Chap 21- Lower urinary tract and male genital system Flashcards
urothelium
- aka transitional epithelium
- lines ureters, bladder, and urethra (except terminal portion)
- changes shape when stretched
possible complications in female lower urinary tract
- ureter lies close to uterine a and vulnerable to injury during operations
- genital tract lose to bladder and makes it possible for disease to spread from one tract to another
bifid ureter
- congenital
- two ureters arising from one kidney
- often associated with kidney malformations
- ureters can remain seperate or join together
ureteropelvic junction obstruction
- congenital or acquired
- most common cause of hydronephrosis in infants and children
- causes stagnation of urine
diverticula of ureter
- congenital or aquired
- dilation, elongation or tortuosity of ureter
- aquired may be due to calculi, pelvic neoplasm, or pressure on ureter
what are the common causes of cystitis
- e. coli
- proteus
- klebsiella
- enterobacter
- women more likely than men
cysitis
- either acute or chronic
- bacterial pyelonephritis is frequently preceeded by infection of bladder with retrograde spread
predisposing factors for cystitis
- DM
- instrumentation
- immune deficiency
triad of sx of cystitis
- frequency
- lower abdominal pain
- dysuria
diseases resulting in cystitis as a secondary complication
- prostatic enlargement
- cystocele of bladder
- calculi
- tumors
bladder and urothelial neoplasms
- most common in bladder
- highest in men between 50- 80 y/o
- not familial
- acquired mutations -> GF receptor signaling cascades
risk factors for bladder cancer
- cigarette smoking**
- chemical carcinogens
- long term exposure to analgesics
- heavy long term exposure to cyclophosphamide
- irradiation
symptoms of bladder cancer
- painless hematuria**
- frequency
- urgency
- dysuria
- pyelonephritis or hydronephrosis
morphological patterns of bladder cancer
- papilloma
- invasive papillary carcinoma
- flat non-invasive carcinoma
- flat invasive carcinoma
urethritis classifications
- gonococcal
- non-gonococcal- chlamydia or mycoplasma
urethritis
- often accompanied by cystitis in women and prostatitis in men
- gonococcal urethritis is first manifestation of venereal disease
sx of urethritis
- pain
- itching
- frequency
- usually warns of more serious disease at higher levels of UGT
seminiferous tubules
- site of germination, maturation, and transportation of sperm cells
- located within testes
- surrounded by epithelium called sertoli cells
sertoli cells
- surround seminiferous tubules
- provide protection and nourishment to germ cells
function of testes
- produce sperm and male sex steroids
function of epididymides
- store sperm
function of vas deferens
conduct sperm to urethra
function of male sex accessory glands
produce seminal fluid that nourishes sperm
function of urethra
conduct sperm to outside the male body
function of scrotum
provides proper temperature for testes
erectile tissue of the penis
- corpus spongiosum
- two corpora cavernosa
smegma
- oily secretion produced by glans combined with shed skin cells
- accumulates under foreskin
when does spermatogenesis develop in males
- usually by age 16
- involves HPG axis
adrenarche
- onset of androgen dependent body changes
- causes growth of axillary and pubic hair, body oder, acne
gonadarche
- earliest gonadal changes of puberty
- i.e. testicular enlargement
testosterone
- gives males their secondary sex characteristics and sex drive
- regulates metabolism and protein anabolism
- inhibits pituitary secretion of gonadotropins
- promotes K excretion and Na reabsorption
- male pattern baldness
- acne
semen
sperm and ejaculatory fluid from seminal vesicles
prostate gland secretion
- secretes fluid that mixes the semen and decreases acidity
- increases sperm motility
- prolongs sperm life
bulbourethral gland
- aka cowpers gland
- secretes alkaline fluid in urethra to neutralize acidity caused by urine transport
phimosis
- foreskin cannot be retracted from glans penis
- d/t poor hygiene, infections, and carcinoma
- can lead to urinary obstruction and pain
paraphimosis
- foreskin is retracted and cannot be returned over glans penis
- penis becomes constricted and edematous
- medical emergency
- can cause gangrene
hypospadias and epispadias
- abnormal urethral opening
- d/t malformation of urethral groove and urethral canal
- may be associated with failure of abnormal descent of testes and other malformations of urinary tract
- causes urinart tract obstruction and UTI
