Male GU Flashcards
Opening of urethra on inferior surface of penis due to failure of urethral folds to close
Hypospadias
Epispadias is the opening of urethra on superior surface of the penis. What is the difference in etiology between hypospadias and epispadias?
Hypospadias = failure of urethral folds to close
Epispadias = abnormal positioning of genital tubercle
Additional clinical feature associated with epispadias
Bladder exstrophy
Necrotizing granulomatous inflammation of inguinal lymphatics and LNs caused C.trachomatis L1-L3; eventually heals with fibrosis; perianal involvement may result in rectal strictures
Lymphogranuloma venereum
2 major risk factors for SCC of the penis
High risk HPV (2/3 of cases)
Lack of circumcision
3 Precursor lesions of SCC of the penis (shaft vs. glans vs. reddish papules)
Bowen disease = shaft
Erythroplasia of Queyrat = glans
Bowenoid papulosis = reddish papules; similar to bowen disease but does not tend to invade
[these are all considered in situ carcinoma]
Most cases of cryptoorchidism resolve spontaneously by the age of 2. If they do not, complications include testicular atrophy with infertility and increased risk for what type of cancer?
Seminoma
Causes of orchitis
Chlamydia trachomitis (D-K) or N.gonorrhoeae
E.coli and Pseudomonas (older adults with UTI)
Mumps virus
Autoimmune orchitis (granulomatous inflammation of tubules — ddx includes TB which can be differentiated with AFB stain)
Testicular torsion is twisting of the spermatic cord leading to _____ infarction. It is due to congenital failure of testes to attach to the inner lining of the scrotum. Presents in adolescents with sudden testicular pain and absent ______ reflex
Hemorrhagic; cremasteric
A varicocele is a dilation of the spermatic vein due to impaired drainage; presents as scrotal swelling with bag of worms appearance. Usually left sided, seen in a large population of infertile males, and is associated with what malignancy?
Left-sided renal cell carcinoma
[RCC loves to invade the renal vein]
Hydrocele = fluid accumulation within the _____ _____; presents as scrotal swelling that can be transluminated
Tunica vaginalis
Etiology of hydrocele in infants vs adults
Infants — incomplete closure of processus vaginalis
Adults — blockage of lymphatic drainage
The 2 basic types of testicular tumors arise from germ cells or sex-cord stroma. Typical presentation is a firm, painless testicular mass that cannot be transilluminated.
T/F: gold standard for testicular tumor diagnosis is biopsy
False — not biopsied due to risk of seeding scrotum; instead they are just removed via radial orchiectomy
Most common type of testicular tumors
Germ cell tumors
Germ cell testicular tumors usually occur between ages of 15-40 and are divided into seminoma and non-seminoma. Risk factors include ______ and _______ ______
Cryptorchidism; Klinefelter syndrome
Malignant tumor of large cells with clear cytoplasm and central nuclei; composed of a homogenous mass with no hemorrhage or necrosis and rare cases may produce beta hCG
Seminoma
[similar to dysgerminoma of ovary]
Prognosis of seminoma
Good prognosis; responds to radiotherapy
Malignant tumor of immature, primitive cells that may form glands; composed of hemorrhagic mass with necrosis
Embryonal carcinoma
Embryonal carcinomas are non-seminomas that are considered aggressive with early ______ spread. Chemotherapy may result in ________. In addition, increased _____ or _____ may be present
Hematogenous; differentiation; AFP; beta hCG
[differentiation to something like teratoma]
Most common testicular tumor in children; AFP is characteristically elevated
Yolk sac tumor
[similar to yolk sac tumors in females — have schiller duvall bodies that appear as glomeruloid-like structures]
Choriocarcinoma of the testicle is a malignant tumor of _____ and ______ that spreads early via the ______ route. Of note is that there is characteristic ABSENCE of villi
Syncytiotrophoblasts; cytotrophoblasts; hematogenous
_______ is characteristically elevated in choriocarcinoma due to production from syncytiotrophoblasts, which may lead to symptoms of ______ or ______
Beta hCG; hyperthyroidism; gynecomastia
[beta hCG can activate TSH receptors leading to hyperthyroidism, or it can activate FSH/LH receptors leading to gynecomastia]
T/F: Teratomas in males are composed of mature fetal tissue derived from 2-3 embryonic layers, may produce AFP or beta hCG, and are ALWAYS considered malignant
True
[benign in females, malignant in males]
T/F: The vast majority of germ cell tumors are usually mixed; the prognosis is based on the worst component
True
Sex cord-stromal tumors of the testicle are usually benign. Which type of sex cord-stromal tumor usually produces androgen and presents with precocious puberty in children or gynecomastia in adults with characteristic Reinke crystals seen on histology?
