Male Genital Tract Flashcards
Prostate Functions
Located at the base of bladder
Has contractile properties
Helps close of bladder neck during climax
Fluid properties of semen
Nutritive role for sperm cells
Buffer vaginal acidity
Prostate Anatomy
The prostate can be divided into biologically distinct regions, the most important of which are the peripheral and transition zones.
The types of proliferative lesions are different in each region.
For example, most hyperplastic lesions arise in the inner transition zone, while most carcinomas arise in the peripheral zones.
Benign Prostatic Hyperplasia
An extremely common cause of prostatic enlargement resulting from the proliferation of stromal and glandular elements.
Incidence rises rapidly >40y (men)
2-5x normal weight
Transitional zone
Age-related hormone changes
Cause of urinary obstruction
Nodular appearance
Symptoms and Complications of benign prostatic hyperplasia
Symptoms
Frequency, urgency, nocturia (needing to go to the washroom)
Decreased force of urinary stream
Complications (long-term)
Bladder hypertrophy, dilatation
Urinary stone formation
Bladder trabeculation (dilated and distended bladder)
Treatment for benign prostatic hyperplasia
Medications
Relax smooth muscle in the prostate
Hormonal (anti-androgen, reduce stimulation)
Surgery
Trans-urethral procedures (carve out tissues)
Prostate Cancer
Carcinoma of the prostate is a common cancer of older men between 65 and 75 years of age.
Prostate carcinomas range from indolent lesions that will never cause harm to aggressive fatal tumors.
Incidence rises rapidly >50y
Most common non-skin cancer in men
Glandular organ → adenocarcinoma
1 in 9 lifetime risk
1 in 39 cause of death
More die with than from (thanks to screening and modern treatment)
Prostate Cancer risk factors
Established: Age, Family History, Ethnicity: Africa > Europe > Asia, Geography: NA, Europe, Australia
Maybe: Obesity, Diet: Red meat, diary Industrial: Diesel fumes, pesticides, lifestyle: sedentary, stress, shift work
Screening for prostate cancer
No specific early warning symptoms
Adenocarcinoma occurs in the peripheral aspect of prostate (does not impinge on the urethra)
Use manual testing (feeling for bumps)
Usually slow growing (chance to catch early)
Prostate Specific Antigen (PSA)
Present normally in secretions
Elevated serum PSA in cancer
Screening test, but not specific
Also useful in post-treatment monitoring
Cryptorchidism
Cryptorchidism is a failure of testicular descent into the scrotum.
Normally, the testes descend from the abdominal cavity into the pelvis by the third month of gestation and then through the inguinal canals into the scrotum during the last 2 months of intrauterine life.
The diagnosis of cryptorchidism is only established with certainty after 1 year of age, particularly in premature infants, because testicular descent into the scrotum is not always complete at birth.
Testicles remains other places
Abdominal: 15%
Inguinal canal: 25%
High scrotal: 60%
Incidence, risk factors, mechanisms of cryptorchidism
INCIDENCE
3% term gestation
10-30% preterm
RISK FACTORS
Prematurity
Low birth weight
Family history
MECHANISMS
Anatomical influences
Hormonal influences
Complications and treatment for cryptorchidism
Complications: Tumors (Neoplasia), Infertility, Hernia, Testicular torsion, Mechanical injury
Treatment: 80% descend within 3 months, Surgery after 6 months: Preserve fertility, Reduce tumor risk (but not eliminate), Improve early detection of
tumors
Testes typically descend within 3 months of birth
Surgery recommended at 6 months to preserve fertility, reduce tumour risk (BUT NOT ELIMINATE - still increased risk due to hormonal issues), and improve early detection of tumours
Testicular Torsion
Anomalous development leaves testis free to twist
Strangulate blood supply
You can untwist if you get it treated quickly
Peak incidence in teens and infancy
Emergency condition
Manual detorsion ± surgical correction
Testicular Cancer
PATIENT ENCOUNTER
25 yr pro cyclist
Painless testicular asymmetry
Sought medical attention with onset of pain
In retrospect, one episode of hemoptysis, though due to overexertion
Imaging:
Ultrasound: testicular mass
CT: spread to abdomen, lungs, brain
Surgical resection + chemotherapy
Mixed germ cell tumor
Presently disease free…
Risk factors of Testicular Cancer
Undescended testes (10-40x)
Family history
Contralateral testicular tumor
Male infertility
Abnormal gonadal development
Most tumours are germ cell tumours (seminoma group and non-seminomatous group)
Pure seminoma vs Non-Seminomatous Testicular Cancer
Pure Seminoma: Majority of cases, slow growing,
Homogenous, fleshy
Non-seminomatous: More likely advanced stage, More variegated appearance, Often a mix of subtypes
