4 - Problems of the male reproductive tract Flashcards
Size of normal prostate
20g
3cm long
4cm wide
2cm depth
Regions of the prostate and percentages of each
Peripheral zone - 70%
Central zone - 25%
Transitional zone -5%
Function of prostate
Secrete a fluid making up the semen
Which zone does hyperplasia mainly occur
Transitional zone
Which zone does prostate cancer mainly occur in
Peripheral Zone
Difference between normal prostate, BPH, prostate with cancer
Normal - smooth and small
BPH - smooth and enlarged
Cancer - craggy and enlarged
Causes of BPH
Advanced age - inc in proliferation and decrease in apoptosis
Increase in testicular androgen
Oestrogens
NTS from the gland
Where is testosterone converted to estrodiol
Stroma cells
What is the enzyme that converts testosterone to estrodiol
Aromatase
What is the action of estrodiol at a Era
Cell proliferation
Where is testosterone converted to DHT
Epithelial cells
What does DHT cause
Antaonistic activity of apoptosis
What converts Testosterone to DHT
5-alpha reductase
Signs and symptoms of BPH
Slow stream Hesitancy Intermittent flow Terminal dribbling Emptying is incomplete Increase in frequency, urgency and nocturia
What percentage of men over 40 develop histological hyperplasia of the prostate
50
Diagnosis of BPH
History, Digital Rectal Exam , Ultrasound with biopsy PSA test (g-seminoprotein, kallikrelin-3)
Treatment of BPH
A1-adrenergic blockers
5-a reductase inhibitors
MoA of a-1 adrenergic blockers
Relaxes smooth muscle in bladder neck and prostate improving urine flow rate
Tamsulosin
MoA of 5a-reductase inhibitors
Prevent testosterone –> DHT
Finasteride
Surgery for BPH
Transurethral resection of the prostate
Open prostatectomy
Difference between BPH and prostate cancer?
Symptoms similar but PSA much more raised in cancer
Which inguinal hernia is more common and what age does it occur in
Indirect inguinal hernia
Occurs in young - babies
Borders of hasselbach’s triangle
Rectus abdominis
Inferior epigastric vessels
Inguinal ligament
Where does a direct inguinal hernia occur
The intestine pushes through the hasselbachs triangle (the sheath)
Where does an indirect inguinal hernia occur
Through the deep inguinal ring
Cause of indirect inguinal hernia
Failure of inguinal canal to close properly
What are the 3 dysfunctions that can be classified as erectile dysfunction
Complete inability to have an erection;
Inconsistent ability to achieve an erection;
Ability to have short-term erections.
Control of erection
PSN neuron releases NO to smooth muscle to cavernosa cells –> Binds to soluble guanylyl cyclase –> CGMP produced and causes Smooth muscle relaxation (causes dilation)
Control of ejaculation
SN –> Releases NA –> Binds to A1 receptor –> Contraction
What breaks down CGMP
Pde5
Treatment for erectile dysfunction
PDE-5 Inhibitors
Penile prosthesis
Examples of PDE- inhibitors
Sildenafil - viagra
Vardenafil - levitra
Tadalafil - cialis
What is peyronie’s disease
Scar tissue forms on the shaft of the penis which causes bending or deformity of the penis
Painful erections and difficulties with sexual intercourse
How do you treat peyronie’s disease
Para-aminobenzoate
Topical verapamil
What are varioceles
Varicose veins of the scrotum
2degree raise in temp
Where do varioceles form in the scrotum
pampiniform venous plexus