- cause of sterility
hypospodias location
opening on ventral surface of penis
epispadias
opening on dorsal surface of penis
varicocele
- dilation of veins in spermatic cord
- d/t inadequate or absent valves in spermatic veins
hydrocele
- scrotal swelling d/t collection of fluid in tunica vaginalis
- imbalance between fluid secretion and reabsorption
tunica vaginalis
serous membrane that covers testes
spermatocele
- painless diverticulum of epididymis located between head of epididymis and testis
- contains milky fluid with sperm
what types of conditions are associated with the epididymis
inflammatory diseases
cryptorchidism
- complete or partial failure of intra-abdominal testes to descend into scrotal sac
- assoc with testicular dysfunction and cancer
- should be completely descended by end of 1st year
risk factors for cryptorchidism
- prematurity and low birth weight
- familial history of genital dev
- maternal alcohol use or cigarette smoking during pregnancy
- exposure to second hand smoke during pregnancy
phases of testicular descent
- transabdominal phase
- inguinoscrotal phase
- testes can get stuck in either phase in cryptorchidism
complications of crytorchidism
- sterility
- testicular cancer
testicular torsion
- twisting of spermatic cord
- cuts off venous drainage of testes
- surgical emergency because can cause testicular infarction
- sudden onset of testicular pain
cause of testicular torsion
- bell clapper abnormality- bilateral anatomic defect that leads to increased mobility of testes
- testes don’t get attached to posterior wall of scrotum
testicular tumor classifications
- germ cell tumors (majority)
- sex- chord stromal tumors
- germ cell tumors further divided into seminomas or non-seminomas
seminomas
- most common type of germ cell tumor
causes of testicular tumors
- environmental factors
- genetic factors
dysgerminoma
he ovarian tumor that is similar to testicular tumors
what is the peak incidence of testicular tumors
- usually in men 15-34
- peak in third decade
- cause 10% of all cancer deaths
pathogenesis of testicular tumors
- originate from intratubular germ cell neoplasia (ITGCN)
- retain expression of transcription factors OCT3/4 and NANOG
- biologic markers= hCG, AFP, LDH
what do OCT3/4 and NANOG normally do
maintain pluripotent stem cells
clinical features of testicular tumors
- painless enlargement of testis
- any solid testicular mass should be considered neoplastic until proven otherwise
how does testicular cancer spread
- lymphatic spread to retroperitoneal and para-aortic nodes -> mediastinal and supraclavicular nodes
- then hematogenous to lungs
zones of the prostate
- peripheral zone
- central zone
- transitional zone
- periurethral zone
where do most prostatic hyperplasias occur
transitional zone
where doe most prostatic carcinomas occur
peripheral zone
BPH
- most common benign prostatic disease in men >50
- nodular hyperplasia in periurethral region -> partial or complete urethral obstruction
pathogenesis of BPH
- testosterone converted to DHT by 5 alpha reductase
- binds to androgen receptors in stromal and epithelial cells
- binding -> growth and proliferative pathway activation
clinical features of BPH
- urinary obstruction, bladder hypertrophy and distention
- frequency, noturia
- difficulty in starting and stopping urine stream
- overflow dribbling
- dysuria
- increased UTI risk
treatment for mild cases of BPH
- decrease fluid intake esp before bedtime
- moderating intake of alcohol and caffeine
- timed voiding schedules
prostate cancer
- adenocarcinoma is most common form of cancer in men
- tied with colorectal cancer mortality
- occurs in 20% of men in 50s
- occurs in 70% of men 70- 80 y/o
pathogenesis of prostate cancer
- largely unknown
- associated with androgen levels, age, and race
- african americans have higher risk
- environmental factors like charred red meat are associated
- family history
- increased fat consumption
what are protective factors against prostate cancer
- soy
- vit D
mutations associated with prostate cancer
- short CAG repeats
- BRACA2
- hypermethylation of glutathione S- transferase gene
what is the prostatic cancer precursor lesion
- prostatic intraepithelial neoplasia (PIN)
clinical course of prostate cancer
- if localized is asymptomatic
- discovered based on rectal exam or elevated PSA
- arise in periphery so urinary sx occur late
PSA
- prostate specific antigen
- used to dx and manage prostate cancer
- estimates pt treatment response
