Disorders of Genitourinary and Reproductive Function Flashcards
Spermatogenesis
Testosterone is also required (the intratesticular concentration of testosterone is 100-fold greater than serum levels)
Male sex hormones and spermatogenesis
Gonadotropin-releasing hormone (GnRH)
Follicle-stimulating hormone (FSH):
Sertoli cells - initiation of spermatogenesis
Luteinizing hormone (LH):
Leydig cells
Production of testosterone
Systems maintaining temperature of testes
Sperm production requires temperature that are 2 to 3 degrees Centigrade below body (core) temperature.
Main actions of testosterone
Promote spermatogenesis and maturation of sperm.
Hypogonadism
Primary - testicular failure
Hypospadias and Epispadias
Congenital disorders of the penis.
Hypospadias - the termination of the urethra is on the ventral surface of the penis.
Categorized as glandular (involving the glans penis), penile, or perineoscrotal.
Epispadias - the opening of the urethra is on the dorsal surface of the penis.
Peyronie disease
A localized and progressive fibrosis of known origin that affects the tunica albuginea.
Manifestations - painful erection, bent erection, and the presence of a hard mass at the site of fibrosis.
Priapism
Erection lasting more than four hours or unrelated to sexual interest or stimulation.
Low-flow (ischemic) priapism: there is stasis of blood flow in the corpora cavernosa with a resultant failure of detumescence.
The two main types of priapism are ischemic and nonischemic priapism.
Ischemic priapism, also called low-flow priapism, is the result of blood not being able to leave the penis. It’s the more common type of priapism and is usually more painful.
Cryptorchidism (undescended testes)
Occurs when one or both of the testicles fail to move down into the scrotal sac.
The testes develop intra-abdominally in the fetus and usually descend into the scrotum through the inguinal canal during the 7th to 9th months of gestation.
Consequences of Cryptorchidism
Infertility
Malignancy
Testicular torsion (10x increased risk)
Disorders of the scrotum and testes
Varicocele: varicosities of the pampiniform plexus; a network of veins supplying the testes
Testicular torsion
Epididymitis
Inflammation of the epididymis.
Types -
Sexually transmitted infections associated with urethritis.
Primary nonsexually transmitted infections associated with urinary tract infections and prostatitis.
Causes - bacterial pathogens
Benign Prostatic Hypertrophy (BPH) pathophysiology
Cause unknown; aging is largest risk factor.
Age-related, nonmalignant enlargement of the prostate gland.
Characterized by the formation of large, discrete lesions in the periurethral region of the prostate rather than the peripheral zones, which commonly are affected by prostate cancer.
Hormone changes -
Reduced testosterone
Increased proportion of estrogen and dihydrotestosterone
Lead to prostatic cell proliferation and growth
Not considered a prostate cancer precursor.
Prostate enlarges; gland impinges on urethra obstructing urine flow.
Urinary frequency:
Dribbling - interrupted urine stream
Hesitancy - trouble starting urine
Size of prostate does not always correlate with symptoms.
Erectile dysfunction
The inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.
Erectile dysfunction pathophysiology
Inability to achieve or maintain an erection sufficient for satisfactory sexual performance.
Medications - antihypertensives
Erectile dysfunction treatment
Pharmacologic treatment - not within 24 hours of nitrates
Sildenafil (Viagra)
Vardenafil
Tadalafil
Testicular cancer pathophysiology
Exact cause often unknown.
Cryptorchidism a major risk factor.
Testicular cancer clinical manifestations
Small, painless testicular mass.
Testicular cancer diagnostic criteria
Imaging studies (ultrasound)
Function of the ovaries and fallopian tubes
The ovaries store the female germ cells or ova.
Ovaries produce the female sex hormones, estrogen, and progesterone.
Ovarian cycle
Follicular phase
Luteal phase
Phases of the endometrial cycle
Proliferative phase, or preovulatory, phase: the glands and stroma of the superficial layer grow rapidly under the influence of estrogen.
Secretory, or postovulatory, phase: progesterone produces grandular dilation and active mucus secretion, and the endometrium becomes highly vascular and edematous
Menstrual phase: the superficial layer degenerates and sloughs off.
The ovarian cycle has two phases - follicular which is from the beginning of menses to ovulation and the secretory phase that is from ovulation to beginning of menses.
