Male genitourinary disorders Flashcards
Review A & P (Porth, chpts 43 + 45)
* Esp review p. 1039 figure 43-4 and 43-5
d
Prostate
- What is it?
- where is it situated?
- Shape?
- Name of part of urethra it surrounds?
- Is accessory organ in male urinary system
- Secretory gland – produces prostatic fluid, which has various components that have different functions – helps to nurture sperm, helps to neurtralize pH of ejaculate + in women’s vagina
- Anatomically: prostate is encapsulated; sits close to and inferior to the bladder and lies at the neck of the bladder;
- Pear shaped organ….if core the pear have the urethra (NOT the ureter…which runs from kidney to the bladder) = the prostatic urethra; rest is the penile urethra (passes through penis)
Name structure other than prostate that is accessory gland that adds to ejaculate?
• Seminal vesicles also secretory: produce seminal fluid, which is also added to the ejaculate
Which structure is most important structure for neoplasia (both benign + malignant) in male GU system?
Prostate
Site of sperm production in testes?
Outline anatomy from there until ejaculate
Seminiferous tubules
–> becomes rete testes –> efferent tubules converge to form epididymus (site of final maturation of sperm) –> vas deferens –> sperm stored in ampulla of vas defens until ejaculated through urethra (can be fertile for up to 42 days)
How common is BPH in men?
• One of most common repro disorders in men…every single man beyond 50 or so will develop BPH!! Just severity is different
o >40 y ~20% have BPH
o >60 y ~50%
o >80 y ~90%
Where does the hypertrophy occur in BPH? Is it fast or gradual?
- Gradual periurethral englargement (occurs around the urethra, central in the prostate)
- Continual inc → will not stop unless you intervene
WHat tissues comprise the prostate? Which are growing and what kind of growth in BPH?
• P Comprised mostly of secretory cells (glandular tissue) but also have muscle tissue within the ducts – the muscle tissue is affected along with the exocrine tissues but is muscle so has HYPERTROPHY here, NOT hyperplasia
Etiology of BPH?
• Not all info is available – therefore et is unclear
• Ageing is the major risk factor –> Age related changes in adrogen levels??
o Altered T : E ?? (testosterone to estrogen ratio)
• Genetics, race, diet??
–> seen higher in African, lower in Japanese…possible genetic ties
–> role of these factors seem evident but unclear
What are androgens?
2 primary?
Male sex hormones
testosterone + DHT (Dihydrotestosterone)
WHy is the growth of the prostate (rather than atrophy) strange with increasing age?
Have to look at what supports the growth of the prostate…is reproductive, so supported by sex hormones. So if gland is increasing is size, would think that inc in sex hormones, but we know they decline with age…
What is DHT?
What role does E plan in relation to DHT?
T produced in testes, enters circulation + most enters accessory structures in repro tract (bit in other systems as well); 95% of T converts to DHT, which is the active form
Wiki: The enzyme 5α-reductase synthesizes DHT from testosterone in the prostate, testes, hair follicles, and adrenal glands
Estrogen responsible for facilitating action of DHT on the cells; sensitizes the prostatic cell for DHT binding + action, causing cells to carry out secretory fx and regulating proliferation of the cells
Patho of BPH?
- Related to changes in T, DHT, and E
- 5a reductase is enzyme responsible for T —–→ DHT
- DHT supports prostate growth + fx
- E sensitizes prostate to DHT
- T declines with age → alters T:E ratio
- Relative inc in E → sensitizes prostate to DHT → enlargement
- Hyperplasia of periurethral tissue → compresses urethra
- Also hypertrophy of smooth muscle (as these cells are also sensitized by E)
- Impedes urine flow (Urine accumulates in bladder → attempt to urinate → partial voiding with residual volume)
- Bladder wall thickens
- Trabeculations + Diverticula form
- Urine stasis
- Ureters distend w urine = hydroureter (Backing up of urine as cannot exit bladder → fills ureters and then into kidneys…calices fill up)
- Ureters loop downward & “fishhook”
- Urine backs up in the kidney causing hydonephrosis
Why thickening of bladder wall in BPH?
Is this compensatory + helpful?
• Bladder has single layer of epithelial tissue (transitional tissue) → structural changes will occur to counter risk of rupture
which is compensatory but seems to worsen problem b/c can actually allow more and more urine to accumulate)
Why do Trabeculations + Diverticula form in the bladder in BPH?
Is this helpful?
Attempts to inc size of bladder to compensate for inc retention…
Folds in wall of bladder….further allows urine stasis in the bladder…not good!
