Table Of Content

W.-B.Schill·F.H.Comhaire·T.B.Hargreave(Eds.) AndrologyfortheClinician W.-B. Schill · F. H.Comhaire · T. B. Hargreave (Eds.) Andrology for the Clinician With225Figuresin300Partsand120Tables Prof.em.Dr.Dr.Wolf-BernhardSchill CenterofDermatologyandAndrology,JustusLiebigUniversityGiessen Gaffystraße14 35385Giessen,Germany Prof.em.Dr.FrankComhaire CenterforMedicalandUrologicalAndrologyandReproductive Endocrinology,UniversityHospitalGhent6K12IE DePintelaan185 9000Ghent,Belgium Prof.Dr.TimothyB.Hargreave DepartmentofOncology,UniversityofEdinburgh HumanGeneticsBuilding,WesternGeneralHospital EdinburghEH42XU ScotlandUK ISBN3-540-23171-4 Springer-VerlagBerlinHeidelbergNewYork LibraryofCongressControlNumber:2005935881 Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations, recitation,broadcasting,reproductiononmicrofilmorinanyotherway,andstorageindata banks.Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisions oftheGermanCopyrightLawofSeptember9,1965,initscurrentversion,andpermissionfor usemustalwaysbeobtainedfromSpringer-Verlag.Violationsareliableforprosecutionunder theGermanCopyrightLaw. SpringerisapartofSpringerScience+BusinessMedia http://www.springer.com ˇ Springer-VerlagBerlinHeidelberg2006 PrintedinGermany Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformationaboutthe applicationofoperativetechniquesandmedicationscontainedinthisbook.Ineveryindividual casetheusermustchecksuchinformationbyconsultingtherelevantliterature. Editor:MarionPhilipp DeskEditor:EllenBlasig ProductionEditor:JoachimW.Schmidt Coverdesign:eStudioCalamar,Spain Typesetting:FotoSatzPfeiferGmbH,D-82166Gräfelfing Printedonacid-freepaper–24/3151–543210 Foreword Andrologyinitswidestsenseisafastgrowingmedicaldisciplinewithspecialem- phasisonthedisturbancesofmalereproductivefunctionincludingerectiledysfunc- tionandproblemsoftheageingmale.Thereisagreatneedtoeducateboththespe- cialistswhopractiseasandrologists,suchasendocrinologists,urologistsandder- matologists,aswellasthegeneralpractitioner,whoisofteninvolvedinthemanage- mentofthesepatients.Threeinternationalscientistsfromdifferentmedicaldisci- plines (dermatology, endocrinology and urology) have created an alternative to a classicaltextbookbyprovidinganewformatinthisbooktofacilitatethereviewof informationinthefieldprovidedbyalargenumberofinternationalexperts. Thistextbookiswrittenintwoparts.PartIprovideseasilyaccessible,brief,problem-orientedinformationaboutmodernandrologyincludingmalefactorinfertility, malecontraception,malegenitaltractinfectionandtumours.Thebookisintended tobeofusetothebusyclinicianandtoprovidequickaccesstodidacticinformation aboutcurrentpractice.PartIIissubject-orientedandprovidesthebackgroundsci- entificinformationfortherecommendationsinPartI.Thethreeeditorsarerecog- nizedexpertsinthefieldandhaveinvitedkeyinternationalscientiststowritevari- oussectionsofthisbookbut,bytheirextensivesub-editing,havecreatedahomoge- neousconcept.Thekeyfeaturesofthisbookaretheclearrecommendationsabout currentpracticeandeasyaccesstotheunderlyingscience.Ihavenodoubtthatthis textbookwillbeanassettotheclinicalandrologistbyfacilitatinginformationonto therapidlyincreasingscientificdatainthefastgrowingfieldofandrology. Itistheaimofthistextbooktoreachdoctorsworkinginthefieldofandrologyall overtheworldbutshouldbeofparticularvalueinEuropeancountries.Thebook willbevaluableforurologists,andrologists,dermatologists,endocrinologists,gyn- aecologists,reproductivebiologists,generalpractitioners,gerontologists,psycholo- gists,psychiatrists,paediatriciansandparamedicalsincludingallprofessionsallied tomedicineaswellaspharmaceuticalcompaniesworkinginthefieldofandrology. Iamsurethatthebookwillbeagreatsuccessandwillbeofgreatvaluetoitsreaders. DaviddeKretser MonashInstituteofMedicalResearch MonashUniversity,Melbourne Preface