendChild(editNote); const removeHighlight = document.createElement(“span”); removeHighlight.textContent = “x”; removeHighlight.title = “Remove highlight”; noteControls.appendChild(removeHighlight); highlight.style.position = “relative”; highlight.appendChild(noteControls); let noteBox = null; const updateNotePosition = () => { const rect = highlight.getBoundingClientRect(); if (noteBox) { noteBox.style.top = `${rect.height}px`; noteBox.style.left = `${rect.width / 2}px`; } }; const hideControlsAndNoteAfterDelay = () => { setTimeout(() => { noteControls.classList.remove(“visible”); if (noteBox) noteBox.style.display = “none”; }, 3000); }; // Show controls for 3 seconds after highlighting hideControlsAndNoteAfterDelay(); highlight.addEventListener(“click”, () => { noteControls.classList.add(“visible”); if (noteBox) noteBox.style.display = “block”; hideControlsAndNoteAfterDelay(); }); editNote.addEventListener(“click”, () => { const noteText = prompt(“Add or edit a note:”, noteBox?.textContent || “”); if (noteText) { if (!noteBox) { noteBox = document.createElement(“div”); noteBox.className = “note-box”; highlight.appendChild(noteBox); } noteBox.textContent = noteText; noteBox.style.display = “block”; highlight.classList.add(“with-note”); updateNotePosition(); hideControlsAndNoteAfterDelay(); } }); removeHighlight.addEventListener(“click”, () => { const parent = highlight.parentNode; while (highlight.firstChild) { parent.insertBefore(highlight.firstChild, highlight); } parent.removeChild(highlight); if (noteBox) noteBox.remove(); }); }; /** * Handles the mouseup event to validate and apply highlighting. */ document.body.addEventListener(“mouseup”, () => { const selection = window.getSelection(); if (selection.rangeCount > 0 && selection.toString().trim()) { if (!isSelectionValid(selection)) { alert(“Zaznaczenie musi być w obrębie jednego akapitu, komórki tabeli lub punktu listy!”); selection.removeAllRanges(); return; } const range = selection.getRangeAt(0); wrapTextWithHighlight(range); selection.removeAllRanges(); } }); });
Szacowany czas lekcji: 28 minut
.lesson-duration-container { background-color: #f0f4f8; /* Szarawe tło dopasowane do reszty strony */ padding: 8px 15px; /* Wewnętrzny odstęp */ border-radius: 8px; /* Zaokrąglone rogi */ font-family: ‘Roboto’, Arial, sans-serif; /* Czcionka Roboto, jeśli dostępna */ font-size: 16px; /* Rozmiar tekstu */ color: #6c757d; /* Ciemny szary kolor tekstu */ display: inline-block; /* Wyświetlanie jako element blokowy */ margin-bottom: 20px; /* Odstęp na dole */ border: none; /* Bez obramowania */ } .lesson-duration-label { font-weight: 700; /* Pogrubienie dla etykiety */ color: #6c757d; /* Ciemny szary kolor dla etykiety */ margin-right: 5px; /* Odstęp od wartości */ } .lesson-duration-value { color: #6c757d; /* Ciemny szary kolor dla wartości */ font-weight: 700; /* Pogrubienie dla wartości */ }

Testicular Cancer

Testicular cancer is the most common cancer in young men aged 15 to 35 years. Despite its prevalence in this age group, it is highly treatable, especially when detected early. The disease primarily originates from germ cells within the testes and is categorized into two main types: seminomas and non-seminomas.

Etiology and Risk Factors

  • Genetics: Family history of testicular cancer increases the risk.
  • Cryptorchidism: Undescended testes are a significant risk factor.
  • Demographics: Caucasian men have a higher incidence than African American or Asian men.
  • Age: Most commonly affects young men, particularly those between 15 and 35 years.

Pathophysiology

Testicular cancer originates from the germ cells of the testes. The cells undergo malignant transformation, leading to uncontrolled proliferation. Depending on the type, the cancer may grow slowly or rapidly, with varying tendencies to spread:

  • Seminomas: Typically grow slowly and are sensitive to radiation therapy.
  • Non-seminomas: More aggressive and may require a combination of surgery, chemotherapy, and radiation.

