Andrology

Question 1

Sertoli cells of the testis function

Answer 1

spermatogenesis

Question 2

Leydig cells of the testis function

Answer 2

testosterone production

Question 3

Erectile dysfunction definition

Answer 3

persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

Question 4

3 cylindrical structures of the penis

Answer 4

2x corpus cavernosa
corpus spongiosum

Question 5

Mechanism of erection

Answer 5

dilation of arterioles and arteries - increased blood flow
trapping of blood by the expanding sinusoids
compression of the subtunical venous - reducing venous outflow
stretching of the tunica - occludes emissary veins - decreases venous outflow
contraction of ischiocavernosus muscles

Question 6

Phases of erectile process

Answer 6

flaccid phase
latent (filling) phase
tumescent phase
full erection phase
rigid erection phase
detumescence phase

Question 7

Organic erectile dysfunction characteristics

Answer 7

gradual onset
global - can never get an erection
poor non-coital erection

Question 8

Psychogenic erectile dysfunction characteristics

Answer 8

acute onset
situational
rigid non-coital erection (eg. morning)
long history of psychosexual problem
anxiety and fear

Question 9

Erectile dysfunction risk factors

Answer 9

smoking
blood pressure
cholesterol
diabetes

Question 10

Treatment of erectile dysfunction

Answer 10

PDE5 inhibitors (eg. sildenafil)
Alprostadil
Psychotherapy
Surgical implants

Question 11

What intracavernosal agents can be given for erectile dysfunction?

Answer 11

PGE1 (alprostadil)
papaverine (non-selective PDE5 inhibitor)
phentolamine (alpha blocker)

Question 12

Which patients cannot be given sildenafil?

Answer 12

patients on nitrates

Question 13

PDE5 inhibitors side effects

Answer 13

vasomotor effects
headaches
flushing

Question 14

Penile prosthesis side effects

Answer 14

infection
erosion
mechanical malfunction

Question 15

Define varicocele

Answer 15

tortuous dilatation of pampiniform plexus

Question 16

What side is varicocele more common on?

Answer 16

left
(vertical drainage into renal vein)

Question 17

Drugs that can impair male fertility

Answer 17

impaired spermatogenesis - sulfasalazine, nitrofurantoin, methotrexate, colchicine

pituitary suppression - testosterone injections, GnRH analogues

anti-androgenic effects - cimetidine, spironolactone

ejaculation failure - alpha blockers, antidepressants, phenothiazines

erectile dysfunction - beta blockers, thiazide diuretics, metoclopramide

drugs of abuse - anabolic steroids, cocaine, heroin, cannabis

Question 18

What condition is priapism more common in?

Answer 18

sickle cell

Question 19

Priapism treatments

Answer 19

corporal aspiration
ice pack
alpha blockers/phenylephedrine
shunts
penile prosthesis if all fails

Question 20

What is Peyronie’s disease?

Answer 20

benign lesion of penis leading to curvature of erect penile shaft due to formation of fibrous tissue plaques within the tunica albugenia

Question 21

What is a vasectomy?

Answer 21

removal of a small section of vas from both sides with interposition of tissue between the divided ends to prevent recanalisation

Question 22

What is mandatory after a vasectomy?

Answer 22

post-vasectomy semen analysis (PVSA)
confirms azoospermia - at this point alternative contraception can be discarded