GU Pathophys Flashcards
penis anatomy
- Glans: head of the penis
- Urethra: tube located inside the penis that runs from the bladder to the head of the penis, crosses through the prostate gland
- Meatus: opening at the tip of the glans where urine or semen exit the body
- Prepuce: foreskin; loose fold of skin that covers the head of the penis, removal of the foreskin is circumcision
- Corpus Cavernosa: 2 columns of spongy tissue that run along the interior shaft of the penis; When filled with blood, tissue stiffen, and this causes the erection
- Corpus spongiosum: the third column of tissue that prevents the urethra from closing during an erection
testicle anatomy
- Testes: also called testicles that produce and store sperm
- Scrotum: Sac of skin that contain the testes
- Seminiferous tubules: coiled tubes that make up most of each testis that are responsible for spermatogenesis
- Sertoli cells: part of the epithelium cells that line the seminiferous tubules that aid in the production of hormones that produce sperm
- Leydig cells: tissue next to the seminiferous tubules that produce male hormones such as testosterone and other androgens
- Vas deferens: “ductus deferens or sperm duct” that runs from the epididymitis and connects to the urethra through the ejaculatory duct
- Rete testis: sperm cells travel toward the epididymis through this structure
- Efferent ducts: series of tubes that join the rete testis to the epididymis that absorb most of the fluid that helps to move sperm cells
- Epididymis: structure that stores sperm until they are mature
Male- layers of testes
Testes are surrounded by several layers of tissue:
* Tunica vasculosa: first thin layer of blood vessels
* Tunica albuginea: thick protective layer to protect the testes
* Tunica vaginalis: made up of three layers to further protect the testes
Hydrocele
etiologies
- Idiopathic: most common
- Inflammatory: acute reactive hydrocele can occur w/ inflammatory conditions
Hydrocele
types
- Communicating: peritoneal/abd fluid enters scrotum via patent processus vaginalis that failed to close
- Non-Communicating: derived from fluid from the mesothelial lining of the tunica vaginalis (no connection to peritoneum)
priapism- types
- Ischemic (low flow): decreased venous outflow may lead to compartment syndrome leading to acidosis and hypoxia in the cavernous tissues (most common type; painful/rigid errection)
- Non-Ischemic (high flow): increased arterial inflow due to a fistula between the cavernosal artery and corpus cavernosum (commonly due to perineal or penile trauma; less painful & not fully rigid)
priapism- etiologies
- idiopathic (50%)
- Sickle Cell Disease (10%)
- use of injectile agent (for ED, drugs [cocaine, marijuana], EtOH)
- trauma causing rupture of cavernosal artery
- meds (PDE-5 inhibitors, trazadone, anti-psychs, anti-convulsants, alpha blockers), and neurologic conditions (head trauma, meningitis, subarachnoid hemorrhage, post-op)
Testicular Cancers- Prognosis
Very curable, high survival rate if treated appropriately
5-year survival rate of 95%
* Large majority of patients relapse withing the first 2 years of treatment completion
* Testicular examination by a clinician is recommended for men with a history of contralateral testicular cancer
Men who live for 2 years after diagnosis without relapsing have a high probability of being cured and very low risk of dying of the cancer
Horseshoe Kidney
anat/phys
- renal fusion when a portion of one kidney is fused to the other due to abnormal migration of kidneys; horseshoe most commonly is each pole fused together
- isthmus lies in the mid-line or sometimes slightly lateral to the mid-line and can be composed of renal parenchyma or just fibrous tissue, but the renal collecting systems remain separate
Anatomy
* fusion occurs before the kidneys ascend from the pelvis to their normal dorsolumbar position (5th-9th wks gestation)
* fusion abnormalities found in lower lumbar vertebral level (L4/5)
* blood supply variable
prostate gland anatomy/physio
- Walnut-sized structure in males that is primarily composed of glandular tissue
- Positioned inferior to the bladder and surrounds the superior portion of the urethra
- Primary function is to secrete a weakly acidic fluid that nourishes and transports sperm
- Semen = sperm + seminal fluid
- Prostate specific antigen (PSA) is secreted within the seminal fluid and can pass into the blood
- avg dimensions: 3cm long, 4 cm wide, 2 cm deep (AP depth)
prostate zones
Peripheral Zone
* 70% of prostate gland
* responsible for 70% of prostate cancers
* closest to rectum
Central Zone
* 15-20% of prostate cancers
* surrounds ejaculatory ducts
Transitional Zone
* 10-15% of prostate cancers
* surrounds proximal urethra
* key area of concern for BPH
Fibromuscular Zone
* cancer in the fibromuscular stroma is rare
* doesn’t contain glandular tissue
* surrounds the apex of the prostate
Prostate Cancer
considerations when interpreting PSA levels
Long-term use of 5-alpha-reductase inhibitors
* Commonly used medications to treat benign prostatic hypertrophy
* Associated with ↓ PSA levels
* Correction factor should be applied for accurate interpretation
Urological conditions that can elevate PSA levels:
* Benign Prostatic Hypertrophy (BPH)
* Prostatitis
* UTI/Urinary retention
* Urological procedures (catheter placement, cystoscopy)
Repeat testing is recommended in the case of ↑ PSA (after addressing factors possibly influencing the elevation)
Prostate Cancer
clinical variables to interpret PSA levels
AGE ADJUSTED
* 40-49 years of age: 2.5 ng/dL
* 50-59 years of age: 3.5 ng/dL
* 60-69 years of age: 4.5 ng/dL
* 70-79 years of age: 6.5 ng/dL
PSA VELOCITY
* more cancer = more rapidly rising PSA level
* 3 measurements over 2 yrs
anatomy/phys of testis
- Responsible for production of sperm and androgens (testosterone)
- Ovoid structure measuring 3-5 cm
- One testis may be slightly larger and one testis (usually the left) with hang slightly lower
Tunica vaginalis
* Fascial layer that encapsulates the anterior 2/3 of the testis
* Location for potential fluid accumulation
Epididymis
* Tightly coiled, spongy, tubular structure located on the posterior aspect and running from a superior to inferior pole
* Aids in the storage and transport of sperm cells
* Facilitates sperm maturation
Spermatic cord
* Consists of the vas deferens and testicular blood vessels
* Transverses into the retropubic space
causes of localized vs diffuse scrotal pain
Localized scrotal pain
* Testicular appendiceal torsion
* Acute epididymitis
Diffuse scrotal pain
* Testicular torsion
* Acute epididymo-orchitis or acute orchitis
* Fournier’s gangrene (necrotizing fasciitis of the perineum)