Andrologyisthemedicalpracticeofdisordersthatafflictmen.Theseincludecon- genitalandacquiredabnormalitiesofthemalereproductivesystemaswellasdisor- dersofthemaleendocrinesystem.Asthesemaybetreatedbydifferentdisciplines includingendocrinology,dermatology,urologicalsurgery,plasticsurgery,oncology, venereology,andsexualmedicine,itisdifficultfordoctorsinthesevariousspecial- tiestohaveaholisticviewofandrology.Wehopethatthisbookwillbeasourceof referencetothebroadspectrumofandrologicalconditionsandthatitwillpromote aholisticviewofandrologyandcatalyseinterdisciplinaryco-operationintheman- agementofandrologicaldisorders. Thebookiswrittenintwoparts:PartIpresentscurrentclinicalpractice,whereas PartIIprovidesthereaderwithmoredetailonthetheoreticalbackground.Theread- erwillfindchaptersonthediagnosisandtreatmentofdisordersofmalefertility,dis- ordersofmalesexualfunction,sexuallytransmittedinfections,disordersofandro- gen status, including ageing changes, and chapters on benign and malignant growthsofthemalereproductiveorgans.Inaddition,wehaveincludedchapterson phytotherapeutics and aesthetic dermatology and medical cosmetics because in practicemanymenseekthesetreatmentsandthecompetentandrologistneedsto understandalternativeaswellastraditionalapproaches. Ourcontributorsarefrommanydifferentcountriesandeachisanacknowledged expert. Wherever possible, reference has been made to the results of randomized clinicaltrialsandithasbeenourintentionthattheinformationinthisbookshould beevidence-based.Allcontributorswereaskedtopresentacomprehensivereviewof theirfieldaswellastheirownwork. Inpreviousyears,andrologicalproblemshavebeenrelativelyignoredbutthisis changingbecauseofthedevelopmentofeffectivetreatmentssuchasphosphodies- teraseinhibitorsforerectiledysfunctionand5-[-reductaseinhibitorsforprostatic enlargement, and as a result, greater media coverage of andrological disorders. Therefore,moremenseektreatmentandincreasinglymenexpecttheirclinicianto bewellinformedaboutallaspectsofandrology.Wehopethatthisbookwillhelpad- vancetowardsthatobjective. Wolf-BernhardSchill,FrankComhaire,TimothyHargreave Giessen–Ghent–Edinburgh,February2006 Contents ListofContributors ...........................XXI I.1.1.5 Prognosis ............................ 22 References............................ 22 Introduction I.1.2 DisordersofSexualDifferentiation Andrology:Definition,ClinicalIssues G.G.R.T’Sjoen........................ 23 andPrevalence I.1.2.1 Definition ............................ 23 W.-B.Schill,F.Comhaire,T.B.Hargreave .... 1 I.1.2.2 AetiologyandPathogenesis ............. 23 References .................................. 3 I.1.2.3 ClassificationofIntersex................ 23 I.1.2.4 ClinicalFindings ...................... 24 LayoutandHowtoUsetheBook I.1.2.5 Management.......................... 24 F.Comhaire ................................ 4 I.1.2.6 Prevention............................ 25 References............................ 25 GeneralConsiderations Evidence-BasedMedicineinReproductiveMedicine I.2 Problem:AbnormalPubertalDevelopment andAndrology S.A.Wudy............................ 27 F.Comhaire,A.Mahmoud ................... 5 I.2.1 Physiology ........................... 27 References .................................. 6 I.2.2 PrecociousPuberty .................... 27 EconomicCostandCost-Effectiveness F.Comhaire,A.Mahmoud ................... 7 I.2.3 DelayedPuberty ...................... 28 References .................................. 9 References............................ 28 EthicsofReproductiveResearchandTreatment I.3 MaleFactorFertilityProblems T.B.Hargreave ............................. 9 Introduction ................................ 9 I.3.1 Consensus-BasedApproachtoStandardized BasicPrinciplesUnderlyingEthicalConsiderations 10 DiagnosisandManagement Consent .................................... 10 oftheInfertileMale ApplyingthePrinciplestoReproductiveMedicine 11 F.Comhaire,A.Mahmoud ............ 