Conditions of the Male Reproductive System Flashcards
Describe the condition of acute prostatitis
Definition:
- acute inflammation of prostate
Classifications:
- non-bacterial
- most common
- caused by trauma, autoimmune response, infection - bacterial
- e coli, chlamydia, gonorrhea
SSX:
- Pain
- variable distribution (perineal, lumbosacral, suprapubic)
- dull and poorly localized - obstructive voiding SSX
- hesitancy
- poor calibre of stream - irritative voiding SSX
- urgency
- frequency - if infective prostatitis
- fever / chills
- positive urine culture
Describe the condition of benign prostatic hyperplasia (BPH)
Definition:
- hyperplasia of prostate
- affects transition zone
- non malignant
Incidence:
- 20% of men in 40s
- 50% of men in 50s
- 90% of men in 80s
Aetiology:
- imbalance of androgens and growth factors
- ageing men: higher ratio of DHT (dihydrotestosterone) to testosterone
Pathophysiology:
- 5a reductase (enzyme) converts testosterone to DHT
- DHT binds to androgen receptors in nucleus of prostate and stimulates growth factor production
- hyperplasia of glandular and stromal components of prostate
- causes nodule formation
- compression of prostatic urethra causes obstructive or irritative SSX
SSX:
- Obstructive
- hesitancy
- decreased force of stream
- straining to urinate
- post void dribbling - Irritative (caused by urine retention)
- urgency
- frequency
- nocturia
- palpable bladder
Complications:
- bacterial infections (develop in stagnant urine in bladder)
- bladder stones / diverticuli
- acute urinary retention (emergency catheterization required)
Management:
- 5a alpha reductase inhibitors (finasteride)
- alpha 1 receptor inhibitors (tamsulosin)
- surgery (prostate removal) to reduce SSX
What is the role of 5a reductase in BPH?
- 5a reductase is an enzyme that converts testosterone into DHT (dihydrotestosterone)
- DHT binds to androgen receptors in nucleus of prostate and stimulates growth factor production
Which examinations are used to diagnose BPH?
- DRE
- PSA blood test (prostate specific androgen)
- TRUS (trans-rectal ultrasound) biopsy
What are the actions of alpha-1 receptor antagonists in relation to BPH?
- bind to alpha 1 receptors in prostatic smooth muscle and detrusor muscle in bladder; inhibit SNS activation of prostate gland and bladder
- decrease contraction of prostatic smooth muscle
- decrease contraction of detrusor muscle to initiate urination
Describe the condition of prostate cancer
Incidence:
- most common cancer in Australia
- 3rd most common cancer death in Australia
- affects 20% of Australian men (85% over 65 y.o.)
Most common type:
- adenocarcinoma
Risk factors:
- tobacco
- diet high in fat and charred red meat
- chronic disease (obesity, insulin resistance)
Pathophysiology:
- develops in peripheral zone
- primary and secondary tumours grow slowly
- cause osteoplastic secondaries (visible on X ray)
- metastasis via blood or lymphatics commonly spreads to spine
SSX:
- often asymptomatic in early stages
1. obstructive SSX
2. irritative SSX
3. pain (lumbosacral, sciatic, perineal)
4. systemic (weight loss, fatigue)
5. haematuria (blood in semen)
6. DRE: craggy / hard prostate
Management:
- TURP (transurethral resection of prostate)
- open prostatectomy
- brachytherapy
What are the obstructive and irritative symptoms present in prostate cancer?
- Obstructive (caused by urine obstruction)
- hesitancy
- decreased calibre of stream
- straining to urinate
- post void dribbling - Irritative (caused by urine retention)
- urgency and frequency
- nocturia
- palpable bladder
Describe the condition of inguinal hernia
Definition:
- protrusion of abdominal contents (intestines / omentum) into inguinal canal
Classifications:
1 indirect / lateral:
- hernia sac passes through deep inguinal ring into inguinal canal
- usually caused by patent vaginal process (incomplete closure of inguinal ring in embryological development) and appears in infancy
- direct / medial:
- hernia sac bulges directly through posterior wall of inguinal canal
- usually caused by weakness in transversalis fascia and evelops in adulthood
Risk factors:
- male
- age
- tobacco
- high BMI
- occupations with increased lifting / standing / walking
SSX:
- lump in groin that disappears with pressure or lying supine
- 70% have mild to moderate discomfort aggravated by activity
Management:
- mesh repair or suture repair
- open or laprascopic surgery
- complications of surgery: recurrence, chronic pain, infertility
What is the difference between a direct and an indirect inguinal hernia?
