Genitourinary Flashcards
Prostate gland is
an accessory reproduction gland, secretes a milky fluid that makes 30% of semen and contains a clotting enzyme to thicken semen in the vagina.
Benign prostatic hyperplasia is
an increase in smooth muscle tone and resistance from prostatic intersitial cells, enlargement of the prostate due to an increase of cell number therefore obstructing the urethra. Occurs >65 years and increased androgen levels
Luminal cells produce
Prostate Specific Antigen (PSA) which helps to liquify semen after ejaculation
Basal cells and luminal cells rely on
androgens including testosterone (produced by testes) and dihydrotestosterone (produced by the prostate by 5a reductase converting testosterone) for survival
5a reductase activity
increases with age but testosterone decreases which can cause hyperplasia
stagnation of urine due to BPH
promotes bacterial growth - can cause UTI
Patho of BPH
Hyperplasia - enlarged prostrate (static)
Hyperplasia of the smooth muscle tone and resistance (dynamic)
aging and testosterone decreasing and 5a reductase increasing creating an imbalance of growth factor and signalling pathways and epithelia interactions = growth promotion and tissue remodelling.
Creates local inflammation - altered cytokine/ROS
Increased O2 demand causes hypoxia
Remodelled environment with prolonged inflammation
Compresses urether.
CM of BPH
Weak and dribble of urine Strain when urinating Dysuria (pain when urinating) Hesitancy urinating, Sense of incomplete bladder emptying leading to nocturia
Diagnosis
digital rectal examination,
levels of Prostate specific antigen (PSA) are increased with BPH not prostate cancer
Treatment of BPH
Relieving obstruction and allowing normal urine flow
Medications for BPH
5a reductase inhibitor - inhibiting the conversion of testosterone into dihydrotestosterone = dutasteride/finasteride
a1a - antagonists - bind to alpha 1 receptors of the smooth muscle (tamsulosin has greater selectivity for bladder and prostate a1 receptors) Prazosin and Phenoxybenzamine are also a1 antagonists
Combinations : Duodart, Tamsulosin
TURP is
Trans Urethral Resection of the Prostate is a surgical procedure to remove part or all of the prostate
Does BPH increase the risk of prostate cancer?
Nope
During BPH the bladder…
Dilates and hypertrophy
Gonorrhea is caused by a gram (-) bacteria
called n.gonorrhaoeae
Symptoms of gonorrhoea include
urethritis, cervitis, vaginitis, purulent discharge - pus colour and smelling burning when urinating
Gonorrhoea initiates inflammation from circulating neutrophils
bacteria releases catalase to inhibit the neutrophils action and causes harmful proteases to be excreted when the neutrophil bursts
Syphillis is caused by
Treponema pallidum, gram (-) bacteria can be transferred by bodily fluids, contaminated needles and touching of a leaky chancre
Syphillis has three stages
Primary (Localised) forming painless skin chancres - localised to infected area
Secondary - bacteria spreads systemically and is found in the lymph nodes - most infectious stage - lesions present on hands and feet
Latent - asymptomatic - serology confirms
Tertiary - most severe/rare when the bacteria enters organs and creates localised damage such as the heart or spinal cord.
it is a type IV (4) Hypersensitivity
Syphillis if reaches the heart can cause
aortitis
If syphillis reaches the spinal cord/CNS it can cause
neurosyphilis - deterioration of the brain
Common sign of secondary stage syphillis is
rash on hands and feet and swollen lymph nodes
Genital herpes is caused by either
Type 1 (HSV-1) or type 2 (HSV-2) Herpes Simplex Virus (HSV)
Transmitted via sexual intercourse from
lesion friction against mucosal surface
