Dr. Houston (GU) Flashcards

1
Q

What are the normal sites fo relative constriction of ureter? (3)

A
  • Urteropelvic junction
  • Crossing iliac vessels and pelvic brin
  • Traversing bladder wall

According to review session: Ureteropelvic Junction is mc site of obstruction in nephrolithiasis

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2
Q
  • How does the ureters implant on the bladder?
  • What is the trigone?
A
  • Ureter: goes posterior and attaches on back side
  • Trigone: triangle of ureters and urethra and has stretch receptors that will fire to make you want to pee (afferent imput)
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3
Q
A
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4
Q
  • Where is the ducuts deferens?
  • Where is the bladder?
A
  • DD: a long, muscular tube that carries sperm from the epididymis to the ejaculatory duct.-> superior to bladder
  • Bladder: is superior/posterior to pubic symphysis
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5
Q
  • What is the difference when the bladder is full and empty?
  • What is the muscle of the bladdder?
  • Wht does the bulbourethral gland do?
A
  • When the bladder is full it pushed up against the parietal perioneum
  • Detrusor muscle
  • Bulb: Pre-ejac fluid that neutralizes the urethra so sperm does not get damage and mositens the penis glans
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6
Q

What are the different parts of the urethra?

A

Know that the ejac duct meets into the prostatic urethra (past exam question)

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7
Q

What does a cystoscopy do?

A
  • The interior of the bladder and its three orifices can be examined with a cystoscope, a lighted tubular endoscope that is inserted through the urethra into the bladder.
  • The cystoscope consists of a light; an observing lens; and various attachments for grasping, removing, cutting, and cauterizing
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8
Q

What are the different muscles compressing the urethra? What is their role?

A

All compresser sphincter to prevent unwanted leakage
* Internal urethral sphincter
* Pubovesicalis
* External urethral sphincter
* Compressor urethrae

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9
Q
A
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10
Q

Prostatic Enlargement
* Because benign enlargement or benign prostatic hyperplasia (BPH) is common when?
* An enlarged prostate projects into what? What does that cause?
* What lobe and zone is mainly affected? (on Dr. Lees review)

A
  • common after middle age
  • projects into the urinary bladder and impedes urination by distorting the prostatic urethra.
  • The middle lobule (transitional zone) usually enlarges the most and obstructs the internal urethral orifice.
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11
Q

Prostatic Cancer
* Common in who?
* **What region and zone is affected? ** (dr. lees review)
* This may be what on exam?
* What happens in advance stages?

A
  • Prostatic cancer is common in men older than 55 years of age.
  • **In most cases, the cancer develops in the posterolateral region (peripheral zone) **
  • This may be palpated during a digital rectal examination A malignant prostate feels hard and often irregular.
  • In advanced stages, cancer cells metastasize (spread) to the iliac and sacral lymph nodes and later to distant nodes and bone.
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12
Q

Prostatectomy
* The prostatic plexus, closely associated with what? What does it give passage of?
* A major concern regarding prostatectomy what?
* What is TURP

A
  • The prostatic plexus, closely associated with the prostatic sheath, gives passage to parasympathetic fibers, which give rise to the cavernous nerves that convey the fibers that cause penile erection.
  • A major concern regarding prostatectomy is that impotency may be a consequence.
  • All or part of the prostate, or just the hypertrophied part, is removed (transurethral resection of the prostate [TURP]).
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13
Q

Past Exam Question

What are the voluntery muscles of urethra?

A
  • External uretheral sphincter
  • Compressor urethrea
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14
Q

How do the seminous vesicles, eject ducts meet and come together?

