Male Module Flashcards
Describe the mechanism of tumescence
Mechanism:
Flaccid State: smooth muscle topically contracted, low arterial flow
Stimulated state: Release of neurotransmitters –> smooth muscle relaxation in sinusoids
Arterial dilation –> increase blood flow in sinusoidal space
Expansion of sinusoids –> compression of emissary veins, trapping of blood as outflow decreased
Increased intracavernosal pressure –> rigid erection with contraction!
Is tumescence sympathetic or parasympathetic?
Parasympathetic -> erection via NO and cGMP
Ejaculation or detumescence is sympathetic
How do you treat ED?
PDE5 inhibitors
PDE5 causes breakdown of cGMP so you don’t get erection. Inhibit PDE5 so that you can have erection.
Side effects of viagra:
Headache, flushing, dyspepsia, visual effects
What are the two types of Priapism?
Which is a medical emergency?
Arterial: Painless erection without ejaculation
Venous: PAINFUL erection without ejaculation (EMERGENCY) - can lead to ischemia and fibrosis
What do hormone levels look like on Anabolic Steroids?
Exogenous Testosterone leads to decrease in FSH and LH –> No sperm production
Testes Exam:
Size of the testes:
Consistency of the testes:
Size –> small indicates sperm production deficiency
Soft –> soft indicates sperm production deficiency
What do varicoceles do to men?
Common cause of spermatogenic deficiency.
Will find a ‘bag of worms’ on physical exam
If you correct surgically you will see great improvement !
Remember: Do GENETIC testing BEFORE biopsy.
If you see AZFa region microdeletion what is it and do you need TESE or Testis Biopsy?
AZFa is a Y chromosomal microdeletion of AZF. Means you have NO spermatogenesis.
Don’t need TESE or biopsy
What about AZF b?
NO spermatogenesis!
No TESE or Testis Biopsy
What about AZFc?
Any ethical issues?
AZFc will have spermatogenic potential, but sons will have offspring issues. Likely will be infertile
How is AZF inherited?
Issues on Y chromosome, so you have ALL sons get it!!
Some may have severe oligospermia, some have some sperm and some have NO sperm
Does Klinefelter have a single phenotype?
47 XXY
NO! Spermatogenic axis failure, so some have severe oligospermia others have azoospermia
Some may present with infertility as their first sign
What is Congenital Bilateral Absence of the Vas Deferens (CBAVD)?
It is mutations in the Cystic Fibrosis genes
CF mutation analysis for both partners should be done prior to sperm harvesting!!
Pathophysiology of BPH?
Microscopic BPH (evidence of cellular proliferation of the prostate) –> macroscopic BPH (enlargement of the prostate) –> Clinical BPH (lower urinary tract symptoms - straining, hesitancy, urgency, frequency)
BPH is proliferation of what?
Both stromal and glandular proliferation
How do you treat BPH?
Alpha blockers (tamulosin) - block alpha 1 receptors, relax prostatic smooth muscle --> decrease bladder outlet obstruction 5-a-reductase inhibitors (Blocks DHT) - Finasteride
What is PSA?
Prostate specific antigen
Elevated PSA results from disruption of cellular architecture (could be BPH, Prostate cancer)
Compare Prostate risk?
Low risk - PSA <10, Gleason 6
Intermediate risk - PSA 10 - 20, Gleason 7
High risk - PSA >20, Gleason 8 - 10
What is HGPIN? What is ASAP?
High grade prostatic intraepithelial neoplasia
Architecturally benign prostatic ducts lined by cytologically atypical cells
Considered a precursor to cancer
ASAP: Atypical small acinar proliferation - suggestive but not diagnostic of cancer
What is Docetaxel?
1st line chemotherapy to treat Prostate Cancer
Induces apoptosis and prolongs progression free and overall survival, ameliorates pain, improves quality of life
