Chapter 14 ( Male Genital System )

Question 1

Mechanism of hypospadias ?

Answer 1

Failure of the urethral folds to close

Question 2

Epispadias mechanism ? Associated with ?

Answer 2

Due to abnormal positioning of the genital tubercle

Associated with bladder exstrophy

Question 3

Lymphogranuloma Venereum mechanism ? Cause ? Fate ?

Answer 3

Necrotizing granulomatous inflammation of the inguinal lymphatics and LNs

Sexually transmitted disease caused by : Chlamydia trachomatis ( serotypes L1-L3 )

Eventually heals by fibrosis
Perianal involvement may result in rectal stricture

Question 4

Penile squamous cell carcinoma risk factors ? Precursor in situ lesions ?

Answer 4

Risk factors :
High risk HPV
Lack of circumcision

Precursor in situ lesions :
1- Bowen disease : in situ carcinoma of the penile shaft or scrotum that presents as Leukoplakia
2- Erythroplasia of Queyrat : in situ carcinoma of the glans that presents as Erythroplakia
3- Bowenoid papulosis : in situ carcinoma that presents as multiple reddish papules , seen in younger patients ( 40y ) and does not progress to invasive carcinoma

Question 5

Most common congenital male reproductive anomaly ?

Answer 5

Cryptorchidism

Question 6

Complications of cryptorchidism ?

Answer 6

Testicular atrophy with infertility

Increased risk for seminoma

Question 7

Causes of Orchitis ?

Answer 7

1- Chlamydia trachomatis ( D-K ) or Neisseria gonorrhea : seen in young adults with increased risk for sterility but libido is not affected because Leydig cells are spared
2- E coli and Pseudomonas : seen in older adults , UTI spreads into the reproductive tract
3- Mumps virus : in teenagers , increased risk for infertility
4- Autoimmune orchitis : characterized by granulomas involving the seminiferous tubules

Question 8

Cause of testicular torsion ?

Answer 8

Due to congenital failure of testes to attach to the inner lining of the scrotum ( via the processus vaginalis )

Question 9

Most common type of testicular tumors ?

Answer 9

Germ cell tumors

Question 10

Germ cell tumors of testicles occur in age ?

Answer 10

Between 15-40 years

Question 11

Risk factors for germ cell tumors ?

Answer 11

Cryptorchidism

Klinefelter syndrome

Question 12

Gross appearance of seminoma ?

Answer 12

Homogenous mass with no hemorrhage or necrosis

Question 13

Embryonal carcinoma of testicles consequence of chemotherapy ? Labs ?

Answer 13

Chemotherapy may result in differentiation into another type of germ cell tumor ( teratoma )

Labs : increased AFP or Beta-hCG may be present

Question 14

Elevated Beta-hCG may lead to ? Why ?

Answer 14

Hyperthyroidism or Gynecomastia

Because alpha subunit of hCG is similar to that of FSH , LH and TSH

Question 15

Is teratoma benign or malignant in males ? Labs ?

Answer 15

Malignant

AFP and Beta-hCG may be increased

Question 16

Presentation of sertoli cell tumor ?

Answer 16

Usually clinically silent

Question 17

Most common cause of testicular mass in males > 60 years old ?

Answer 17

Lymphoma usually of diffuse large B-cell type

Question 18

Prostatic glands are composed of ? Secrets ? Maintained by ?

Answer 18

Inner layer of luminal cells and outer layer of basal cells

Secrets alkaline milky fluid thats added to sperms and seminal vesicle fluid to make semen

Maintained by androgens

Question 19

Acute prostatitis causes ? Presentation ? On DRE ? Inv ?

Answer 19

In young adults : Chlamydia trachomatis and Neisseria gonorrhoeae
In older adults : E coli and Pseudomonas

Presents as dysuria with fever and chills

On DRE : prostate is tender and boggy

Inv : prostatic secretions show WBCs
Culture reveals bacteria

Question 20

Chronic prostatitis presentation ? Inv ?

Answer 20

Presents as dysuria with pelvic or low back pain

Inv : prostatic secretions show WBCs
Cultures are negative

Question 21

Mechanism of benign prostatic hyperplasia ?

Answer 21

DHT acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

Question 22

Site of benign prostatic hyperplasia ?

Answer 22

In the central periurethral zone of the prostate

Question 23

PSA source ? Function ?

Answer 23

Made by prostatic glands

Liquifies semen

Question 24

Non selective alpha1- antagonist ?

Answer 24

Terazosine ( acts on both alpha1a and alpha1b receptors )

Question 25

Selective alpha1a antagonist ?

Answer 25

Tamsulosin ( used in normotensive individuals to avoid alpha1b effects on blood vessels )

Question 26

5alpha-reductase inhibitors ?

Answer 26

Finasteride

Dutasteride

Question 27

Risk factors for prostatic adenocarcinoma ?

Answer 27

Age
Race ( african american > caucasians > asians )
Diet high in saturated fats

Question 28

Most common site of prostate adenocarcinoma ?

Answer 28

In the peripheral posterior region of the prostate ( hence does not produce urinary symptoms early on )

Question 29

Prostatic adenocarcinoma effect on free-PSA ?

Answer 29

Makes bound-PSA —> ⬇️ free-PSA %

Question 30

Prostatic adenocarcinoma micro picture ?

Answer 30

Small invasive glands with prominent nucleoli

Question 31

Grading of prostate adenocarcinoma ? Based on ?

Answer 31

Gleason grading system

Based on architecture alone ( not nuclear atypia )

Question 32

Prostate adenocarcinoma is commonly spread to ? Results in ? Presentation ?

Answer 32

Lumbar spine or pelvis

Results in osteoplastic metastasis

Presents as :
Low back pain 
⬆️ serum alkaline phosphatase 
⬆️ PSA
⬆️ PAP ( prostatic acid phosphatase )

Question 33

Ttt of advanced prostate adenocarcinoma ?

Answer 33

Hormone suppression by :
1- continuous GnRH analogs as Leuprolide ( shuts down anterior pituitary gonadotrophs FSH and LH )
2- Flutamide ( competitive inhibitor at the androgen receptor )