Genital Tract Obstruction

• Most men with genital tract obstruction have azoospermia, normal testicular size, normal virilization, and normal serum FSH levels.
• However, some have combined obstruction and spermatogenic disorders, or partial obstructions and severe oligospermia. There may be a history of an event that caused the obstruction, such as epididymitis with gonorrhea or associated respiratory disease.
• Because a few men with normal spermatogenesis have elevated FSH levels and some spermatogenesis may occur in association with a severe spermatogenic disorder, all patients should be offered further investigation.
• In men with congenital absence of the vas or ejaculatory duct obstruction, semen volume, pH and fructose levels are low.
• The semen also does not have its characteristic smell and does not form a gel after ejaculation because it contains only prostatic and urethral fluid.
• The semen characteristics of complete ejaculatory duct obstruction are the same as for BCAV but the vasa are palpable.
• Rectal ultrasound may show the cause of the obstruction such as a cyst of the prostatic utricle.
• Some men may have partial or intermittent ejaculatory duct obstruction and may notice the low ejaculate volume.
• Testicular biopsy is normal or there may be some reduction in spermatogenesis either as a coincidence or as a result of the obstruction particularly after vasectomy.

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The two sexes injure their lower urinary tracts in different ways. A woman’s urinary tract is vulnerable to obstetric disaster, but seldom to trauma, whereas a man may sustain any of the injuries.

 What Conditions Might Affect A Patient In This Area?

Conditions that most commonly require reconstructive female genital tract surgery include:

• Vulval, cervical and anal cancer/pre-cancer
• Congenital problems
• Birth trauma
• Ovary
• Infundibulum
• Fimbriae
• Fallopian or uterine tube
• Ampullary part of the tube
• Uterine musculature
• Uterine mucosa
• Cervix
• Portio
• Vagina
• Ligamentum ovarii proprium
• Suspensory ligament of the ovary
• Ovary cut open (follicles in various stages)

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Immediately After An Injury Of The Lower Urinary Tract in India

How did the injury occur?

This will tell you the kind of injury to suspect.

Has the patient passed urine since the accident?

If he wants to pass urine, let him try, gently without straining. If he strains, urine will extravasate into his tissues.

If he has passed blood–free urine since the accident, his urinary tract has not been seriously injured. If he can pass no urine, or only a little blood stained urine, with frequency and dysuria, his urethra has been injured.

If his bladder is distended, you may have to needle it to reduce his distress.

Has he ever had even a little bleeding from the external orifice of his urethra? If necessary, milk his urethra to demonstrate blood at its tip. You will usually find this bleeding if you look for it. It confirms a rupture (complete or partial) of some part of his urethra (injuries D, E, or F, and occasionally B, or C). He needs a suprapubic catheter. The absence of bleeding is of no significance.

Prolapse of the genital tract Surgery

Prolapse of the genital tract is a relatively common condition; in the United Kingdom, for instance, genital prolapse accounts for 20% of women on the waiting list for major gynaecological surgery. Prolapse can involve the uterus (womb), the vagina or, as is often the case, both. It can be looked upon as a type of hernia where structures around the vagina drop down because of a weakness or tears in the supporting tissues. Thus, weakness anterior to the vagina can lead to a urethrocele (prolapse of the urethra) or cystocele (prolapse of the bladder), weakness at the top to uterine or vault prolapse, and weakness posteriorly to an enterocele (prolapse of Pouch of Douglas) or rectocele (prolapse of the rectum). Of the different types of genital tract prolapse, prolapse of the bladder is the commonest.

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