A
  • Sperm travel from the epididymis through the ductus deferens.
  • The ductus deferens joins with the duct of the seminal gland.
  • They form the ejaculatory duct.
  • The ejaculatory duct passes through the prostate gland and opens into the prostatic urethra.
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15
Q

Sterilization of males
* What is the common method?
* What do they do in this procedure?
* What happens to the sperm? (2)

A
  • The common method of sterilizing males is deferentectomy, usually called a vasectomy.
  • During this procedure, part of the ductus deferens is ligated and/or excised through an incision in the superior part of the scrotum.
  • Hence, the ejaculated fluid from the seminal glands, prostate, and bulbourethral glands contains no sperms.
  • The unexpelled sperms degenerate in the epididymis and the proximal part of the ductus deferens.
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16
Q

What is the sympathetic nerve inn of the bladder?

A
  • Spinal Segments: The sympathetic nerves originate from the lumbar segments L1 and L2 of the spinal cord.
  • Hypogastric Ganglion: From the sympathetic chain, the fibers synapse in the hypogastric ganglion.
  • Hypogastric Nerve: Postganglionic fibers from the hypogastric ganglion travel via the hypogastric nerve to the bladder and internal sphincter.
  • Symapthetic fiber to internal urethral sphincter: Contraction to not have leakage (relax in order to pee)
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17
Q

What is the parasympathetic nerve inn of the bladder?

A
  • Spinal Segments: The parasympathetic nerves originate from the sacral segments S2, S3, and S4 of the spinal cord.
  • Pelvic Nerve: These preganglionic fibers form the pelvic nerve.
  • Bladder and Internal Sphincter: The pelvic nerve innervates the bladder and internal sphincter, promoting bladder contraction and relaxation of the internal sphincter during urination.
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18
Q

What is the somatic nerve inn for urinary bladder?

A
  • Pudendal Nerve: The somatic innervation is via the pudendal nerve, which also originates from the sacral segments S2, S3, and S4.
  • External Urethral Sphincter: The pudendal nerve controls the external urethral sphincter, allowing voluntary control over urination.
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19
Q

Past exam question

What is the autonomic nervous system in the processes of erection and ejaculation?

A

Point: Erection->Parasympathetic Nervous System:
* The parasympathetic nerves, originating from the sacral segments S2, S3, and S4, are responsible for the process of erection.
* These nerves release nitric oxide, which causes vasodilation and increased blood flow into the corpora cavernosa of the penis, leading to an erection.

Shoot: Ejaculation-> Sympathetic Nervous System:
The sympathetic nerves, originating from the lumbar segments L1 and L2, control ejaculation.
* The process involves two stages: emission and expulsion.

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20
Q

What is the overview of oogenesis and spermatogenesis?

A
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21
Q
A
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22
Q

What regulates LH and FSH in male repro?

A

Hypothalamic GnRH regulates both LH and FSH secretion

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23
Q

What does LH and FSH regulate?

A

LH and FSH regulate testosterone secretion and sperm production

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24
Q

Fill in

A
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25
Q

Explain what happens when the environment, drugs and age effect the brain centers for male reproduction. (include the feedback mechanisms)

A
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26
Q

Testis are the site of what?

A

Testis is the site of sperm and seminal fluid formation

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27
Q

Leydig (interstitial) cells:
* Where are they located?
* What do they produce?
* What hormone binds to them?

A
  • in interstitium of the testes, between seminiferous tubules
  • produce testosterone.
  • LH binds to receptors on these cells
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28
Q

Sertoli cells (nurse cells):
* Where are they located?
* What hormone binds to them?
* What do they support?
* Contain what receptors? (2)
* produce low levels of what?
* What do they also produce? What does this regulate?

A
  • located within the seminiferous tubules
  • FSH binds to receptors on these cells
  • support spermatogenesis
  • contain FSH and testosterone receptors
  • produce low levels of estradiol
  • also produces activin, follistatin, and inhibin that regulate the secretion of FSH.
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29
Q

How are sertoli cells connexted? What do they divide?

A

Sertoli cells are connected by tight junctions, which divide the intercellular space into a basal compartment and an adluminal compartment.