29 Conclusion.................................. 13 References............................ 30 References .................................. 13 I.3.2 WHORecommendedDiagnostic HumanTissueforResearch FlowChart T.B.Hargreave ............................. 14 F.Comhaire,A.Mahmoud ............ 31 I.3.3 ImplicationsofMultifactorialAetiology intheDiagnosisandManagement I DiagnosingandSolvingClinicalProblems ofMaleInfertility F.Comhaire,A.Mahmoud ............ 33 I.1 Problem:GenderDysphoriaandDisorders References............................ 35 ofSexualDifferentiation I.3.4 SexualDysfunctionandMaleFertility I.1.1 GenderDysphoria T.B.Hargreave....................... 35 G.G.R.T’Sjoen........................ 19 I.3.4.1 DefinitionoftheDisease................ 35 I.1.1.1 Definition ............................ 19 I.3.4.2 AetiologyandPathogenesis ............. 35 I.1.1.2 AetiologyandPathogenesis ............. 19 I.3.4.3 ClinicalFindings:History,Physical I.1.1.3 ClinicalFindings ...................... 19 Examination,TechnicalInvestigations, I.1.1.4 Treatment ............................ 20 LaboratoryFindings ................... 36 X Contents I.3.4.4 DifferentialDiagnosis .................. 37 I.3.10 CongenitalDisordersandMaleInfertility I.3.4.5 Treatment ............................ 37 T.B.Hargreave...................... 63 I.3.4.6 ResultsofTreatment ................... 37 I.3.10.1 DefinitionoftheDisease............... 63 I.3.4.7 Prevention............................ 39 I.3.10.2 AetiologyandPathogenesis ............ 63 References.............................. I.3.10.3 ClinicalFindings:History,Physical Examination,TechnicalInvestigations, I.3.5 ReferenceValuesofSemenVariables LaboratoryFindings .................. 63 andTheirInterpretation I.3.10.4 DifferentialDiagnosis ................. 64 F.Comhaire,A.Mahmoud ............ 40 I.3.10.5 Treatment ........................... 64 References............................ 43 I.3.10.6 ResultsofTreatment .................. 65 I.3.6 NormalSpermatozoaandIsolated I.3.10.7 Prevention........................... 66 AbnormalitiesofSeminalPlasma I.3.11 AcquiredTesticularDamage F.Comhaire,A.Mahmoud ............ 44 G.Haidl ............................ 66 I.3.6.1 Definition ............................ 44 I.3.11.1 Definition ........................... 66 I.3.6.2 AetiologyandPathogenesis ............. 44 I.3.11.2 AetiologyandPathogenesis ............ 66 I.3.6.3 ClinicalandLaboratoryFindings ........ 45 I.3.11.3 ClinicalandLaboratoryFindings ....... 67 I.3.6.4 DifferentialDiagnosis .................. 45 I.3.11.4 DifferentialDiagnosis ................. 67 I.3.6.5 Treatment ............................ 45 I.3.11.5 Treatment ........................... 67 I.3.6.6 ResultsofTreatment ................... 46 I.3.11.6 ResultsofTreatment .................. 67 I.3.6.7 Prognosis ............................ 46 I.3.11.7 Prognosis............................ 67 I.3.6.8 Prevention............................ 46 I.3.11.8 Prevention........................... 68 I.3.6.9 Other ................................ 46 I.3.11.9 Other ............................... 68 References............................ 46 References ........................... 68 I.3.7 ImmunologicalCauses I.3.12 Cause:Varicocele A.Mahmoud,F.Comhaire ............ 47 F.Comhaire,A.Mahmoud............ 68 I.3.7.1 Introduction .......................... 47 I.3.12.1 Definition ........................... 68 I.3.7.2 MechanismsofMaleImmunityto I.3.12.2 AetiologyandPathogenesis ............ 68 Spermatozoa.......................... 47 I.3.12.3 ClinicalFindings,TechnicalInvestigations I.3.7.3 DetectionofAntispermAntibodies....... 48 andLaboratoryFindings............... 69 I.3.7.4 AntispermAntibodiesinMale I.3.12.4 DifferentialDiagnosis ................. 70 Infertility 49 I.3.12.5 Treatment ........................... 