15. Problems of the male reproductive system Flashcards
What is the function of the prostate gland?
Secretion of alkaline fluid which acts to neutralise acidic fluid from vagina
Also secretion of anticoagulent to allow for motility of the sperm
Where is the prostate located?
Between bladder and rectum (where uterus would be in female)
What are the three components of the prostate and what do these surround?
Central zone - around ejaculatory ducts
Peripheral zone - around the urethra
Transitional zone - around the proximal urethra
Which of these zones is the glandular zone?
The peripheral zone
Which zone is affected in BHP?
Transitional zone
Which of these zones is affected by prostatic cancer?
Peripheral zone
When is the central zone affected?
Generally not affected
What is the appearance of a BHP prostate vs. cancerous prostate?
BHP prostate - smooth, round and same appearance as normal prostate but BIGGER
Cancerous - nodular and asymmetric and bigger
Is BHP hypertrophy or hyperplasia?
Both - proliferation of cells and reduced apoptosis of cells
How does BHP occur?
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
What are the signs and symptoms of BHP?
Hesitancy Pain/burning upon urination Nocturia Residual void volume Weak flow
Will all men with BHP experience symptoms?
No - only about 50%
What is the main driving force for BHP?
Testosterone
How is BHP diagnosed?
History - nocturia?
Digital rectal exam - size and feel - is it smooth?
Ultrasound and biopsy
Blood test - PSA
What is PSA?
Prostate specific antigen
This is the anticoagulant produced to allow motility of sperm
When will PSA levels be greatly increased and why?
Good diagnosis for cancer - greatly increased in cancer because produced by glandular tissue - peripheral zone - affected by cancer
What is the pharmacological treatment for BHP?
Alpha-1 adrenergic blocker
5alpha-reductase inhibitor
These are generally used in conjunction
How do alpha-1 adrenergic blockers work to treat BHP?
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
How do 5alpha-reductase inhibitors work to treat BHP?
5alpha reductase is the enzyme responsible for the conversion of testosterone to DHT
Remember DHT inhibits apoptosis SO working to prevent this
Give two 5alpha reductase inhibitors used for the treatment of BHP
Dutasteride
Finasteride
What does DHT stand for?
Dihydrotestosterone
When might surgery be administered to treat BHP?
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
How can you tell the difference between BHP and prostatic cancer?
Symptoms are very similar
PSA in prostatic cancer will be raised to a much greater degree
What are the two types of inguinal hernias?
Direct - less common - in the elderly - Hesselbach’s triangle
Indirect - common in newborn males - through inguinal canal
What is the treatment for direct inguinal hernias?
If reducable (pressing on it causes it to move inwards - wear a truss to push it in Otherwise - surgery
ERECTILE DYSFUNCTION - COVERED IN PBL GO THROUGH
ERECTILE DYSFUNCTION - COVERED IN PBL GO THROUGH