30
Q

Where are spermatogina and maturing sperm located? Explain the process

A
  • Spermatogonia are located in the basal compartment and maturing sperm in the adluminal compartment (closest to the lumen).
  • Spermatocytes are formed from the spermatogonia and cross the tight junctions into the adluminal compartment; they mature into spermatozoa.
31
Q
  • What is located between the nonproliferating sertoli cells?
  • Where does mitosis of the spermatogonia occur?
  • The early meiotic cells (primary spermatocytes) move across the junctional complexes into where? What do they do?
A
  • Located between the nonproliferating Sertoli cells are germ cells at various stages of division and differentiation.
  • Mitosis of the spermatogonia occurs in the basal compartment of the seminiferous tubule
  • The early meiotic cells (primary spermatocytes) move across the junctional complexes into the adluminal compartment, in which they mature into spermatozoa or gametes after meiosis.
32
Q

How is the Blood-testis barrier (BTB) formed? What is the function of the BTB?(2)

A

Blood–testis barrier (BTB): formed by tight junctions between Sertoli cells
* Separates sperm from immune system
* Prevents antibodies and other large molecules in the blood from getting to germ cells
* Germ cells are immunologically different from body cells and would be attacked by immune system

33
Q
A
34
Q

The hypothalamic-pituitary-testis endocrine axis controls what?

A

Spermatogenesis

35
Q
  • Where is LH and FSH secreted from? What is it under the control of?
A

LH and FSH are secreted from the anterior pituitary under the control of GnRH from the hypothalamus.

36
Q

What does LH stimulate? What does this cause?

A

LH stimulates Leydig cells to produce testosterone, which diffuses locally into the seminiferous tubules and also enters the systemic circulation.

37
Q

What does FSH stimulate? what does this cause?

A

FSH stimulates the Sertoli cells, resulting in the secretion of androgen-binding protein (ABP) into the lumen of the seminiferous tubule

38
Q

Under the sertoli cells

  • ABP increases what?
  • FSH also stimulates what? What does this cause?
A
  • ABP increases local concentration of testosterone at the site of spermatogenesis.
  • FSH also stimulates the secretion of inhibin from the Sertoli cells, which exerts negative feedback on FSH secretion by the anterior pituitary.
39
Q

What does testosterone exert?

A
  • Testosterone exerts negative feedback on the secretion of both FSH and LH.
40
Q

Explain leydig and sertoli cells and their relationship

A

Leydig cells:
* secrete testosterone into blood and onto seminiferous tubules
* Stimulated by LH from ant. pit.
* Inhibited by excess testosterone

Sertoli cells:
* Secrete ABP to bind and concentrate testosterone in seminiferous tubules
* FSH also stimulates tehe secretions of inhibin from sertoli cells, which has negative feedback to only FSH

41
Q

What is the spermatic cord?

A

bundle of fibrous connective tissue containing the ductus deferens, blood and lymphatic vessels, and testicular nerve

42
Q

Why does the human testes reside in the scrotum?

A

Human testes reside in the scrotum because of its cooler environment
* Cannot produce sperm at core body temperature of 37°C
* Must be held at about 35°C

43
Q

What are the three ways to regulate temperature of the testes?

A
  • Cremaster: strips of the internal abdominal oblique muscle
  • Dartos fascia: subcutaneous layer of smooth muscle
  • Pampiniform plexus: an extensive network of veins from the testes that surrounds the testicular artery and spermatic cord
44
Q

How does cremater muscle regulates temperature of the testes?

A

Cremaster: strips of the internal abdominal oblique muscle
* In cold temperatures, contracts and draws testes upward toward body
* In warm temperatures, relaxes suspending testes further from body

45
Q

How does the dartos fascia regulate temperature of testes?

A

Dartos fascia: subcutaneous layer of smooth
muscle
* Contracts when cold, wrinkling the scrotum, holding testes against warm body
* Reduces surface area of the scrotum and heat loss

46
Q

How the pampiniform plexus regulate temperature of testes?

