Class 23 Pt. 3 - Alterations in Reproduction, Structural Flashcards
Hypospadias
When the urethra, instead of the opening on the central part of the glans, tends to open on the undersurface of the penis
- Congenital
- Relatively common 1/300 boys have some degree of hypospadias
Risk factors
- Maternal age
- Associated to exposure to progestin and other unknown environmental factors
Can easily be repaired with surgery depending on how serious or how harmful it is
Epispadias
There is an opening on the upper surface of the penis, or an absolute defect in the formation of the urethral groove
- Congenital
- Can occur in females (less common)
- Can project all the way to the bottom of the bladder; incontinence
Phimosis
Foreskin is too tight to move backwards over the glans
- Physiological or pathological cause
- Treatment: circumcision
Paraphimosis
Foreskin cannot be moved back forward over the glans once it has been pushed backward
- Physiological or pathological cause
- Can cause edema and necrosis of the glans if not corrected
- Important to move foreskin back over the top
- Treatment: circumcision
Varicocele
Abnormal dilation of veins in the spermatic cord
- Usually due to congenital incompetence of the valves in those veins
- Backflow pressure - decreased blood flow to the testes - decreased spermatogenesis - infertility
Hydrocele
Collection of fluid in the outermost layer of the testes
- Can be congenital (if so, usually resolves on its own after the first year)
- Acquired anytime; can be associated with trauma, infection or tumours
- Can achieve large sizes - difficult to move around
Cryptorchidism
Undescended testes
- Testes remain stuck in the abdominal cavity in the inguinal canal and fails to descend into the scrotum
- Unilaterally or bilaterally
Physical assessment
- Palpate the scrotum of the newborn to make sure they are in the scrotum at birth
- If is it not there, usually descends on own by age 1
Left untreated
- Infertility
- Increased rate of cancer of the testes
Treatment
- Hormonal therapy (small amounts will allow it to come down on its own)
- If not down by age 2, surgery
Torsion of the Testes
Testes rotate on itslef and along with the rotation of the testicular artery and veins too
- Cuts off blood supply to the testes, causing what is called acute scrotum
- emergency situation involving manual reduction or surgery
- More common in newborns or adolescents
- Can occur spontaneously or after vigorous physical activity or trauma
Manifestations
- Pain and swelling
- Ischemia can lead to permanent damage and necrosis of the testes
Cystocele
Occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina
Cysourethocele
Drooping of the bladder and the urethra into the vagina
Urethrocele
Drooping of the urethra into the vagina
Rectocele
Rectum bulging into the vagina
- Causes problems with defecation
Uterine Prolapse
Descent of the cervix and sometime the entire uterus into the vaginal canal
Mild: pessary can be used (round ring that is fit up around the neck of the cervix and elevates the uterus to keep it in place)
Severe: hysterectomy
Kegel exercises help strengthen the muscles of the pelvic region and the vaginal wall
- Women encourage to start Kegel exercises very early on in life to prevent this compliccation
- Avoid constipation and straining
- Surgery to re-anchor the bladder, uterus or to remove the uterus
Ammenorrhea
Absence of a menstrual cycle
Primary
- No menstrual cycle before 14 along with no secondary sex characteristics or no menstrual cycle before 16 regardless
- Can be associated with congenital defect in gonadotropin production or genetic defects such as Turner’s syndrome
Secondary
- The absence of three or more menstrual cycles once a women has established her periods
- Often associated with starvation, psychogenic disturbances, extreme exercise, tumorus
- Can be associated with certain medical treatments such as chemotherapy
- If the cause is treated - menstrual cycle returns
Dysmenorrhea
Painful periods
Primary: results primarily from an excess in prostaglandins in the endometrium
- Increased myometrial contractions and constriction of the endometrial blood vessels
- Results in pain an can be associated with headache, Gi upset, and fainting
- 50-75% of women between 15-25 are affected by some degree of primary dysmenorrhea
- Incidence seems to increase after mid 20’s
- Taking birth control seems to decrase the pain
Secondary: associated with a number of other diseases
- Endometriosis or PID
- Associated with adhesion and uterine fibroids
