Varicoceles

What are Varicoceles?

Varicoceles

A varicocele is when veins become enlarged inside your scrotum (the pouch of skin that holds your testicles). These veins are called the pampiniform plexus. Ten to 15 of every 100 males have a varicocele. It is like getting a varicose vein in your leg.

What Happens Normally?

The male reproductive system makes, stores, and moves sperm. The scrotum is the sac of skin that holds the testicles (testes). Sperm and the hormone testosterone are made in the testicles. Sperm mature while moving through a coiled tube (the epididymis) behind each testicle.

Sperm travel to the prostate from each epididymis using a tube called the vas deferens. When you ejaculate, seminal fluid mixes with sperm in the prostate to form semen. The semen travels through the urethra and comes out the end of your penis.

The spermatic cord holds the vas deferens and the testicular artery, which brings blood to the testicle. It also houses the pampiniform plexus, a group of connected veins that drains the blood from the testicles. The pampiniform plexus cools blood in the testicular artery before it enters the testicles. This helps keep it at the temperature needed to make sperm.

Male Reproductive System

What are Varicoceles?

Varicoceles are when the pampiniform plexus veins in the scrotum become enlarged. These veins are like varicose veins in the leg. Varicoceles form during puberty, and can grow larger and easier to notice over time. Varicoceles are more common on the left side of the scrotum. This is because the male anatomy isn’t the same on both sides. Varicoceles can exist on both sides at the same time, but this is rare. About 10 to 15 boys out of 100 have a varicocele.

Most of the time, varicoceles cause no problems and are harmless. Less often varicoceles can cause pain, problems fathering a child, or 1 testicle to grow slower or shrink.

A UTI is when bacteria gets into your urine and travels up to your bladder. As many as 8 in 100 of girls and 2 in 100 of boys will get UTIs. Young children have a greater risk of kidney damage linked to UTI than older children or adults.

How Does the Urinary Tract Work?

Female urinary tract

The “urinary tract” is the organs in your body that make, store, and get rid of urine, one of the waste products of your body. Urine is made in the kidneys and travels down to the bladder through the ureters (the tubes that join them). The kidneys make about 1½ to 2 quarts of urine a day in an adult, and less in children, depending on their age. In children, the bladder can hold 1 to 1½ ounces of urine for each year of age. For example, a 4-year-old child’s bladder can hold 4 to 6 ounces—a little less than a cup.

The bladder stores the urine until it is emptied through the urethra, a tube that links the bladder to the skin, when you urinate. The urethra opens at the end of the penis in boys and in front of the vagina in girls.

The kidneys also balance the levels of many chemicals in the body (sodium, potassium, calcium, phosphorous and others) and check the blood’s acidity. Certain hormones are also made in the kidneys. These hormones help control blood pressure, boost red blood cell production and help make strong bones.

Male urinary tract

Male urinary tract

Normal urine has no bacteria in it, and the one-way flow helps prevent infections. Still, bacteria may get into the urine through the urethra and travel up into the bladder.

What is a Urinary Tract Infection (UTI) in Adults?

A UTI is when bacteria gets into your urine and travels up to your bladder. UTIs cause more than 8.1 million visits to health care providers each year. About 10 in 25 women and 3 in 25 men will have symptoms of at least 1 UTI during their lifetime.

How Does the Urinary Tract Work?

Female urinary tract

The urinary tract makes and stores urine, one of the waste products of your body. Urine is made in the kidneys and travels down the ureters to the bladder. The bladder stores the urine until it is emptied through the urethra, a tube that connects the bladder to the skin, when you urinate. The opening of the urethra is at the end of the penis in a male and in front of the vagina in a female.

The kidneys are a pair of fist-sized organs in the back that filter liquid waste from the blood and remove it from the body in the form of urine. Kidneys balance the levels of many chemicals in the body (sodium, potassium, calcium, phosphorous and others) and check the blood’s acidity. Certain hormones are also made in the kidneys. These hormones help control blood pressure, boost red blood cell production and help make strong bones.

