diseases of the prostate, testis, and penis Flashcards
BPH
very frequent disorder with 70% at age 60 but only half of them would have clinical diagnostically enlargement and only have of these have symptoms
BPH more common
in blacks
LUTS (lower urinary tract symptoms) are result of (2)
BPH and age-related detrusor dysfunction
why is there BPH occuring
there is an increase in epithelial and stromal cell in the periurethral area due to an impaired apoptosis thought to be due to androgen and estrogens inhibiting that leads to an increase cellular accumulation
Type 1 5alpha
found in the blood
Type 2 5alpha
reductase predominantly prostatic and it is critical in normal development of prostate and hyperplastic growth
Presence of __________ is required for development of prostate and BPH
androgens
90% of prostatic andorgen is
DHT which has a higher affinity to androgen receptors
this is a target that might reverse BPH by allowing apoptotsis to occur again
why are we seeing BPH more now?
more people are living longer and there is a correlation between increase in estrogen (this increase in adrogen receptors) and aging
bladder function undergo obstruction leads to induction 2 changes
- decrease in compliance/ detrusor instability- frequency and urgency
- decrease in contractility- leading to decrease in flow rate, hesitancy and increase in PVR … detrusor failure
BPH occurs mainly in the
transition zone
focal atrophy of the prostate occurs in the
peripheral zone
complication of BPH (2)
- bladder stones due to urinary stasis
- UTI/Urosepsis which is a main indicator of surgical intervention
- bladder decompensation- fibrosis that is irreversible
- urinary incotinence
- renal insufficiency
- hematuria
2 end point of BPH
- acute urinary retention
2. surgery- TURP
international prostate symptom score
symptom score that classifies as either mild, moderate or severe and is a primary determinant of treatment response or disease progression
medical therapy for BPH (4)
- alpha-adrenergic blockers
- 5alpha-reductase inhibitors
- aromatase inhibitors
- plant extracts
98% alpha-ARs are localized in
prostatic stroma
BOO associated with alpha-AR in prostate
smooth muscle
Suppression of DHT synthesis through a 5alpha reductase inhibitor leads to
decrease in prostate size
- pts. with larger size of prostate have greater effect
prostate cancer
most common cause of cancer in men
- 1/6 lifetime probability but only 3% lifetime risk of death
what is a main goal for prostate cancer
prevent the development of metastatic disease due to its higher risk of death
overall PSA has done what?
improvements for screening with overall declining age at diagnosis, shifts to earlier stages, decreased tumor volumes and increased treatment rates
There is no safe PSA value below which reassure patient he does not have CaP
yep
the only way to diagnosis cancer of the prostate
biopsy duhhhh
Remains the gold standard for long term control of clinically localized CaP in young healthy man
Goals:
- Cure of disease
- Urinary control
- Preservation of erectile function
radical prostatectomy
5-10% of prostatitis causes that can be treated effectively is
bacterial infections
symptoms of prostatitis
related to pain or discomfort in the pelvic region with problems with urination and ejaculation
treatment of prostatitis
- alpha blockers
- pain relievers
- prostatic massage
- lifestyle changes/home remedies
- alternative therapies
testicular cancer
most common solid tumor in young adults where most of them are germ cell cancer such as seminoma or non-seminoma
most common testicular tumor in >50 is
lymphoma
testicular cancer met spreads usually via
lymphatic but yol sac tumor (choriocarcinoma) may met hematogenously
most common lymph node affected in met in testicular cancer
retroperitoneal lymph node
most common testicular tumor in 0-10
yolk sac tumor
most common testicular tumor in 20-30
choriocarcinoma
____________is the primary management for all solid testicular tumors
Radical inguinal orchiectomy
twisting of the spermatic cord leading to sudden onset of severe pain in one testicle w/ or w/0 previous event and immediate surgery is required to to chance of infarction of the blood supply being cut
testicular torsion
2 premalignant penile lesions
- bowenoid papulosis
2. carcinoma in situ
Bowenoid Papulosis vs. Carcinoma in situ
- age at diagnosis
- usual foreskin status
- HPV has been detected
- risk of developing SCC
- age at diagnosis: 20-30 vs 50-60
- usual foreskin status: circumcised vs. uncircumcised
- HPV has been detected: yes for both
- risk of developing SCC: rare vs. 10%
Inflammatory lesion due to chronic infection, trauma, and inflammation. it rarely undergoes malignant transformation but presents with flat white patches son the glans and prepuce
balantis xerotica obliterans (BXO)
penile carcinoma
squamous cell carcinoma in >95%
with increased risk due to
- uncircumcised
- premalignant lesions
- tobacco
gold standard for penile carcinoma treatment
partial or total penectomy
penile carcinoma lymph node spread
inguinal lymph node
_______ is a condition in which the foreskin is tight and narrow, making it impossible or painful to retract
Phimosis
Persistent erection for over 4 hour’s duration
2 types
- ischemic low flow and
- non ischemic with high flow
priapism
treatment of ischemic slow flow priapism
- corporal aspiration and irrigation
2. penile corporal shunts
Inelastic scar (plaque) in tunica albuginea of the corpora with cause unknown. Present with penile pain (esp. with erection), shortening, deformity, or induration/plaque
peyronie’s disease
treatmet of peyronie’s
- medical therapy-
- intracorporal injection
- surgery
