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3B week 5 - LUTS, The Scrotum and Genitalia > andrology (see DM) > Flashcards

andrology (see DM) Flashcards

1
Q

what are sertoli cells

A

cells in the testes where spermatogenesis takes place

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2
Q

what are leydig cells

A

the primary source of testosterone or androgens in males

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3
Q

what is erectile dysfunction

A

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

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4
Q

what are the cylindircal structures of the penis

A
  1. paired corpora cavernosa
  2. corpus spongiosim
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5
Q

what is the tunica albuginea

A

a two layered fibrous envelope that extends the length of the corpus cavernosum penis and corpus spongiosum penis

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6
Q

what are the 2 layers of the tunica albuginea + function

A
  1. inner layer bundles -> support and contain the cavernous tissue
  2. outer layer bundles -> orietnated longitudionally from glans penis to proximal crurua and insert into the inferior pubic rami
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7
Q

what areas fill with blood during an erection

A

the central and peripheral sinusoids, located in the tunica albuginea

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8
Q

preservation of what artery during prostatectomy surgery allows for preservation of sexual function

A

the accessory pudendal artery during radical retropubic prostatectomy

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9
Q

what is the arterial supply to the penis

A

internal pudenal artery

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10
Q

what is the venous drainage of the penis

A

tiny venules from the peripheral sinusoids travel in the trebeculae and form the subtinical venous plexus -> drained by:
1. deep dorsal vein
2. circumflex vein
3. periutheral vein
4. cavernous vein
5. crural vein
-> these go on to form the periprostatic plexus and internal pudendal vein

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11
Q

what is dutemescence

A

subsidence or diminution of swelling or erection

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12
Q

what are the erectile tissues of the penis (2)

A
  1. cavernous smooth musculature
  2. smooth muscles of the arteriolar and arterial walls
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13
Q

what changes occur to produce/maintain and erection (6)

A
  1. dilation of the arterioles and arteries resulting in increased blood flow
  2. trapping of blood by expanding sinusoids
  3. compression of the subtunical veins, reducing venous outflow
  4. stretching of the tunica results on occlusion of emissary veins and decreases venous outflow further
  5. an increase in pO2 and intracavernous pressure
  6. contraction of the ischiocavernosus muscle -> further pressure increase (rigid erection phase)
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14
Q

what is tumescence

A

the swelling of the penis for sexual activity

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15
Q

what neural pathways govern tumescence

A

sympathetic pathway -> T11-L2

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16
Q

what neural pathways govern detumescence

A

parasympathetic pathway:
S2,3,4 -> pelvic nerves -> pelvic plexus

“point and shoot”
P - parasympathetic - point (erection)
S - sympathetic - shoot - subsidation of erection

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17
Q

what nerves innervates the penis (2)

A
  1. cavernous nerves - can be damaged in surgery
  2. pudendal nerve -> S2-4 root, innervates ischiocavernosus and bulbocavernosus muscles
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18
Q

how does nitric oxide mediate the erection pathway (4)

A
  1. NO is a gaseous molecule produced by the vascular endothelium and parasympathetic nerve
  2. NO acts as a NT on the parasympathetic system to increase the production of cGMP
  3. cGMP results in cavernous smooth muscle relaxation -> increased blood flow in sinusoids
  4. venous compression against hard tunica albugenia

in contrast symp stim results in NA release causing muscle contraction and reduced blood flow to the sinusoids

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19
Q

phases of the erectile process (6)

A

0 - flaccid phase (cavernosal smooth muscle contracted, sinusoids empty)
1 - latent filling phase (increase pudendal artery flow, penile elongation)
2 - tumescent phase (rising intracavernosal pressure, erection forming)
3 - full erection phase (increased cavernosal pressure causes penis to become fully erect)
4 - rigid erection phase (further increases in pressure + ischiocavernosal muscle contraction)
5 - detumescence phase (following ejaculation, sympathetic discharge resumes -> smooth muscle contraction and vasoconstriction, reduced arterial flow)

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20
Q

if a man with ED still has erections at night what is the likely cause

A

psychogenic -> situational ED

21
Q

what other organ system can ED be linked to

A

cardiovascular -> men with heart disease, diabetes or hypertension are 4x more likely to develop complete ED

erections are vascular

22
Q

what factors of metabolic syndrome contribute to erectile dysfunction

A
  1. endothelial dysfunction
  2. low testosterone
23
Q

side effects of PGE5 inhibitors (sildenafil etc.)