Normal urine has no bacteria in it, and the one-way flow helps prevent infections. Still, bacteria may get into the urine from the urethra and travel up into the bladder.

Male urinary tract

Male urinary tract

What is Urinary Incontinence?

Urinary incontinence is leaking of urine that you can’t control. Many American men and women suffer from urinary incontinence. We don’t know for sure exactly how many. That’s because many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done. So they suffer in silence.

Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don’t want to be too far from a toilet. Urinary incontinence can keep people from enjoying life.

Many people think urinary incontinence is just part of getting older. But it’s not. And it can be managed or treated. Learn more here. Talk to your doctor. Find out what treatment is best for you.

Key Statistics

A quarter to a third of men and women in the U.S. suffer from urinary incontinence. That means millions of Americans. About 33 million have overactive bladder (also known as OAB) representing symptoms of urgency, frequency and with or without urge incontinence.

Studies show that many things increase risk. For example, aging is linked to urinary incontinence. Pregnancy, delivery, and number of children increase the risk in women. Women who have had a baby have higher rates of urinary incontinence. The risk increases with the number of children. This is true for cesarean section (c-section) and vaginal delivery.

Women who develop urinary incontinence while pregnant are more likely to have it afterward. Women after menopause (whose periods have stopped) may develop urinary incontinence. This may be due to the drop in estrogen (the female sex hormone). Taking estrogen, however, has not been shown to help urinary incontinence.

Men who have prostate problems are also at increased risk. Some medications are linked to urinary incontinence and some medicines make it worse. Statistics show that poor overall health also increases risk. Diabetes, stroke, high blood pressure and smoking are also linked.

Obesity increases the risk of urinary incontinence. Losing weight can improve bladder function and lessen urinary incontinence symptoms.

Female urinary tract

What happens normally?

The brain and the bladder control urinary function. The bladder stores urine until you are ready to empty it. The muscles in the lower part of the pelvis hold the bladder in place. Normally, the smooth muscle of the bladder is relaxed. This holds the urine in the bladder. The neck (end) of the bladder is closed. The sphincter muscles are closed around the urethra. The urethra is the tube that carries urine out of the body. When the sphincter muscles keep the urethra closed, urine doesn’t leak.

Once you are ready to urinate, the brain sends a signal to the bladder. Then the bladder muscles contract. This forces the urine out through the urethra, the tube that carries urine from the body. The sphincters open up when the bladder contracts.

What are the types of urinary incontinence?

Male urinary tract

Male urinary tract

Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence:

Stress Urinary Incontinence (SUI)

With SUI, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.

SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking my happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe.

There are no FDA approved medicines to treat SUI yet, but there are things you can do. Ways to manage SUI include “Kegel” exercises to strengthen the pelvic floor. Lifestyle changes, vaginal and urethral devices, pads, and even surgery are other ways to manage SUI.

Nerves carry signals from the
brain to the bladder and sphincter

To learn more about SUI risk factors, diagnosis and treatments visit our SUI article page.

Overactive Bladder (OAB)

OAB is another common type of urinary incontinence. It is also called “urgency” incontinence. OAB affects more than 30% of men and 40% of women in the U.S. It affects people’s lives. They may restrict activities. They may fear they will suddenly have to urinate when they aren’t near a bathroom. They may not even be able to get a good night’s sleep. Some people have both SUI and OAB and this is known as mixed incontinence.

With OAB, your brain tells your bladder to empty – even when it isn’t full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate.

The main symptom of OAB is the sudden urge to urinate. You can’t control or ignore this “gotta go” feeling. Another symptom is having to urinate many times during the day and night.

OAB is more likely in men with prostate problems and in women after menopause. It is caused by many things. Even diet can affect OAB. There are a number of treatments. They include life style changes, drugs that relax the bladder muscle, or surgery. Some people have both SUI and OAB.

To learn more about OAB risk factors, causes and treatments visit our OAB page.

Mixed Incontinence (SUI and OAB)

Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.

Overflow Incontinence

With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should.

One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called “dribbling.”

This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.

Female urinary tract

What is Urethral Cancer?