70 I.3.7.5 ClinicalAspectsofMenwithAntisperm I.3.12.6 ResultsofTreatment .................. 70 Antibodies............................ 50 I.3.12.7 Prognosis............................ 70 I.3.7.6 Perspectives .......................... 50 I.3.12.8 Prevention........................... 71 References............................ 51 I.3.12.9 Other ............................... 71 I.3.8 IatrogenicCausesofAbnormalSpermatozoa References ........................... 71 G.Haidl ............................. 53 I.3.13 Infection/InflammationoftheAccessory I.3.8.1 Definition ............................ 53 SexGlands I.3.8.2 AetiologyandPathogenesis ............. 53 F.Comhaire,A.Mahmoud............ 72 I.3.8.3 ClinicalandLaboratoryFindings ........ 55 I.3.13.1 Definition ........................... 72 I.3.8.4 DifferentialDiagnosis .................. 55 I.3.13.2 AetiologyandPhysiopathology ......... 72 I.3.8.5 Treatment ............................ 55 I.3.13.3 ClinicalandLaboratoryFindings ....... 72 I.3.8.6 ResultsofTreatment ................... 55 I.3.13.4 DiagnosisandDifferentialDiagnosis .... 73 I.3.8.7 Prognosis ............................ 55 I.3.13.5 Treatment ........................... 73 I.3.8.8 Prevention............................ 56 I.3.13.6 ResultsofTreatment .................. 73 I.3.8.9 Other ................................ 56 I.3.13.7 Prognosis............................ 74 References............................ 56 I.3.13.8 Prevention........................... 74 I.3.9 SystemicCausesofMaleInfertility References ........................... 74 A.Mahmoud,F.Comhaire ............ 57 I.3.14 EndocrineFactors I.3.9.1 Introduction .......................... 57 R.Weber ........................... 75 I.3.9.2 SystemicCauses ....................... 57 I.3.14.1 Definition ........................... 75 References............................ 61 I.3.14.2 AetiologyandPathogenesis ............ 75 I.3.14.3 ClinicalFindings ..................... 76 Contents XI I.3.14.4 Treatment ........................... 77 I.4.3 EjaculatoryDysfunction.Premature References ........................... 77 Ejaculation,DelayedEjaculation, Anejaculation,Low-VolumeEjaculation, I.3.15 Oligo-Astheno-Teratozoospermiawithno RetrogradeEjaculationandPainful DemonstrableCause(IdiopathicO-A-T) Ejaculation F.Comhaire,A.Mahmoud............ 77 T.B.Hargreave....................... 99 I.3.15.1 DefinitionoftheDisease............... 77 I.4.3.1 DefinitionoftheDisease................ 99 I.3.15.2 AetiologyandPathogenesis ............ 78 I.4.3.2 AetiologyandPathogenesis ............ 100 I.3.15.3 ClinicalFindings:History,PhysicalExam- I.4.3.3 ClinicalFindings:History,Physical ination,TechnicalInvestigations,Laboratory Examination,TechnicalInvestigations, Findings............................. 78 LaboratoryFindings .................. 101 I.3.15.4 DifferentialDiagnosis ................. 78 I.4.3.4 Treatment ........................... 102 I.3.15.5 Treatment ........................... 79 I.4.3.5 Prognosis ........................... 103 I.3.15.6 ResultsofTreatment .................. 79 I.4.3.6 Prevention........................... 103 I.3.15.7 Prognosis............................ 79 References I.3.15.8 Prevention........................... 79 I.3.15.9 Other ............................... 79 I.4.4 OrgasmDysfunction.................. 105 References ........................... 80 T.B.Hargreave...................... 105 I.4.4.1 DefinitionoftheDisease............... 105 I.3.16 Azoospermia I.4.4.2 AetiologyandPathogenesis ............... G.R.Dohle.......................... 81 I.4.4.3 ClinicalFindings:History,PhysicalExam- I.3.16.1 Definition ........................... 81 ination,TechnicalInvestigations,Laboratory I.3.16.2 Introduction ......................... 81 Findings............................. 106 I.3.16.3 Investigations ........................ 