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Reproductive > Lec 14 Erectile dysfunction > Flashcards

Lec 14 Erectile dysfunction Flashcards

1
Q

What percent of testicular volume dedicated to spermatogenesis?

A

80%

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2
Q

What carries out spermatogenesis?

A

seminiferous tubules

sertoli cells

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3
Q

What makes testosterone?

A

leydig cells

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4
Q

What is function of sertoli cells?

A
  • blood-testis barrier
  • nourish sperm
  • help transport sperm into epididymis
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5
Q

What is role of FSH in males?

A

FSH stimulates sertoli cells and spermatogenesis

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6
Q

What is role of LH in males?

A

LH stimulates leydig cells

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7
Q

What feedback does testosterone have?

A
  • negative feedback on both GnRH from hypothalamus and FSH/LH from pituitary
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8
Q

What feedback does inhibin have?

A

inhibin secreted by sertoli cells has negative feedback on FSH

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9
Q

How long does one full cycle of spermatogenesis take?

A

64 days

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10
Q

WHat is acrosome?

A

lysosome-like organelle of sperm involved in penetration of egg

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11
Q

What composes semen?

A

60-75% from seminal vesicles
25-30% from prostate
5% from bulbuourethral glands
5% contains sperm

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12
Q

What is significance of fructose in semen?

A

lack of fructose means obstruction of or after seminal vesicles

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13
Q

Where do mature sperm live?

A

stay in vas deferens until ejaculation

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14
Q

What normal LH and testosterone but high FSH tell you?

A

germinal cell aplasia = failure to make sperm

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15
Q

WHat does high FSH and LH but normal/low testosterone tell you?

A

primary testicular failure

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16
Q

What does low FSH/LH/testosterone tell you?

A

hypogonadotropic hypogonadism = problem from hypothalamus or pituitary

17
Q

What ia a varicocele?

A

varicose vein of the pampiniform plexus; keeps testicles a degree or two warmer than normal

usually L > R

18
Q

What is intrauterine insemination?

A

aids in delivering sperm; turkey baste sperm into uterus directly

19
Q

What is intracyctoplasmic sperm injection [ICSI]?

A

IVG = requires much less sperm so good if male infertility problem

20
Q

What are functions of DHT?

A
  • differentiation of penis/scrotum/prostate
  • male hair pattern and baldness
  • prostate growth
  • sebaceous gland activity
21
Q

What is mech of action finasteride?

A

5a reductase inhibitor; controls prostate growth and increases hair growth

good for treatmetn of BPH or male pattern baldness

22
Q

What is bioavailability of testosterone?

A

1-2% free is the biologically active T
40-60% bound to sex hormone binding globulin
40-60% bound to albumin

23
Q

What are symptoms of hypogonadism?

A
  • loss of muscle mass
  • weight gain
  • loss of libido or erectile dysfunction
  • depression/fatigue
  • osteoporosis
  • regression of 2ndary sex characteristics
  • azoospermia
24
Q

What are two causes of secondary [pituitary] congenital hypogonadism?

A

kallmans = anosmia and hypogonadism

prader willi = deletion/non-expression of paternal 15Q; low muscle tone; short stature; cognitive problems; excess hunger [obesity]; hypogonadism; behavioral disorders

25
Q

What chronic diseases associated with hypogonadism?

A
  • obesity
  • DM
  • htn
  • asthma
  • hyperlipidemia
26
Q

What causes low T in older men?

A

decreased frequency of GnRH pulses

27
Q

What is effect of low T on bones?

A

low T can cause osteoporosis–> more hip fractures

28
Q

What are benefits of T replacement?

A
  • improved muscle mass and strength
  • increased bone density
  • restored or maintained secondary sex characteristics
  • restored libido, better erectile function
  • increased energy and improved mood
29
Q

What are risks of T replacement?

A
  • suppress testicular function –> decreased sperm production and infertility
  • increased plasma estrogen –> gynecomastia
30
Q

What are contraindications of T replacement?

A
  • known or suspected prostate cancer
  • male breast cancer
  • HCT > 50%
  • women
  • untreated prolactinoma
31
Q

What do vascular causes of ED suggest?

A

cardiovascular risk –> more likely to have an early CV event

32
Q

What is action of PDE-5 inhibitors [sildenafil, vardenafil]?

A
  • cause increase cGMP –> smooth muscler relaxation in corpus cavernosum and increased blood flow / erection
33
Q

What are adverse events of PDE-5 inhibitors [sildenafil, vardenafil]?

A 
headache
flushing
nasal congestion
blue-green color vision impaired
hypotension in pt taking nitrates
34
Q

What are advantages/disadvantages of intraurethral alprostadil?

A

direct vasodilator
its minimally invasive, few side effects, fast acting

disadvantage: urethral burning

35
Q

Who should get penile prostheses?

A

pts refractory to other treatments
suffering severe priapism [sickle cell]
with severe peyronie’s

Reproductive (14 decks)

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