Urethral cancer is the most rare of all urological cancer. Only 1 or 2 people out of 100 patients with cancer get this type. It is more common in men than women. Some people with urethral cancer don’t have any symptoms, but most do. This information will tell you more about urethral cancer, how it’s diagnosed and treatment options.

What is the Urethra?

The urethra is a hollow tube that lets urine pass from the bladder, the organ that stores urine until ready for release, to the outside of the body. In men the urethra is about 8 inches long, and passes through the prostate to the end of the penis. In women the urethra is about 1.5 inches long, and opens to the outside just above the vaginal opening.

Male urinary tract

Male urinary tract

What are Undescended Testicles (Cryptorchidism)?

What Happens under Normal Conditions?

How the testicles descend into the scrotum during pregnancy

The testicles (or “testes”) are 2 organs that hang in a pouch-like skin sac (the scrotum) below the penis. The testicles are where sperm and testosterone (the male sex hormone) are made. The scrotum keeps the testicles in a cooler setting than the body. This is because sperm can’t grow at body temperature. During childhood, sperm in the testicles go through a process that results in mature sperm at puberty.

Normal testicles form early in a baby boy’s growth. They form in the lower belly (abdomen), but descend, or “drop,” into the scrotum toward the end of pregnancy. Normal testicles attach themselves with stretchable tissue in the bottom of the scrotum. This is controlled by the baby’s normal hormones.

What are Undescended Testicles?

An undescended testicle (or “testis”) is when it fails to drop into the normal place in the scrotum. Your child’s health care provider can find this during a routine exam. This issue is found in about 3 or 4 out of  100 newborns (and up to 21 out of 100 premature newborns). Luckily, about half of these testicles will drop on their own during the first 3 months of life. But testicles won’t drop on their own after 3 months of age. Thus, about 1 or 2 out of 100 boys with undescended testicles will need treatment.

It’s important not to confuse undescended testicles with “retractile” testicles. After 6 months of age, a male child has a reflex that temporarily pulls the testicles up to protect them when he’s cold or frightened. These testicles are in the scrotum at other times and don’t need treatment. Only testicles that are truly undescended need treatment. A pediatric urologist can tell the difference with a physical exam.

The testicles need to be 2 to 3 degrees cooler than normal body temperature to make sperm. The scrotum is many degrees cooler than body temperature, and so is the ideal place for the testicle. Testicles that don’t drop into the scrotum won’t work normally. The longer the testicles are too warm, the lower chances are that the sperm in that testicle will mature normally. This can be a cause of infertility, especially when both testicles are affected.

Undescended testicles are also linked to a higher risk of:

  • Testicular cancer in adulthood (though the risk is still less than 1 in 100)
  • Testicular torsion (twisting of the chord that brings blood to the scrotum)
  • Developing a hernia near the groin

What is Testicular Cancer?

With timely diagnosis, testicular cancer is most likely treatable and most often curable. It is the most common cancer in men 15 to 34 years old. Still, it is fairly rare. About 8,850 men will be diagnosed with testicular cancer in the U.S. this year. The risk of death from testicular cancer is small. About 410 men will die of testicular cancer in the U.S. this year.

The Testicles

Male Reproductive System

The testicles (also known as testes or testis) are part of the male reproductive system. These 2 golf ball size glands are held in a sac (scrotum) below the penis. The testicles have a firm, slightly spongy feel. At the top and outside edge is a rubbery, tube-like structure called the epididymis. The firmness of the testicle should be the same throughout. The size of the testicles should also be about the same.

The testicles are where sperm mature before being delivered to the vas deferens and ejaculated. The testicles also make male hormones such as testosterone. This hormone controls the sex drive in men. It also triggers the development of male traits.

What are Spermatoceles (Spermatic Cysts)?

Spermatocele on the Epididymis

Spermatoceles are also known as spermatic cysts. They are fluid-filled masses, often painless, and they grow near the testicles. They tend to be benign (not cancerous). These cysts are found near the top and behind the testicle, but are separate from the testicle. They can be smooth, filled with a whitish, cloudy fluid, and most often hold sperm. Their size can vary. If their size becomes a bother or causes pain, then there are some ways to fix the problem. As a rule, they are not a serious medical issue.

