CM- Male Reproductive System Flashcards
When doing a thorough examination of the penis, what 5 things are you on the lookout for?
- developmental abnormalities
- discharge
- skin lesions
- fibrosis
- masses
During a penile exam, you retract the forskin and examine the glans. The urethral meatus opens on the ventral surface of the penis. What is this called?
Hypospadias- the urethral meatus is on the ventral surface anywhere from the glans to the perineum.
Even if the meatus is very proximal, there will still be a blind-opening pit on the glans
On PE, the foreskin and glans of the penis have a grey, thickened, fibrotic appearance.
What is this condition and what is it associated with?
It is lichen sclerosis [BXO] and can be associated with meatal stenosis and urethral stricture.
It can lead to phimosis and SCC.
On PE, you notice thick fibrous plaques that are palpable deep to the base of the penile shaft. These plaques are characteristic of what disease?
What is the cause of the disease?
These plaques at the base of the penis are characteristic of Peyronie’s disease.
In Peyronie’s disease there is an inciting event [usually trauma during an erection] that causes the penis to become deformed and curved when erect.
When examining the penis, it is important to look for skin lesions. What diagnosis is associated with the following lesions:
- painless ulcers
- grouped vesicles
- painful ulcers
- mucopurulent discharge
- syphilitic chancre
- Herpes virus
- H. ducreyi [chancroid]
- gonorrhea or chlamydial urethritis
When you are doing a male genital exam, what are you examining during the scrotal portion of the exam?
- testicular size and mass
- epididymal masses and pain
- other masses
- hernias
You are doing a male genital exam and note the absence of testes in the scrotum. What is the most likely problem and what are the implications?
Cryptorchidism [undescended testes].
This puts the patient at an increased risk for infertility and testicular cancer
When doing an examination of the scrotum, what is the implication of:
- painless firm masses of the testicular parenchyma
- small atrophic testes
- testicular cancer - grows rapidly and metastasizes but is still really treatable
- oligospermia because volume of testis corresponds to the number of healthy seminiferous tubules
A patient has sudden onset intense pain in his scrotum. He has abdominal pain, nausea and vomiting. What is the likely disorder? What is the pathology behind it and how is it treated?
It is testicular torsion where the spermatic cord is twisted making the testicle ischemic.
Detorsion and orchiopexy [where you tack the testicles in place] must be done within 8 hours to save the testicle and prevent subsequent contralateral torsion.
While examining the male genitals, you palpate a painful mass of gradual onset originating from the ridge behind the testes. What is the likely problem?
Epididymitis
When you are palpating the epididymis, how do you know when you have reached the lower pole that drains into the vas deferens?
What is likely if the vas deferens is absent?
It will feel like a firm toothpick.
If the vas deferens is absent, most likely there is renal agenesis because the testis and kidney share a common embroylogical origin, the mesonephric/wolffian duct in development.
Missing vas deferens is also associated with CF
On male genital exam, you note a soft homogenous scrotal mass that transilluminates. What is the diagnosis?
Hydrocele
On male genital exam, you palpate dilated, engorged testicular veins like a “bag of worms” in the spermatic cord on the left. The man discloses that he has been having trouble conceiving with his wife. What is the likely cause?
Varicocele- the leading cause of male factor infertility
What are the 3 types of hernias assessed while examining the scrotum?
Where would you feel each?
- direct inguinal- peritoneal cavity into the scrotum
- indirect inguinal - circuitous route through patent inguinal canal
- femoral - bulges below the inguinal ligament
To differentiate direct and indirect, place exam finger at the exit of the inguinal canal by following vas deferens proximally and then have the patient cough or bear down.
Direct = will press along the side of the exam finger
Indirect = will press at the tip of the exam finger
When you do the DRE to check the prostate, what 3 features are you examining?
- size
- contour
- tenderness
Size approx of volume “40g = a shot glass”
DRE estimate of prostate size tends to be an underestimate
On DRE, the prostate is tender and there is excessive warmth.
The patient has fever and dysuria.
What is the likely problem?
acute bacterial prostatitis
On DRE, you note irregular contour, firmness and nodules. What is the diagnosis?
Prostatic carcinoma
On DRE, you note a symmetrically enlarged prostate. What is the diagnosis?
BPH
How long does spermatogenesis take?
What takes place in the seminiferous tubules?
What cells are involved?
The production of sperm takes about 70 days.
Seminiferous tubules are lined by Sertoli cells which support the development of the germ cells undertaking meiotic division.
Gonocyte–> spermatogonia which migrates to periphery to divide mitotically–. spermocyte [pre-meiotic division]–> spermatid [post-meiotic differentiating cell] –> spermatozoa [MATURE]
Where do the non-motile, mature spermatozoa go from the seminiferous tubules?
The non-motile sperm empty into the epididymis for storage and maturation [20 more days].
This is where the sperm gain motility and fertility.
Where in the testes is testosterone made? What triggers the release?
Testosterone is made and secreted by the interstitial Leydig cells adjacent to the seminiferous tubules of the testes.
Hypothalamus releases GnRH which stimulates pituitary to secrete LH which acts on Leydig cells to make testosterone
The hypothalamus produces _______ which stimulates the pituitary to release _____ which acts on the Leydig cells to secrete testosterone and ____________ which acts on the seminiferous tubules/Sertoli cells to produce sperm.
GnRH releases:
LH–> Leydig –> testosterone
FSH–> Sertoli/seminiferous vesicles–> sperm
What all does FSH stimulate the Sertoli cells to produce?
- AMH
- inhibin
- androgen binding protein
- stimulate spermatogenesis
What is ED?
The consistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity
52% of men btw 40-70 with the incidence increasing with age
