Genitourinary Disorders - Male

Question 1

What are the two male genitourinary disorders which were covered in class?

Answer 1

Benign Prostatic Hyperplasia (BPH) and Prostate Cancer.

Question 2

When in the lifespan can genitourinary disorders occur? Are they common?

Answer 2

Can occur across the lifespan. They are fairly common.

Question 3

Where is the prostate located?

Answer 3

The prostate is located inferior to and around the neck of the bladder. It is an encapsulated gland.

Question 4

What anatomical structure is the posterior surface of the prostate in contact with?

Answer 4

The rectum.

Question 5

What is the most common site of neoplasm in men?

Answer 5

The prostate.

Question 6

What structure does the prostate surround?

Answer 6

The urethra.

Question 7

What is Benign Prostatic Hyperplasia?

Answer 7

BPH is gradual periurethral enlargement, of the muscle and gland. It is very common as men age.

Question 8

What is the occurance rate of BPH in men over 40 yrs of age?

Answer 8

20%

Question 9

What is the occurance rate of BPH in men over 60 yrs of age?

Answer 9

50%

Question 10

What is th occurance rate of BPH in men over 80 yrs of age?

Answer 10

80%

Question 11

Is BPH malignant?

Answer 11

No, BPH is not cancer. It is a hyperplasia of the muscle and gland around the urethra.

Question 12

What is the etiology of BPH?

Answer 12

The cause is unclear. However, ageing is a major risk factor and may have to do with age related changes in androgen levels and changes to the testostorone:estrogen ratio. Genetrics, Race, and Diet may also play a significant role.

Question 13

Why is race a possible etiology for BPH?

Answer 13

Some individuals may have increased incidence rate. Japanese men, for example, have a lower incidence. While, Afrcan individuals have a higher incidence rate.

Question 14

What is the pathophysiology of BPH?

Answer 14

The patho of BPH is related to changes in testosterone, DHT, and estrogen. Testosterone, through the action of the enzyme 5alpha-reductase, converts to DHT (dihydrotestosterone). DHT supports protate growth and function. Estrogen sensitizes the prostate to DHT, making it more responsive to its precence. Testosterone decreases with age, altering and causing a “relative increase in estrogen” and alters the T:E ratio. The realitive increase in estrogen sensitizes the prostate to DHT and it enlarges. Hyperplasia of periurethral tissue compresses the urethra, and hypertrophy of smooth muscle impedes urine flow.

Question 15

What structural changes occur in the BPH patient?

Answer 15

Bladder wall thickens. Trabeculations and Diverticula. Urine stasis leading to UTI infections and calculi.

Question 16

What is travecuation and diverticula. Why are we seeing these structural changes in a patient with BPH?

Answer 16

Trabeculations are the thicken and hypertrophied muscle wlls of the bladder. Diverticula are outpouching due to bladder outlet obstruction. They are both caused as a result of bladder obstruction.

Question 17

What are the consqeuntial changes caused by BPH?

Answer 17

The ureters distend with urine leading to hydroureter. The ureters loop downward causing what is called “fish-hook ureters”. Urine can back up in the kidney causing hydronephrosis.

Question 18

What is hydroureter?

Answer 18

Hydroureter is dilation of the ureter. Can be physologic or pathologic, acute, chornic, unilateral or bilateral. Often secondary to obstruction of the urinary tract.

Question 19

What is hydronephrosis?

Answer 19

Hydronephrosis is distention of the renal calyces and pelvis with urine as a result of obstruction of the outflow of urine distal to the renal pelvis.

Question 20

What are the manifestations of BPH?

Answer 20

Frequency of urine, hesitancy, weak urine stream, terminal dribbling, compete obstruction?, urine retention?.

Question 21

What does a patient with BPH experience increased frequency of urine?

Answer 21

They only void part of their bladder, thus they get the urge and need to urinate more frequently.

Question 22

What does hesitancy mean, in relation to a BPH patient’s need to urinate?

Answer 22

Hesitancy is trouble starting urine flow.

Question 23

How is BPH diagnosed?

Answer 23

Diagnosis is made through Hx, mnfts, and Px. The “gold standard” of diagnosis is a digital rectal exam, and a prostate-specific antigen (PSA) test. BUN and creatinine will also be measured and a urinalysis will search for infection and hematuria.

Question 24

What is PSA?

Answer 24

Prostate-Specific Antigen is a protein made by the cells of the prostate gland. An increase in total PSA is proportional to prostate mass. Thus an elevated PSA means increased prostate mass.

Question 25

What is the significance of BUN and creatinine test?

Answer 25

The kidney should be filtering out creatinine and urea nitrogen. If they are found in elevated levels is signifies that the kidney has expereienced some damage.

Question 26

What is the treatment for BPH?

Answer 26

Often there is no treatment. However, it is based on severity and complications. Alpha-Adrenergic Antagonists, 5alpha-reductase Inhibitors (long-term). If severe both drugs may be combined. As a last resort the patient may receive a TURP or Laser Prostatectomy.

Question 27

What is a prostatectomy?

Answer 27

Removal of all or part of the protate gland.

Question 28

What is a TURP?

Answer 28

Transurethral Resection of the Prostate is a type of surgery where a resectoscope is inserted through the tip of the penis and into the urethra. Using the resectoscope the doctor trims away excess prostate tissue that’s blocking urine flow and increases the size of the channel, allowing the emptying of the bladder.

Question 29

What is Prostate Cancer?

Answer 29

Cancer of the prostate. It is a common cancer in men. Accounting for 3rd in cancer deaths most being after the age of 65.

Question 30

What are the risks associated wth prostate cancer?

Answer 30

Age, Diet, Ethnicity, Familial, and Androgens.

Question 31

When discussing the familial risks associated with prostate cancer, what does it mean to have a familial risk?

Answer 31

It means that a 1st or 2nd degree relative has cancer, and the patient has an increased risk of also having prostate cancer.

Question 32

What is the pathophysiology of prostate cancer?

Answer 32

Prostate cancer is made up of adenocarcinomas which occurs on the peripheral of the prostate. They are also multicentric. There are no early manifestations which delays diagnosis. Manifestations appear after invasion or metasis.

Question 33

Where does prostate cancer typically extends to which structures?

Answer 33

Bladder and Seminal Vesicles

Question 34

If prostate cancer metastasises, where is it most likely to appear as its secondary location?

Answer 34

Bone, Liver, and Lungs.

Question 35

What are the manifestations of prostate cancer?

Answer 35

Prostate cancer is asymptomatic in the early stages. When it does present, prostatitis is commong. The patient may also experience late hip and back pain due to bone metastasis.

Question 36

How Is prostate cancer diagnosed?

Answer 36

History, Presentation, Digital rectal exam, Prostate-Specific Antigen, biopsy, Ultrasound.

Question 37

How is prostate cancer treated?

Answer 37

Treatment is based on the stage, grade, and age of the patient. If the cancer is localized, it is deemed as low risk and the patient undergoes active surveillance. The fist line of defense is antiandrogens. Younger patients may undergo radical prostatectomy. Radiation is also a possible treatment option.

Question 38

What is removed during a radical prostatectomy?

Answer 38

The prostat and the semical vesicles.