The endometrial cycle involves menses; proliferative phase (end of menses to ovulation); secretory phase (ovulation to menses)
Polycystic Ovarian Syndrome (PCOS) pathophysiology
A condition of excess androgen production from the ovaries.
Exact cause unknown; genetic?
Anovulation due to lack of follicular maturation produces bilaterally distended cystic ovaries.
Relationship between high androgen levels and insulin resistance.
Polycystic Ovarian Syndrome (PCOS) clinical manifestations
Menstrual irregularities - few cycles
Excess androgen production -
Hirsutism
Acne
Male-pattern baldness
Obesity - 50% of women
Acanthosis nigricans (darkened velvety skin)
PCOS diagnostic criteria
Oligo-ovulation or anovulation (very few cycles or no cycles)
Hyperandrogenism (elevated testosterone)
Polycystic ovaries visible on ultrasound
*two of these to meet criteria
PCOS treatment
Overall goal of treatment is directed toward:
Symptom relief
Prevention of potential endometrial malignancy
Reduction in risk of diabetes and CV disease
Disorders of the uterus
Endometritis (infection or inflammation of endometrium; sexually or not sexually transmitted)
Endometriosis: functional endometrial tissue is found in ectopic sites.
Adenomyosis: endometrial glands and stroma are found within the myometrium (muscle of the uterus).
Endometrial cancer: most common cancer found in the female pelvis.
Endometriosis
Etiology uncertain - retrograde menstruation; lymphatic spread; misplaced cells. (outside of the uterus)
Endometrial burden not correlate with symptoms.
Endometrial implants.
Endometrial cancer
Prolonged estrogen stimulation and endometrial hyperplasia.
Hyperestrinism and endometrial hyperplasia.
(cancer of the lining of the uterus)
Painless bleeding.
Leiomyomas (Fibroids)
Cause - uncertain but believe to arise from a stem cell in the smooth muscle tissue (myometrium) of the uterus.
Estrogen and progesterone appear to promote growth of fibroids.
Uterine fibroids are not associated with increase risk of uterine cancer and almost never develop into cancer.
Types -
Submucosal
Suberosal
Intramural
Pelvic Inflammatory Disease (PID) pathophysiology
The result of a sexually transmitted infection of the reproductive tract. (an ascending infection)
An inflammation of the upper reproductive tract the involves -
The uterus (endometritis)
The Fallopian tubes (salpingitis)
The ovaries (oophoritis)
Fallopian tubes obstructed with purulent exudate.
Clinical diagnostic criteria for PID
One or more of the following minimum criteria must be present on pelvic examination to diagnose PID:
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
Ectopic prgnancy
Occurs when a fertilized ovum implants outside the uterine cavity (commonly in the fallopian tube).
Causes - delayed ovum transport, which may result from decreased tubal motility or distorted tubal anatomy.
Aging and postmenopausal changes to pelvic floor
Cystocele is a herniation of the bladder into the vagina.
Rectocele is the herniation of the rectum into the vagina.
Uterine prolapse
Uterine prolapse is the bulging of the uterus into the vagina.
Dysfunction of menstrual cycles
Amenorrhea: absence of menstruation
Menorrhagia: excessive menstruation
Pain and the menstrual cycle
Dysmenorrhea: pain or discomfort with menstruation that causes some degree of monthly disability.
Primary - no physical abnormality or pathology.
Secondary - specific organic condition;
Endometriosis
Fibroids
Adenomyosis
Pelvic adhesions
OCP’s effective in regulating menstrual cycles BUT not effective in managing pain.
NSAIA effective if implemented approptiately.
Infertility
Inability to conceive a child after 1 year of unprotected intercourse.
Women get a bad rep when it comes to infertility.
In reality:
1/3 of infertile couples, the problem is with the male.
1/3 of infertile couples, the problem is with the female.
1/3 of infertile couples, the problem can not be identified or is with both the man and the woman.
One year unprotected intercourse, 12-15% of couples are unable to conceive.
Menopause pathophysiology
Cessation of ovarian activity (age 48-55 y)
Menopause clinical manifestations
Occur as a result of loss of estrogen.
Menses cessation
Mood disorders -
Depression
Irritability
Dyspareunia
Sleep disorders -
Insomnia
Disrupted sleep
Menopause diagnostic criteria
History of amenorrhea for at least 12 months in absence of other causes.
Serum FSH (increases)
Menopause treatment
Treat symptoms, when possible
