15. Problems of the male reproductive system

Question 1

What is the function of the prostate gland?

Answer 1

Secretion of alkaline fluid which acts to neutralise acidic fluid from vagina
Also secretion of anticoagulent to allow for motility of the sperm

Question 2

Where is the prostate located?

Answer 2

Between bladder and rectum (where uterus would be in female)

Question 3

What are the three components of the prostate and what do these surround?

Answer 3

Central zone - around ejaculatory ducts
Peripheral zone - around the urethra
Transitional zone - around the proximal urethra

Question 4

Which of these zones is the glandular zone?

Answer 4

The peripheral zone

Question 5

Which zone is affected in BHP?

Answer 5

Transitional zone

Question 6

Which of these zones is affected by prostatic cancer?

Answer 6

Peripheral zone

Question 7

When is the central zone affected?

Answer 7

Generally not affected

Question 8

What is the appearance of a BHP prostate vs. cancerous prostate?

Answer 8

BHP prostate - smooth, round and same appearance as normal prostate but BIGGER
Cancerous - nodular and asymmetric and bigger

Question 9

Is BHP hypertrophy or hyperplasia?

Answer 9

Both - proliferation of cells and reduced apoptosis of cells

Question 10

How does BHP occur?

Answer 10

Testosterone - converted to oestradiol which increases proliferation and also converted to DHT which antagonises apoptosis
Oestrogen normally functions to reduce apoptosis
BUT with increasing age - greater exposure to testosterone throughout life so there is increased growth of the prostate

Question 11

What are the signs and symptoms of BHP?

Answer 11

Hesitancy 
Pain/burning upon urination 
Nocturia 
Residual void volume 
Weak flow

Question 12

Will all men with BHP experience symptoms?

Answer 12

No - only about 50%

Question 13

What is the main driving force for BHP?

Answer 13

Testosterone

Question 14

How is BHP diagnosed?

Answer 14

History - nocturia?
Digital rectal exam - size and feel - is it smooth?
Ultrasound and biopsy
Blood test - PSA

Question 15

What is PSA?

Answer 15

Prostate specific antigen

This is the anticoagulant produced to allow motility of sperm

Question 16

When will PSA levels be greatly increased and why?

Answer 16

Good diagnosis for cancer - greatly increased in cancer because produced by glandular tissue - peripheral zone - affected by cancer

Question 17

What is the pharmacological treatment for BHP?

Answer 17

Alpha-1 adrenergic blocker
5alpha-reductase inhibitor

These are generally used in conjunction

Question 18

How do alpha-1 adrenergic blockers work to treat BHP?

Answer 18

Blocks the receptors in the bladder and so acts to relax the smooth muscle of the bladder neck i.e. the IUS
Improves flow through urethra and urine flow rate

Question 19

How do 5alpha-reductase inhibitors work to treat BHP?

Answer 19

5alpha reductase is the enzyme responsible for the conversion of testosterone to DHT
Remember DHT inhibits apoptosis SO working to prevent this

Question 20

Give two 5alpha reductase inhibitors used for the treatment of BHP

Answer 20

Dutasteride

Finasteride

Question 21

What does DHT stand for?

Answer 21

Dihydrotestosterone

Question 22

When might surgery be administered to treat BHP?

Answer 22

If pharmacological treatments are unsuccessful

If very severe e.g. complete voiding or blood in urine or the renal pelvis becomes too dilated due to backflow

Question 23

How can you tell the difference between BHP and prostatic cancer?

Answer 23

Symptoms are very similar

PSA in prostatic cancer will be raised to a much greater degree

Question 24

What are the two types of inguinal hernias?

Answer 24

Direct - less common - in the elderly - Hesselbach’s triangle
Indirect - common in newborn males - through inguinal canal

Question 25

What is the treatment for direct inguinal hernias?

Answer 25

If reducable (pressing on it causes it to move inwards - wear a truss to push it in 
Otherwise - surgery

Question 26

ERECTILE DYSFUNCTION - COVERED IN PBL GO THROUGH

Answer 26

ERECTILE DYSFUNCTION - COVERED IN PBL GO THROUGH