Clinical Manifestations

  • Painless Testicular Mass: The most common symptom, often discovered by the patient during self-examination.
  • Testicular Discomfort: Some men may experience a dull ache or heaviness in the scrotum.
  • Gynecomastia: Hormone-producing tumors can lead to breast enlargement or tenderness.
  • Symptoms of Metastasis: If the cancer has spread, patients may present with back pain, chest pain, or respiratory symptoms.

Diagnostic Approach

  • Physical Examination: A thorough testicular examination to detect masses or irregularities.
  • Ultrasound: The primary imaging tool to distinguish between solid and cystic masses.
  • Tumor Markers: Blood tests measuring levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH).
  • CT Scan: Used to assess for metastatic disease.

Treatment

  • Orchiectomy: Surgical removal of the affected testicle is the standard treatment.
  • Radiation Therapy: Often used for seminomas, particularly in early-stage disease.
  • Chemotherapy: Commonly used for non-seminomas or advanced cases.
  • Surveillance: Regular monitoring with imaging and blood tests to detect recurrence.

Prognosis

  • Generally Excellent: The overall 5-year survival rate for testicular cancer is over 95%, even for cases that have spread beyond the testicle. Early-stage testicular cancer has an even higher survival rate, close to 99%, with effective treatments like surgery and chemotherapy.

Benign Prostatic Hyperplasia (BPH)

BPH is a non-cancerous enlargement of the prostate gland, most commonly seen in aging men. While it is not life-threatening, BPH can cause significant urinary symptoms and affect a man’s quality of life.

Etiology and Risk Factors

  • Age: BPH is strongly associated with aging, with prevalence increasing significantly after the age of 50.
  • Hormonal Changes: Dihydrotestosterone (DHT) plays a key role in prostate growth.
  • Genetics: Family history may contribute to an increased risk.
  • Lifestyle: Obesity, lack of physical activity, and diet are associated risk factors.

Pathophysiology

BPH results from the hyperplasia of stromal and epithelial cells in the prostate, primarily in the transition zone. As the prostate enlarges, it compresses the urethra, leading to obstruction of urinary flow.

Clinical Manifestations

  • Urinary Frequency: Increased need to urinate, often more pronounced at night.
  • Urgency: A sudden, strong urge to urinate.
  • Weak Urine Stream: Reduced force of the urine stream.
  • Incomplete Bladder Emptying: Sensation of residual urine after urination.
  • Straining: Difficulty initiating urination.

Diagnostic Approach

  • Digital Rectal Exam (DRE): Assesses the size and texture of the prostate.
  • Prostate-Specific Antigen (PSA) Test: Elevated PSA levels can suggest BPH, though PSA is not specific to this condition.
  • Urinalysis: Rules out infection or hematuria.
  • Uroflowmetry: Measures urine flow rate to assess the severity of obstruction.
  • Bladder Ultrasound: Evaluates post-void residual volume.

Treatment

  • Watchful Waiting: Appropriate for men with mild symptoms.
  • Medications:
    • Alpha-Blockers: Relax the muscles of the prostate and bladder neck, improving urine flow.
    • 5-Alpha Reductase Inhibitors: Reduce prostate size by inhibiting the conversion of testosterone to DHT.
  • Minimally Invasive Procedures:
    • Transurethral Microwave Thermotherapy (TUMT): Uses heat to reduce prostate size.
    • Transurethral Needle Ablation (TUNA): Destroys excess prostate tissue with radiofrequency energy.
  • Surgical Options:
    • Transurethral Resection of the Prostate (TURP): The most common surgical procedure, involving the removal of prostate tissue via the urethra.
    • Laser Therapy: A less invasive option that uses laser energy to remove excess tissue.

Prognosis

Generally Good: BPH is not life-threatening, and about 50% of men experience symptom improvement with medication. Minimally invasive procedures have a success rate of 80-90% for long-term symptom relief. However, 30% of patients may experience progression or require further treatment to manage complications such as urinary retention or bladder damage.

Prostatitis

Prostatitis is an inflammation of the prostate gland that can be acute or chronic. It significantly affects a man’s quality of life due to pain, urinary symptoms, and sexual dysfunction. The condition is classified into four main types: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and asymptomatic inflammatory prostatitis.