The male reproductive tract handles the growth, maturation and delivery of sperm. Faults in the male reproductive tract can cause a mass to grow. If a mass forms in the scrotum, it may mean nothing or it could be a sign of something serious. A set course of action is needed to learn the nature of the mass and the best treatment. For example, if the mass is testicular cancer, it is a source of great concern and requires action. Other masses, such as varicoceles, can cause pain or harm reproductive function. Spermatocele masses are not cancerous, and do not increase your risk of testicular cancer, but they may be a nuisance.

What is Prostate Cancer?

Prostate cancer is when cancer forms in the prostate gland. It is the second-leading cause of cancer deaths for men in the U.S. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. This year, over 160,000 men will be diagnosed with prostate cancer.

Growths in the prostate can be benign (not cancer) or malignant (cancer).

Benign growths (like benign prostatic hypertrophy (BPH):

  • Are rarely a threat to life
  • Don’t invade the tissues around them
  • Don’t spread to other parts of the body
  • Can be removed and can grow back very slowly (but usually don’t grow back)

Malignant growths (prostate cancer):

  • May sometimes be a threat to life
  • Can infect nearby organs and tissues (such as the bladder or rectum)
  • Can spread (metastasize) to other parts of the body (like lymph nodes or bone)
  • Often can be removed but sometimes grow back

Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph nodes to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors, causing damage where they land.

When prostate cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer in bone.

To understand prostate cancer, it helps to know how the prostate normally works.

The Prostate

Male Reproductive System

The prostate and seminal vesicles are part of the male reproductive system. The prostate is about the size of a walnut and weighs about one ounce. The seminal vesicles are two much smaller paired glands. These glands are attached to each side of the prostate. The prostate is below the bladder and in front of the rectum. It goes all the way around the urethra. The urethra is a tube that carries urine from the bladder out through the penis.

The main job of the prostate and seminal vesicles is to make fluid for semen. During ejaculation, sperm is made in the testicles, and then moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture-semen-goes through the urethra and out of the penis as ejaculate.

When cancer occurs, it is found in the prostate gland and almost never in the seminal vesicles.

What is Premature Ejaculation?

Ejaculation is the release of semen from the body. Premature ejaculation (PE) is when ejaculation happens sooner than a man or his partner would like during sex. Occasional PE is also known as rapid ejaculation, premature climax or early ejaculation. PE might not be a cause for worry. It can be frustrating if it makes sex less enjoyable and impacts relationships. But it happens often and causes problems, your health care provider can help.

In the U.S., about 1 in 3 men 18 to 59 years old have problems with PE. The problem is often thought to be psychological, but biology may also play a role.

How Does Ejaculation Work?

Ejaculation is controlled by the central nervous system. When men are sexually stimulated, signals are sent to your spinal cord and brain. When men reach a certain level of excitement, signals are then sent from your brain to your reproductive organs. This causes semen to be released through the penis (ejaculation).

Ejaculation has 2 phases: emission and expulsion.

Phase 1: Emission

Emission is when sperm moves from the testicles to the prostate and mixes with seminal fluid to make semen. The vasa deferentia are tubes that help move the sperm from the testicles through the prostate to the base of the penis. (When you are talking about just 1 of these tubes, it is called a vas deferens.)

Phase 2: Expulsion

Expulsion is when the muscles at the base of the penis contract. This forces semen out of the penis. Usually, ejaculation and orgasm (climax) happen at the same time. Some men climax without ejaculating. In most cases, erections go away after this step.

Premature Ejaculation and Erectile Dysfunction (ED)

Sometimes PE is a problem for men who have erection problems (erectile dysfunction or ED). This is when men are not able to get or keep an erection that’s firm enough for sex. Since an erection goes away after ejaculation, it can be difficult to know if the problem is PE or ED. ED should be treated first. Premature ejaculation may not be a problem once the ED is treated.