A

Pampiniform plexus: an extensive network of veins from the testes that surrounds the testicular artery and spermatic cord
* Countercurrent heat exchanger—without the pampiniform plexus, warm arterial blood would heat the testis and inhibit sperm production
* Removes heat from the descending arterial blood
* By the time it reaches the testis, the blood is 1.5° to 2.5°C cooler

47
Q

What can cause sterility? What is left unaltered?

A

Prolonged exposure of the testes to elevated temperature, fever, or thermoregulatory dysfunction can lead to temporary or permanent sterility as a result of a failure of spermatogenesis, whereas steroidogenesis is unaltered.

48
Q

What is the primary sex site and sex acessories?

A
  • Primary: testes
  • Accesories: i.e., the epididymis, vas deferens, seminal vesicles, ejaculatory duct, prostate, bulbourethral gland, urethra, penis)
49
Q
  • After formation in the seminiferous tubules, spermatozoa travel where?
  • What happens in the epidiymis?
  • What accomplishes the movement of sperm?
A
  • travel to the rete testes and, from there, through the efferent ductules to the epididymis
  • In epididymis storage, protection, transport, increased motility and maturation of sperm
  • Ciliary movement in the efferent ductules, muscle contraction, and the flow of fluid accomplish this movement of sperm.
50
Q

What is the pathway for erection reflex in males?

A
51
Q
  • What are the two ejaculatory bodies?
  • What is the blood supply and innervation?
  • What is around the urethra?
A
  • Corpus cavernosum
  • Dorsal vein, artery and nerve
  • Urethra is surrounded by corpus spongiosum
52
Q

What is NO derived from? What does it cause?

A
  • nitric oxide (NO) is derived from the nerve terminals innervating the corpora cavernosa, the endothelial lining of penile arteries, and cavernosal sinuses
  • Causes smooth muscle relaxation-> penile erection
53
Q

What is the psychogenic or reflexogenic pathway?

A
54
Q

How is Semen, consisting of sperm and associated fluids expelled?(2)

A

is expelled by a neuromuscular reflex that is divided into two sequential phases: (1) emission and (2) ejaculation

55
Q
  • Seminal emission moves the sperm and associated fluids how?
  • Contraction of the internal bladder sphincter is via what? What does this cause?
A
  • Seminal emission moves the sperm and associated fluids from the cauda epididymis and vas deferens into the urethra.
  • Contraction of the internal bladder sphincter (by α1-adrenergic sympathetic stimulation) prevents the ejaculate from traveling up the urethra and into the bladder, known as retrograde ejaculation
56
Q

What is ejaculation?

A

Ejaculation is the expulsion of the semen from the penile urethra; it is initiated after emission.

57
Q
  • Semen only contains 10% of what? What is the remainder?
  • What is the normal volume of semen?
  • How many sperm per mL
A
  • semen contains only 10% sperm by volume
  • remainder secretions of accessory glands
  • normal volume of semen is 3 mL
  • 20 to 50 million sperm per mL
58
Q

Seminal vesicles:
* What are they?
* Empties where?
* Forms how much of semen?
* What does it contain?
* What is it responsible?

A
  • Pair of glands posterior to bladder w sperm
  • Empties into ejaculatory duct
  • Forms 75% of semen
  • Contains fructose (the principal substrate for glycolysis of ejaculated sperm), ascorbic acid, and prostaglandins
  • Responsible for coagulation of the semen seconds after ejaculation
59
Q

Prostate:
* What does it surround?
* How many glands?
* Where does it empty through?
* What does the thin milky secretion includes? What is this responsible for?

A
  • Surrounds urethra and ejaculatory duct just inferior to the bladder
  • 30 to 50 compound tubuloacinar glands
  • Empty through about 20 pores in the prostatic urethra
  • Thin milky secretion (~0.5 mL) includes fibrinolysin, which is responsible for liquefaction of coagulated semen 15-30 minutes after ejaculation, releasing sperm.
60
Q

Bulbourethral glands:
* Where is it?
* During sexual arousal, what do they produce?
* How does it protect the sperm?