82 I.4.4.4 Treatment ........................... 106 References ........................... 84 References........................... 107 I.4 Problem:SexualDysfunction I.4.5 AbnormalLibido B.Brosig ........................... 107 I.4.1 ErectileDysfunction I.4.5.1 Definition ........................... 107 T.B.Hargreave...................... 85 I.4.5.2 Epidemiology ........................ 108 I.4.1.1 DefinitionoftheDisease............... 85 I.4.5.3 AetiologyandPathogenesis ............ 108 I.4.1.2 AetiologyandPathogenesis ............ 85 I.4.5.4 ClinicalFindings ..................... 109 I.4.1.3 ClinicalFindings:History,PhysicalExam- I.4.5.5 Therapy............................. 109 ination,TechnicalInvestigations,Laboratory I.4.5.6 Prognosis ........................... 110 Findings............................. 87 References........................... 110 I.4.1.4 Treatment ........................... 88 I.4.1.5 ResultsofTreatment .................. 91 I.4.6 SexualDeviationandParaphilias I.4.1.6 Prevention........................... 92 M.Beutel .......................... 111 References ........................... 92 I.4.6.1 Definition ........................... 111 I.4.6.2 AetiologyandPathogenesis ............ 111 I.4.2 ErectileDeformity,IncludingPeyronie’s I.4.6.3 PaedophiliaasanExampleofParaphilia 112 Disease I.4.6.4 DiagnosisandTreatment .............. 112 T.B.Hargreave...................... 93 References........................... 113 I.4.2.1 DefinitionoftheDisease............... 93 I.4.2.2 AetiologyandPathogenesis ............ 93 I.5 Problem:MaleContraception I.4.2.3 ClinicalFindings:History,PhysicalExam- ination,TechnicalInvestigations,Laboratory I.5.1 ControversiesRegardingPost-Vasectomy Findings............................. 94 Management I.4.2.4 Treatment ........................... 95 J.Shah,H.Fisch..................... 114 I.4.2.5 ResultsofTreatment .................. 97 I.5.1.1 Introduction ......................... 114 I.4.2.6 Prevention........................... 98 I.5.1.2 Definition ........................... 114 References ........................... 98 I.5.1.3 Prevalence........................... 114 I.5.1.4 Treatment ........................... 115 I.5.1.5 ResultsofTreatment .................. 115 I.5.1.6 Conclusion .......................... 117 References........................... 117 XII Contents I.5.2 VasectomyReversal I.7 Problem:EmergenciesinAndrology A.Belker ........................... 119 I.7.1 TesticularTorsion I.5.2.1 Indications .......................... 119 C.F.Heyns,A.J.Visser ............... 134 I.5.2.2 Contraindications .................... 119 I.7.1.1 Definition .......................... 134 I.5.2.3 VasectomyReversalTechniques ......... 119 I.7.1.2 AetiologyandPathogenesis ........... 136 I.5.2.4 PostoperativeCare .................... 120 I.7.1.3 ClinicalFindings .................... 138 I.5.2.5 Complications ....................... 120 I.7.1.4 DifferentialDiagnosis ................ 145 I.5.2.6 Results .............................. 120 I.7.1.5 Treatment .......................... 146 I.5.2.7 Conclusions ......................... 120 I.7.1.6 ResultsofTreatment ................. 150 References........................... 121 I.7.1.7 Prognosis........................... 151 I.5.3 MaleContraception I.7.1.8 Prevention.......................... 155 D.Handelsman,G.Waites ........... 121 I.7.1.9 Conclusions......................... 156 I.5.3.1 Introduction ......................... 121 References .......................... 156 I.5.3.2 HormonalMethods ................... 121 I.7.2 BluntTesticularTrauma I.5.3.3 NonhormonalMethods................ 121 J.Vale ............................. 162 I.5.3.4 Vaccines............................. 121 I.7.2.1 Definition .......................... 162 I.5.3.5 Conclusions ......................... 122 I.7.2.2 AetiologyandPathogenesis ........... 