Direct:
- hernia bulges directly through posterior inguinal canal wall
- usually caused by weakness in transversalis fascia
- usually occurs in adulthood
Indirect:
- hernia enters inguinal canal through deep inguinal ring
- usually caused by a congenital condition called patent vaginal process (incomplete closure of inguinal ring in embryological development)
- usually occurs in infancy
What is a hydrocele?
Definition:
- accumulation of fluid between parietal and visceral layers of tunica vaginalis around testes
Classifications:
- primary
- normal fluid nor adequately reabsorbed (no clear aetiology) - secondary
- excess fluid caused by an infection, injury or malignancy - congenital
- caused by a patent vaginal process (connection between abdomen and tunica vaginalis not closed properly in embryological development)
SSX:
- smooth localized scrotal swelling that fluctuates with pressure
- swelling is translucent
Describe the condition of cryptorchidism
Definition:
- failure of one or both testes to descend from abdomen to scrotum at birth
- 75% unilateral, 25% bilalteral
Incidence:
- 5% of full term infants
- 20% of premature low birth infants
Pathophysiology:
- arrest of testicular descent can occur anywhere along normal path of testicular descent
- most common site for arrest is inguinal canal
Complications:
- malpositioned testes are too hot for spermatogenesis to occur, and degenerative changes can begin as early as 2 years old
- inguinal testes increases risk of inguinal hernia
- risk of infertility (75% in bilateral cases and 50% in unilateral cases)
- 3x5 times higher risk of testicular cancer
SSX:
- usually asymptomatic
- in inguinal canal: vulnerable to trauma and crushing injuries
Management:
- orchioplexy (within 1-2 years old)
Describe the condition of varioceles
Definition:
- varicosity of testicular vein and pampinform plexus inside scrotum
Incidence:
- 7% of pre-pubertal males and 10-25% of post-pubertal males
- incidence highest in elderly men
Classifications:
- Primary variocele
- caused by incompetent valves in testicular veins
- genetic predisposition
- more common on left - Secondary variocele
- caused by pathological conditions that increase intravenous pressure (tumour, infection, thrombosis)
SSX:
- scrotal oedema (‘bag of worms’, aggravated by cough, Valsalva, standing)
- dragging / aching sensationo in scrotum
- reduced sperm count / sub-fertility
Management:
- surgery for large cases
Describe the condition of testicular torsion
Definition:
- twisting of spermatic cord (usually medially)
- medical emergency: surgery required before torsion cuts of venous drainage of testes and causes infarction
Aetiology:
- congenital malformation of tunica vaginalis (most common)
- spontaneous
- trauma / exertion
SSX:
- swollen scrotum
- very tender scrotum
- maybe severe abdominal pain
- maybe nausea, vomiting, sweating
Management:
- testes must be surgically untwisted within 6 hours to have a good chance of remaining viable
- after 6 hours ischaemic necrosis of testes occurs
Describe the condition of testicular cancer
Incidence:
- 2nd most common cancer in young men
Prognosis:
- one of the most curable cancers
Classifications:
- seminomas (most common: cancer of semineferous tubule)
- non-semimomas (less common, more aggressive)
Aetiology:
- unclear
- risk factors: family Hx, cryptocrchidism
SSX:
- 10% asymptomatic
- usually painless apart from a dull abdo ache
- testicular enlargement (heaviness, dullness in scrotum)
- metastatic spread: back pain, cough, haemoptysis, dyspnoea
Managemnet:
- surgery: radical orchiectomy (testicle and spermatic cord removed)
- chemotherapy and radiotherapy
- maybe retroperitoneal lymph node dissection
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