Disorders of the male genitourinary system Flashcards
Erectile Dysfunction (ED)
- Inability to achieve and maintain erection sufficient topermit satisfactory sexual intercourse Causes: - Psychogenic - Organic – most common - Both
ED Etiology: Psychogenic
- Performance anxiety
- Emotional issues with partner
- Depression
ED Etiology: Organic
- Neurogenic – stroke, spinal cord injury, surgery
- Vascular – hypertension, smoking, DM
- Hormonal – decreased androgen levels
Drug-induced
- Antihypertensives, nicotine, alcohol, antidepressants, antipsychotics, B-blockers
- Aging
ED Treatment
- Psychosexual Counselling
- Medication
- Androgen replacement
- Oral Phosphodiesterase type 5 inhibitors
- Intracavernous (injection in penis)
- Prosthesis
- Vascular surgery
Penile Inflammation/Infection Cause & Manifestations
- Due to trauma, irritation, infection
- Candida albicans, bacteria
- Often related to STIs
Manifestations
- erythema, edema of glans and prepuce
- Blanitis xerotica obliterans (often UKE):
Sclerosing atrophy of the foreskin in uncircumcised men: precancerous state
Priapism
- Involuntary, prolonged, painful erection d/t impaired blood flow in corpus cavernosa resulting in failure of detumescence
> Risk factors - Any age
- Sickle cell disease, neoplasms
> Primary > Secondary - Hematological, neurological, renal - Medications if not resolved in 48hr: permanent sclerosis, fibrosis, necrosis
Testicular Torsion
- Twisting of the spermatic cord suspending testes
- Extravaginal or Intravaginal
Testicular Torsion (cont)
Extravaginal: more common fetus/neonate
Intravaginal:
- Common in teenager d/t testicular growth
- Obstructs venous drainage first, then arterial
- Edema, pain, nausea
- Often second testes affected… or will be
- Surgery: fixate testes or orchiedectomy (removal of testes)
Cryptorchidism and Risk Factors
- Failure of one or both testicles to move down inguinal canal into scrotal sac by 7-9 months gestation
> Risk factors - Prematurity, small birth weight, genetic if term-baby
Cryptorchidism (cont) Complications & Tx.
- Spontaneously descends by 3 mo. but rarely after 4 mo.
- Abnormal testicular pathology by 6-12 months
Complications
- Infertility, testicular torsion, malignancy (high rate), psychological
Treatment
- Surgery and follow-up screening
Prostatitis causes
- infection of the prostate Causes 1. Spontaneous 2. instrumentation 3. Secondary - HIV - DM - urethral strictures
Types of Prostatitis
- Acute bacterial (UTI related)
- Chronic bacterial
- Chronic prostatitis/pelvic pain syndrome
- Most common/least understood
- Inflammatory but not bacterial, or non-inflammatory - Asymptomatic inflammatory prostatitis
Acute Prostatitis
- E. coli most common pathogen
Manifestations (similar to pyelonephritis) - Fever, malaise
- Dysruia, frequency
- Pelvic aching pain (rectum, perineum)
- Malodorous cloudy urine
- Rectal exam: swollen, tender, warm, thick discharge
Benign Prostatic Hyperplasia (BPH)
> Non-malignant enlargement of prostate d/t imbalance between cell proliferation & apoptosis
- Common >60 years old
Related to
- Proliferation of prostate cells
- Alpha 2 adrenergic receptors overact
- Detrusor instability & impaired bladder contractility (recent thoughts)
BHP Manifestations
Prostate enlargement compresses urethra causing
- Weak stream, urgency, dysuria, nocturia, overflow incontinence
Bladder distension causes destructive changes in bladder wall
- hydroureter, Hydronephrosis, herniations
- infection