Etiology and Risk Factors

  • Bacterial Infection: Commonly caused by gram-negative bacteria, such as E. coli, particularly in acute and chronic bacterial prostatitis.
  • Urinary Tract Infections: Previous UTIs can lead to bacterial prostatitis.
  • Pelvic Floor Dysfunction: Often implicated in CP/CPPS.
  • Prostate Procedures: Increases the risk of bacterial prostatitis.

Pathophysiology

ConditionPathophysiology
Acute Bacterial ProstatitisCaused by a bacterial infection that leads to acute inflammation, swelling, and localized pain.
Chronic Bacterial ProstatitisInvolves a persistent bacterial infection, typically with a biofilm formation that causes chronic inflammation and can lead to recurrent flare-ups.
Chronic Pelvic Pain Syndrome (CP/CPPS)Associated with a multifactorial mechanism, including pelvic floor muscle dysfunction, immune response, and neural mechanisms, though the precise etiology remains unclear.
Asymptomatic Inflammatory ProstatitisCharacterized by histological evidence of inflammation in the prostate tissue without clinical symptoms, often detected incidentally.

Clinical Manifestations

ConditionClinical Manifestations
Acute Bacterial Prostatitis– High fever, chills 
– Severe pelvic or perineal pain 
– Dysuria (painful urination) and urinary retention 
– Painful ejaculation
Chronic Bacterial Prostatitis– Recurrent urinary tract infections (UTIs) 
– Persistent pelvic or perineal discomfort 
– Dysuria 
– Discomfort during ejaculation
Chronic Pelvic Pain Syndrome (CP/CPPS)– Chronic pelvic pain lasting for at least three months 
– Urinary symptoms such as frequency and urgency 
– Erectile dysfunction
Asymptomatic Inflammatory Prostatitis– No symptoms; typically discovered during investigations for elevated PSA levels or infertility

Diagnostic Approach

  • Physical Examination: DRE may reveal a tender, swollen, or firm prostate.
  • Urinalysis and Urine Culture: Essential to detect bacteria and white blood cells, particularly in bacterial prostatitis.
  • Prostate Fluid Analysis: Obtained after prostatic massage, useful in chronic prostatitis to identify bacteria.
  • PSA Test: Often elevated in prostatitis, though not specific to this condition.
  • Imaging: Ultrasound or MRI may be used in complex cases to evaluate abscesses or other complications.

Treatment

ConditionTreatment
Acute Bacterial Prostatitis– Antibiotics: Broad-spectrum antibiotics, typically fluoroquinolones or trimethoprim-sulfamethoxazole, are the mainstay of treatment. 
– Pain Management: NSAIDs and alpha-blockers to relieve pain and urinary symptoms. 
– Hospitalization: Required in severe cases for intravenous antibiotics and supportive care.
Chronic Bacterial Prostatitis– Long-term Antibiotics: Often required for several weeks to eliminate the infection. 
– Alpha-Blockers: To reduce urinary symptoms.
Chronic Pelvic Pain Syndrome (CP/CPPS)– Multimodal Therapy: May include antibiotics, anti-inflammatory medications, alpha-blockers, physical therapy, and psychological support.
Asymptomatic Inflammatory Prostatitis– Typically does not require treatment unless associated with other conditions, such as infertility.

Prognosis

  • Acute Bacterial Prostatitis: Generally good with prompt antibiotic treatment. Most patients recover fully within a few weeks, but delayed treatment can lead to complications, such as abscess formation or progression to chronic prostatitis.
  • Chronic Bacterial Prostatitis: Variable prognosis, with symptoms often persisting despite prolonged antibiotic therapy. Approximately 50% of patients may experience recurrent flare-ups, though symptom control is achievable with a combination of treatments.
  • Chronic Pelvic Pain Syndrome (CP/CPPS): Prognosis is difficult to predict, and complete symptom relief is often challenging. However, many patients experience symptom reduction through multimodal therapy, including pain management and lifestyle modifications.
  • Asymptomatic Inflammatory Prostatitis: Generally good prognosis, as it does not cause symptoms or affect quality of life. It is often discovered incidentally, and treatment is typically unnecessary unless linked to other conditions.