Leydig cell tumor
Sex cord stromal tumor of the testicle comprised of tubules; usually clinically silent
Sertoli cell tumor
Most common cause of testicular mass in males > 60; often bilateral
Lymphoma
[usually diffuse large B-cell type]
Acute prostatitis etiologies in young adults vs. older adults
Young adults = C trachomatis; N gonorrhoeae
Older adults = E coli; Pseudomonas
[same as orchitis!]
Acute prostatitis presents as dysuria with fever and chills; the prostate will be tender and boggy on DRE. Prostatic secretions show _____ and culture reveals ______
WBCs; bacteria
Chronic prostatitis presents as dysuria with pelvic or low-back pain. How do the prostatic secretions in chronic prostatitis differ from acute prostatitis?
Chronic = prostatic secretions show WBCs but cultures are negative
Acute = prostatic secretions show WBCs and bacteria on culture
BPH is hyperplasia of prostatic ____ and _____. It is an age-related change with no increased risk of cancer.
It is primarily related to the hormone _______ and occurs in the ______ zone of the prostate
Glands; stroma
DHT; periurethral
Clinical features of BPH include problems starting and stopping urine stream, impaired bladder emptying, dribbling, _______ of bladder wall smooth muscle and possible associated diverticuli, microscopic hematuria, and slight elevation in ______
Hypertrophy; PSA (4-10)
3 possible pharmacologic treatments for BPH
Alpha 1-antagonist (terazosin) to relax smooth muscle
Selective alpha 1a-antagonists (tamsulosin) in normotensive individuals
5 alpha-reductase inhibitors (finasteride) — only one that decreases size of prostate because this is the enzyme that converts testosterone to DHT - the hormone driving prostate enlargement
Most common cancer in men; 2nd most common cause of cancer death
Prostate adenocarcinoma (malignant proliferation of prostatic glands)
3 major risk factors for prostate adenocarcinoma
Increasing age
Race — african americans > caucasians > asians
Diet high in saturated fats
T/F: prostatic adenocarcinoma typically presents early with urinary symptoms
False — since it arises at the posterior periphery of the prostate, it does not affect the urethra until very late
Screening for prostate cancer begins at age 50 with DRE and PSA. Normal serum PSA increases with age, but a PSA > _____ ng/dL is worrisome at any age. A ______ (increased/decreased?) percent free-PSA in the serum is suggestive of cancer
10; decreased
[a decreased percent free PSA is suggestive of cancer because cancer makes bound PSA]
T/F: A prostatic biopsy is required to confirm the presence of prostatic adenocarcinoma
True
[cannot confirm carcinoma just based on DRE and/or PSA]
How is prostate adenocarcinoma graded?
Gleason grading system — based on architecture, NOT nuclear atypia
[requires looking at multiple regions of prostate, since cancer varies across the prostate gland — higher score = worse prognosis]
Prostate cancer often spreads to the lumbar spine, which is considered _______ metastasis, presenting as low back pain with increased alkaline phosphatase, PSA, and prostatic acid phosphatase
Osteoblastic
[alkaline phosphatase is a marker of osteoblastic activity]
3 treatment options for prostate cancer
Prostatectomy (local disease)
Continuous GnRH analogs (leuprolide)
Androgen receptor inhibitor (flutamide)