162 References........................... 122 I.7.2.3 Diagnosis........................... 162 I.5.4 TraditionalMethods I.7.2.4 Treatment–ConservativeVersusSurgical 163 D.Handelsman,G.Waites ........... 122 I.7.2.5 PostoperativeFollow-up .............. 163 I.5.4.1 Introduction ......................... 122 References .......................... 163 I.5.4.2 Conclusions ......................... 124 I.7.3 PenileFractures References........................... 124 W.D.Aiken ......................... 164 I.7.3.1 DefinitionoftheDisease.............. 164 I.6 Problem:ReproductiveTractInfections I.7.3.2 AetiologyandPathogenesis ........... 164 I.6.1 ReproductiveTractInfections/Sexually I.7.3.3 ClinicalFindings .................... 164 TransmittedDiseases I.7.3.4 PhysicalExamination ................ 165 F.R.Ochsendorf .................... 125 I.7.3.5 Investigations ....................... 165 I.6.1.1 DefinitionoftheDisease............... 125 I.7.3.6 DifferentialDiagnosis ................ 165 I.6.1.2 AetiologyandPathogenesis ............ 125 I.7.3.7 Treatment .......................... 165 I.6.1.3 ClinicalFindings:History,PhysicalExam- I.7.3.8 ResultsofTreatment ................. 166 ination,TechnicalInvestigations,Laboratory I.7.3.9 Prognosis........................... 166 Findings............................. 126 I.7.3.10 Prevention.......................... 166 I.6.1.4 DifferentialDiagnosis ................. 129 References .......................... 166 I.6.1.5 Treatment ........................... 129 I.7.4 Priapism I.6.1.6 ResultsofTreatment .................. 129 P.Kumar,D.J.Ralph ................ 166 I.6.1.7 Prognosis ........................... 129 I.7.4.1 Definition .......................... 166 I.6.1.8 Prevention........................... 129 I.7.4.2 AetiologyandPathogenesis ........... 166 I.6.1.9 Other ............................... 129 I.7.4.3 ClinicalFindings,TechnicalInvestigations References........................... 130 andLaboratoryFindings.............. 167 I.6.2 HIVInfection I.7.4.4 Treatment .......................... 168 F.R.Ochsendorf .................... 131 I.7.4.5 Conclusion ......................... 169 I.6.2.1 DefinitionoftheDisease............... 131 References .......................... 169 I.6.2.2 AetiologyandPathogenesis ............ 131 I.7.5 TesticularPainandRelatedPain I.6.2.3 ClinicalFindings:History,PhysicalExam- Syndromes ination,TechnicalInvestigations,Laboratory T.B.Hargreave,L.Turner-Stokes ... 170 Findings............................. 131 I.7.5.1 DefinitionoftheDisease.............. 170 I.6.2.4 Treatment ........................... 131 I.7.5.2 AetiologyandPathogenesis ........... 170 I.6.2.5 ResultsofTreatment .................. 132 I.7.5.3 ClinicalFindings:History,PhysicalExam- I.6.2.6 Prognosis ........................... 132 ination,TechnicalInvestigations,Laboratory I.6.2.7 Prevention........................... 132 Findings............................ 173 I.6.2.8 Other ............................... 132 I.7.5.4 DifferentialDiagnosis ................ 174 References........................... 132 I.7.5.5 Treatment .......................... 174 Contents XIII I.7.5.6 ResultsofTreatment ................. 176 I.8.5 Circumcision I.7.5.7 Prognosis........................... 177 C.F.Heyns,J.N.Krieger ............. 203 I.7.5.8 Conclusion ......................... 177 I.8.5.1 Introduction ........................ 204 References .......................... 177 I.8.5.2 EpidemiologyofCircumcision......... 204 I.8.5.3 EmbryologyandFunctionoftheForeskin 204 I.8 BenignLesionsandMalignantTumours I.8.5.4 IndicationsforCircumcision .......... 205 oftheMaleGenitalTract I.8.5.5 ContraindicationsforCircumcision .... 206 I.8.5.6 ComplicationsofCircumcision ........ 207 I.8.1 ScrotalBenignLesions,Epididymal I.8.5.7 CurrentControversiesAbout Cysts,EpididymalTumours Circumcision ....................... 