Genitourinary

Question 1

BPH

Answer 1

Benign Prostatic Hyperplasia

Most common reproductive disorder in men
Gradual benign enlargement
Starts at 40yo - prevalence increases with age
Periurethral

Question 2

BPH: Et?

Answer 2

• Unclear
• Ageing is the primary risk
• Hormonal changes (androgens)
• Genetics (predisposition)
• Race (higher prevalence in african-american and lower in japonese)
• Diet/lifestyle

Question 3

BPH: Mnfts?

Answer 3

• Gradual onset of signs and symptoms
• Urinary frequency
• Hesitancy
• Weak urine stream (urethra compressed)
• Post void dribbling (aka terminal dribbling)

If complete obstruction > Urine retention

Question 4

BPH: Dx?

Answer 4

• Hx, Px
• DRE: Digital Rectum Exam- standard screening exam after 50yo
• Blood test: PSA (prostate specific antigen) - excreted by prostate during ejaculation
• US to determine size of gland
• Renal exams to analyze complications: BUN & creatinine
• Urinalysis - infection & hematuria?

Question 5

BPH: Patho

Answer 5

Changes in:
Testosterone
Dihydrotestosterone (metabolite)
Estrogen (sensitizes prostatic cells to DHT)

Prostatic growth mediated by estrogen
With age testosterone levels decline - T:E ratio is altered
Cells become more sensitized to growth
Urethra compressed d/t hyperplasia of periurethral tissue
Urine flow impeded - prostatic smooth muscle hypertrophy

Question 6

BPH: structural changes (think adaptive)

Answer 6

1- Thickening of bladder wall: trabeculations & diverticula
2- Hydroureter - ureters distension - “fish hook”
3 - Hydronephrosis - urine pools > urine stasis > renal calculi and infections?

Question 7

BPH: Tx?

Answer 7

No Tx in early stages

When s+s appear:
- behavioral: avoid fluids at HS, ETOH, caffeine
- drugs:
alpha-adrenergic antagonists (short-acting)
5 alpha reductase inhibitor (long acting) - reduces conversion of T into DHT

TURP (transurethral resection of prostate) or
Laser Prostatectomy

Question 8

Prostate CA: risks?

Answer 8

ageing
diet
ethnicity
familiar (1st or 2nd relatives)
androgens?

Question 9

Prostate CA: Mnfts?

Answer 9

Appear after invasion or mets
dysuria
hematuria
prostatitis
late hip and back pain (bone mets)

Question 10

Prostate CA: Patho

Answer 10

mostly adenocarcinoma
peripheral (does not impact the urethra)
multicentric
variable in appearance
extension to the bladder and seminal vesicle
mets to bone, liver and lungs

Question 11

Prostate CA: Dx

Answer 11

Hx, Px
screens: 
DRE (digital rectal exam)
PSA (prostate specific antigen)
US - transurethral
Biopsy to identify grade and type

Question 12

Prostate CA: Tx

Answer 12

Varied and based on stage, grade and age
active surveillance if localized and low risk

1st line: anti androgens, estrogen in higher doses;
this will not tx the CA, but will withdraw growth support and advancement of malignancy

in early stage: Radical prostatectomy (excision of seminal vesicle, prostate, …)
Radiation (preferred) & combination with Sx

Question 13

Menstrual Disorders

Answer 13

Amenorrhea (absence)
Dysmenorrhea (pain)
Menorrhagia (excessive)
Metrorrhagia (bleeding between periods)

Question 14

Amenorrhea: Types

Answer 14

Primary: failure to menstruate by 15yo; gonadal dysgenesis, hypothalamic-pituitary-ovarian disorder

Secondary: cessation of menses for at least 6months

Question 15

Dysmenorrhea: Types

Answer 15

Primary: menstrual pain that is not associated with any physical abnormality or pathologic process

Secondary: menstrual pain caused by specific organic conditions (eg: endometriosis, uterine fibrosis, PID, IUDs, …)

Question 16

PID

Answer 16

Pelvic Inflammatory Disease

Inflammation of upper reproductive tract (beyond cervix)
Ascending infection > 
uterus: endometritis
tubes: salpingitis
ovary: oophocitis

Question 17

PID: Et

Answer 17

Pyogenic microbe (pus)
Untreated Bacterial infections > sexually transmitted? (chlamydia & gonorrhea)