A
  1. headaches
  2. flushing
24
Q

side effects of penile prosthesis (3)

A
  1. infection
  2. erosion
  3. mechanical malfunction
25
Q

on which side are varicoceles usually seen and why (4)

A

left, due to:
1. vertical drainage into the renal vein -> renal/adrenal metabolites cause vasodilation
2. the the vein being longer compared to the right resulting in higher hydrostatic pressure
3. “nutcracker” effect of vein between SMA and aorta
4. incompetent or absent valves more common on left side

26
Q

what is the hudson classification

A

classification of varicoceles
1 - palpable only on valsalva
2 - palpable on standing
3 - visible

27
Q

how does cystic fibrosis lead to infertility in men

A

abnormal development of the vas deferens, epididymis, and seminal vesicles -> sperm cannot reach semen

28
Q

is there a relationship between Mumps and infertility

A

of mumps causes orchitis there can be shrinking of the testicles and a lower sperm count -> this is a rare complication

29
Q

what drugs can impair spermatogenesis (5)

A
  1. sulphasalazine
  2. nitrofurantoin
  3. methotrextate
  4. colchicine
  5. chemotherapy
30
Q

what drugs can suppress the pituitary causing infertility

A
  1. testosterone injections
  2. GnRH analogues
31
Q

what drugs can result in ejaculation failure (3)

A
  1. alpha blockers
  2. antidepressants
  3. phenothiazines
32
Q

what drugs can result in erectile dysfunction

A
  1. beta blockers
  2. thiazide diuretics
  3. metoclopramide
33
Q

what recreational drugs can result in male infertility

A
  1. anabolic steroids
  2. cocaine
  3. cannabis
  4. heroin
34
Q

what is priapism

A

a pathological condition of erection of the penis which is prolonged (beyond 4 hrs) and devoid of sexual stimulation or excitement

35
Q

what are the 2 types of priapism

A
  1. low flow - venous blood, ischaemic, painful, requires urgent treatment
  2. high flow - arterial blood, non ischaemic, painless
36
Q

what condition is priapism commonly seen in

A

sickle cell disease -> low flow, ischaemic priaprism is seen
also other haem causes such as thalassemia

37
Q

priapism mgx

A
  1. aspiration -> drainage of blood from the cavernosa
  2. flushing with saline (removes oxygen poor blood)
  3. intracavernosal injection of a sympathomimetic agent, such as phenylephrine (if aspiration doesn’t work)
  4. surgical shunt between the corpus cavernosa and glans is fashioned (if above manouvers don’t work)
38
Q

priapism investigations

A

corporeal blood gas
ischaemic - acidotic + raised lactate
non ischaemic - normal pH and normal lactate

39
Q

what is a complication of priapism >24hrs

A

erectile dysfunction

40
Q

what is peyronie’s disease

A

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

41
Q

what extra-urological symptom is peyronie’s disease associated with

A

dupuytrens contracture

42
Q

acute phase peyronie’s disease presentation (3)

A
  1. painful erections
  2. penile deformity
  3. lasts 1-6 months
43
Q

chronic phase peyronie’s disease presentation (3)

A
  1. painless
  2. plaque stabilisation
  3. erectile dysfunction
44
Q

what is the pathophys of peyronie’s disease

A
  1. micro tear/autoimmune disease to the penis
  2. scar tissue (plaque) forms under the skin of the penis
  3. The plaque builds up inside tunica albuginea
  4. As it develops, the plaque pulls on the surrounding tissues and causes the penis to curve or bend
45
Q

peyronie’s disease mgx (4)

A
  1. injections -> Collagenase, verapamil, Interferon-alpha 2b
  2. surgery -> corporoplasty, nesbitt’s procedure
  3. mechanical traction and vacuum devices
  4. shockwave therapy of plaque
46
Q

what is a vasectomy

A

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

47
Q

risks/side effects of vasectomy (6)

A
  1. scrotal bruising/swelling for a few days
  2. seepage of yellow fluid from wound after a few days
  3. blood in semen for first few ejaculations
  4. chronic testicular pain or sperm granuloma
  5. inflammation/infection of testis/epididymis
  6. significant bleeding requiring further surgery
48
Q

what test is mandatory post vasectomy

A

post vasectomy semen analysis to confirm azoospermia -> disappearance of spermatozoa from ejaculate can be slow and some men can have non-motile sperm for months/years after vasectomy

49
Q

3 mechanisms of erection initiation

A
  1. Psychogenic erections - occur in response to afferent sensory stimulation (T11-L2 and S2-S4) to trigger central dopaminergic erection from the pre-optic area
  2. Reflexogenic erections - often preserved in men with spinal cord injury above the sacral level, occur following genital stimulation, and are mediated in the spinal cord and autonomic nuclei
  3. Nocturnal erections - occur during rapid eye movement sleep probably result from suppression of inhibitory sympathetic outflow by the pontine reticular formation and amygdala

3B week 5 - LUTS, The Scrotum and Genitalia (6 decks)

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