208 K.Turner.......................... 179 I.8.5.8 AlternativestoCircumcision .......... 210 I.8.1.1 Hydrocele .......................... 179 I.8.5.9 Conclusions......................... 210 I.8.1.2 EpididymalCysts .................... 181 References .......................... 211 I.8.1.3 EpididymalTumours ................. 181 I.8.1.4 OtherBenignEpididymalLesions:Sperm I.9 Problem:DiseasesoftheProstate(Infection, Granuloma ......................... 182 BenignProstaticHyperplasia,Cancer) I.8.1.5 OtherBenignEpididymalLesions: TuberculosisoftheEpididymis ........ 182 I.9.1 BenignProstaticHyperplasiaand References .......................... 182 ProstaticCancer S.A.McNeill,S.K.W.Leung .......... 213 I.8.2 TesticularCancer,CIS,Microcalcifications, I.9.1.1 Introduction ........................ 213 TNMClassification I.9.1.2 AetiologyandPathogenesis ........... 213 O.Ståhl,J.Eberhard,A.Giwercman 183 I.9.1.3 ProstateCancer...................... 214 I.8.2.1 TesticularCancer .................... 183 I.9.1.4 Symptoms,DiagnosisandTreatment ... 214 I.8.2.2 Carcinoma-in-SituoftheTestis ........ 187 References .......................... 216 References .......................... 188 I.9.2 Prostatitis I.8.3 PenileInflammations M.C.Bishop ........................ 217 F.-M.Köhn ......................... 190 I.9.2.1 Introduction ........................ 217 I.8.3.1 Introduction ........................ 190 I.9.2.2 DiagnosisofProstatitis ............... 218 I.8.3.2 PearlyPenilePapules ................. 190 I.9.2.3 AetiologyofChronicProstatitis........ 220 I.8.3.3 SclerosingLymphangitisofthePenis ... 191 I.9.2.4 Treatment .......................... 221 I.8.3.4 BalanitisandBalanoposthitis .......... 191 References .......................... 223 I.8.3.5 LichenSclerosusetAtrophicus......... 193 I.8.3.6 BalanitisCircumscriptaPlasmacellularis I.10 Problem:MaleBreastDisorder (Zoon’sBalanitis) .................... 193 I.8.3.7 BalanitisCircinata ................... 194 I.10.1 GynaecomastiaandBenignBreast I.8.3.8 PsoriasisVulgaris.................... 195 HyperplasiaIncludingIatrogenicCauses I.8.3.9 LichenPlanus ....................... 196 W.Krause ......................... 225 I.8.3.10 FixedDrugEruption ................. 197 I.10.1.1 Definition,Epidemiology ............. 225 I.8.3.11 OtherDrug-InducedLesionsofthePenis 198 I.10.1.2 AetiologyandPathogenesis ........... 226 I.8.3.12 AllergicandIrritantContactDermatitis I.10.1.3 ClinicalFeatures..................... 227 ofthePenis ......................... 198 I.10.1.4 Histopathology...................... 227 I.8.3.13 AtopicDermatitis.................... 199 I.10.1.5 GeneticRiskFactors ................. 228 I.8.3.14 SeborrhoeicDermatitis............... 199 I.10.1.6 DiagnosticProcedures................ 228 References .......................... 200 I.10.1.7 PreventionandTreatment............. 230 References .......................... 231 I.8.4 PenileCancer I.D.C.Mitchell .................... 201 I.10.2 SkinDiseasesoftheMaleNipple I.8.4.1 Definition .......................... 201 W.Krause ......................... 232 I.8.4.2 AetiologyandPathogenesis ........... 201 I.10.2.1 GeneralSkinDiseases ................ 232 I.8.4.3 ClinicalFindings .................... 201 I.10.2.2 LocalizedInflammatoryDiseases ...... 232 I.8.4.4 DifferentialDiagnosis ................ 202 I.10.2.3 Tumours ........................... 233 I.8.4.5 Treatment .......................... 202 I.10.2.4 Malformations ...................... 235 I.8.4.6 ResultsofTreatment ................. 203 I.10.2.5 SurgicalInterventions ................ 236 I.8.4.7 Prognosis........................... 203 References .......................... 236 I.8.4.8 Prevention.......................... 203 I.8.4.9 Other .............................. 203

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