CM: Intro to Male Repro Flashcards
thick, fibrous plaques palpable deep w/i base of penile shaft
significant penile deformity during erection
Peyronie’s dz
painless, firm masses of testicular parenchyma
testicular cancer
What is testicular torsion?
spermatic cord twists - testicle ischemic - surgery!
painful mass of gradual onset originating from outside testicle
epididymitis
soft homogenous scrotal mass that transilluminates
hydrocele
dilated and engorged testicular veins easily palpable in spermatic cord
varicocele (usually on left) - surgically correctable cause of male infertility
irregular contour, firmness, nodules on prostate exam
prostatic cancer
What is the role of FSH in spermatogenesis?
essential for initiation at puberty
stimulates normal levels in adult
What is the role of the seminiferous tubules during spermatogenesis?
lined by sertoli cells - tight jxns between divide into basal and adluminal compartments
blood testes barrier allows spermatogenesis to occur in immunologically privileged site
What are the roles of sertoli cells in spermatogenesis?
nurse cells
undifferentiated spermatogonia near BM
more advanced spermatids and spermatocytes near luminal surface
What is the order of differentiation of cells during spermatogenesis?
gonocytes –> spermatogonia –> spermatocytes (pre-meiotic) –> spermatids (post-meiotic) –> spermatozoa (mature)
What is the role of the epididymis in sperm production?
sperm transport and storage
sperm fertilizing ability (to penetrate zona pellucida)
motility maturation
transit about 12 days
What is the role of PSA?
to liquefy seminal coagulum
What is the normal physiology of an erection?
stimulus –> NO release –> cGMP formation –> vascular smooth muscle relaxation –> filling of sinuisoids w blood
PDE5 breaks down cGMP to reverse process
What are psychogenic causes of ED?
anxiety, loss of attraction, stress, relationship problems
What are psychiatric causes of ED?
depression
What are neurogenic causes of ED?
trauma, myelodysplasia, multiple sclerosis, DM, alcohol, pelvis surgery
What are endocrine causes of ED?
primary or secondary hypogonadism, hyperprolactinemia
What arteriogenic causes of ED?
HTN, smoking, diabetes, hypercholesterolinemia, peripheral vascular dz
What are venous causes of ED?
impairment of veno-occlusive mechanisms, peyronie’s dz
What are drug induced causes of ED?
antihypertensives, antidepressants, hormones
What findings suggest psychogenic ED?
sudden onset, situational, normal nocturnal erections
What findings suggest organic ED?
gradual in onset, progressive, reduced nocturnal and early morning erections, normal libido and dev during puberty
What are the contraindications for PDE5 inhibitors?
pts taking nitrates
unstable angina or recent MI
What is priapism?
painful, unwanted, persistent erection which may produce ischemic damage to cavernous tissue if left untreated for >6hrs