A
  • Near bulb of penis
  • During sexual arousal, they produce a clear slippery fluid that lubricates the head of the penis in preparation for intercourse (pre-ejaculatory secretion)
  • Protects the sperm by neutralizing the acidity of residual urine in the urethra
61
Q

What does spermatogenesis produce?
What is spermiogenesis?

A
  • Spermatogenesis produces an abundance of highly specialized, mobile sperm
  • spermiogenesis: maturation of the spermatids into sperm cell
62
Q
  • A spermatogonium becomes a mature spermatozoon after going through what?
  • How many spermatozoa are produced daily?
  • While the immune system normally detects and destroys defective somatic cells, what protects the speem?
A
  • A spermatogonium becomes a mature spermatozoon after going through several rounds of mitotic divisions, a couple of meiotic divisions, and a few weeks of differentiation.
  • 200 million spermatozoa are produced daily in the adult human testes, which is about the same number of sperm present in a normal ejaculate.
  • While the immune system normally detects and destroys defective somatic cells, the blood–testis barrier isolates advanced germ cells from immune surveillance.
63
Q

Explain the process of spermatogenesis (picture)

A

Male germ cells, which undergo extensive morphologic changes in cell shape and, ultimately, meiosis to produce the haploid spermatozoa.

64
Q

What are sperm(atozoon) and what do they contain?

A

Sperm(atozoon) 4 to 5 μm long; structure contains nucleus, acrosome, and tail flagellum

65
Q
  • What does the head of the sperm contain?
  • The tail is divided into three regions?
A

Head:
* Nucleus contains haploid set of chromosomes
* Acrosome—enzyme cap over the apical half of the
nucleus that contains enzymes that penetrate the egg
(acrosome reaction)

Tail:
* Midpiece contains mitochondria around axoneme of the flagella, produces ATP for flagellar movement

66
Q

What is the secondary function of the testis?

A

Steroidogenesis

67
Q
  • What is the main hormone produced by steroidogenesis? What is it primarily secreted by?
  • In males, testosterone production is about _ times greater than that in females. What is the key role?
A
  • Testosterone main hormone produced by steroidogenesis and is primarily secreted by the testes of males and the ovaries of females.
  • In males, testosterone production is about 10 times greater than that in females and plays a key role in the development of the testes and prostate as well as promoting secondary sexual characteristics, such as increased hair growth, muscle, and bone mass. It is also essential for health and well-being as well as the prevention of osteoporosis
68
Q

What is testosterone converted into in males?

A

Testosterone is converted to dihydrotestosterone (DHT), the most biologically active androgen, and to estradiol, the most biologically active estrogen (to prevent osteoclast)

69
Q

What cells produce testosterone and what is it derived from?

A

Testosterone is primarily synthesized in Leydig cells and is derived from cholesterol, involving many enzymatic steps.
* The adrenal cortex, ovaries, testes, and placenta produce steroid hormones from cholesterol.
* The major steroid produced by the testis is testosterone, but other androgens, such as androstenediol, androstenedione, and DHEA, as well as a small amount of estradiol, are also produced.

70
Q

What do you need for cholesterol to translocate into the mitochrondia?

A

StAR

71
Q

What are the different conversions of testosterone in extratesticular sites?

A
72
Q

Androgen:
* What is it?
* It is anabolic or catabolic? What are their effects?
* Androgens affects what?
* relative potency ranking of androgens is as follows:
* What marks the onset of puberty?

A
  • a substance that stimulates the growth of the male reproductive tract and the development of male secondary sex characteristics.
  • Anabolic in nature - have effects on almost every tissue, including alteration of the primary sex structures (i.e., the testes and genital tract), stimulation of the secondary sex structures (i.e., accessory glands), and development of secondary sex characteristics responsible for masculine phenotypic expression.
  • Androgens also affect both sexual and nonsexual behavior – e.g. aggression.
  • relative potency ranking of androgens is as follows: DHT > testosterone > androstenedione > DHEA.
  • Enhanced androgenic activity marks the onset of puberty.