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Male Repro Flashcards

1
Q

Hypospadias

A

Congenital defect where urethral meatus is on ventral side of penis (closer to scrotum)
defect on ventral side

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2
Q

The majority of Hypospadias is _________, it affects the glans

A

glandular

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3
Q

What are the different types of urethral openings for Hypospadias?

A

Glandular: affects glans
Penile: affects shaft
Perineoscrotal: affects perineum or scrotum

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4
Q

Hypospadias may be associated with what two conditions?

A

undescended testes or inguinal hernia

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5
Q

What are the causes of Hypospadias?

A

idiopathic, genetic defects, maternal exposures

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6
Q

Epispadias

A

Congenital defect where urethral meatus is on dorsal side of penis
Less common than hypospadias

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7
Q

What are the causes of Epispadias?

A

idiopathic, genetic defects, maternal exposures

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8
Q

What are the three sites of epispadias?

A

Glanular epispadias: found on the head of the penis
Penile epispadias: found along the shaft of the penis
Penopubic epispadias: found near the pubic bone

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9
Q

What may Epispadias be associated with?

A

bladder exstrophy, broad, short penis, and widely spaced pubic bones

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10
Q

What are the risks for Epispadias?

A

incontinence, UTI, urinary reflux

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11
Q

Phimosis

A

tightening of prepuce that prevents retraction over glans.

-By 3 years of age most should have retractable foreskin

Risk factors:
*Boys not circumcised or not properly circumcised.

-Typically asymptomatic but can cause problems with urination/sexual activity
-One of most predisposing factors for penile cancer

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12
Q

Paraphimosis

A

-Prepuce is constricted and cannot cover glans

-Can constrict blood supply to glans causing necrosis of glans

-Usually due to prepuce being forcibly retracted or retracted for extended period of time

-Urologic emergency

-Presents with severe ischemic pain

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13
Q

Balantis

A

acute/chronic inflammation of glans penis

-Can be caused by candida infection due to diabetes

-Noninfectious causes can be due to reactive arthritis

-Balanitis xerotica obliterans with uncircumcised males has been associated with penile cancer

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14
Q

Balanoposthitis

A

inflammation of glans and prepuce

-Usually associated with phimosis or large redundant prepuce or STD

-Cannot adequately clean glans and leads to bacterial infections

-If untreated can lead to ulcerations of glans and scarring

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15
Q

Peyronie’s Disease

A

-Localized and progressive fibrosis that affects the tunica albuginea (surrounds the copora cavernosa). the penis ends up curving and usually bc its typically on dorsal side the penis will curve upright and laterally (if severe)

Idiopathic
-May be caused by trauma to penis
-Associated with severe vasculitis

-Plaque is usually on dorsal midline of shaft of penis causing upward curvature during erection (can also be lateral or cause penis to be shortened)

-Can cause painful erections and difficulty with intercourse

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16
Q

Erectile Dysfunction

A

Inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse

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17
Q

What are psychogenic causes of ED?

A

performance anxiety, depression, strained relationship with partner, can be exacerbated by medication

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18
Q

What are organic causes of ED? (most common one)

A

Wide variety of pathologies: hypogonadism(low serum testosterone) , vascular (very important), diabetes, smoking, HTN, aging

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19
Q

Priapism

A

Involuntary/painful erection lasting longer than 4-6 hours and not associated with sexual excitement

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20
Q

Low flow Priapism

A

ischemic, statis of blood flow in corpus cavernosa. (can get blood in, cant get it out)

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21
Q

High-flow Priapism

A

non-ischemic, persistent arterial flow into corpus cavernosa

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22
Q

Primary reason for Priapism

A

Idiopathic
Trauma, infection, neoplasm

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23
Q

Secondary reason for Priapism

A

Sickle Cell, leukemia, stroke, etc
Drugs: medications for ED, drugs for muscle building (androstenedione)

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24
Q

Hydrocele

A

Collection of fluid in the potential space between the two membrane layers of the tunica vaginalis

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25
Congenital hydrocele
-Caused by patent process vaginalis between the scrotal sac and the peritoneal cavity -Allows fluids to collect in scrotum -S/S include enlarged scrotum, transillumination -Fluids normally will reabsorb and the patency will close; no intervention required
26
Acquired hydrocele
-Can occur secondary to response to infection, tumor, or trauma -Due to overproduction of fluid by testis or obstruction of lymphatic or venous drainage in the spermatic cord -Scrotal mass develops that is usually painless, may note feeling of heaviness
27
Varicocele
-Abnormal dilation of pampiniform venous plexus of veins that drain each testis -Highest incidence in men 15-35 years of age -Presents as dilated vessels that feel like “bag of worms” that is worse when standing, feeling of heaviness -More common on left (left testicular vein to L renal vein not IVC) and usually no symptoms are present -If Right side then probably obstruction/tumor -Sperm concentration and motility may be significantly decreased in 65%-75% of men
28
Testicular Torsion
-twisting of spermatic cord that suspends testis and cuts of blood supply to testis -It is the MOST COMMON acute scrotal disorder in pediatric and young adult population -Patients are usually in severe distress within hours. -Vomiting, nausea and tachycardic with large tender testis -Absence of cremasteric reflex -Can be bilateral (testes twisting on itself) emergency bc cutting off blood supply
29
Cryptorchidism
Undescended testicle(s). -Occurs when one or both testicles fail to move down into the scrotal sac and remain in abdominal region or inguinal canal. -Premature and low birth weight risk factors -With full term it is idiopathic -Can lead to infertility, malignancy, testicular torsion and psych effects -Bilateral undescended testicles may be ambiguous genitalia
30
Urethritis
Inflammation of urethra -Usually caused by - bacterial infection from the skin around the meatus Bacteria: E.Coli, NG/CT, HSV-1 and 2 and Trichomonas Presents with Dysuria Penile discharge Painful intercourse Hematuria or hematospermia
31
Urethritis: Gonococcal
profuse yellow discharge
32
Urethritis: Non-gonococcal
scanty white or clear discharge usually due to Chlamydia trachomatis. Most COMMON reason for penile discharge.
33
What does Urethritis present with?
Dysuria Penile discharge Painful intercourse Hematuria or hematospermia
34
Epididymitis is most commonly due to __________
local spread of infection
35
What are the two major types of Epididymitis?
1. Sexually transmitted infection More common in younger men Associated with urethritis 2. Nonsexually transmitted infection: More common in patients over 35 Associated with UTI and prostatitis E.Coli
36
What is Epididymitis characterized by?
unilateral pain and swelling with erythema and edema of scrotum, cremasteric reflex persists, pain improved with lifting the scrotum slightly Risk for infertility if not recognized and treated
37
Orchitis
Infection of the testes Spread through the GU tract or through hematologic or lymphatic spread May be related to scarlet fever, pneumonia, or mumps orchitis is the most common viral infection Typically unilateral Bilateral infections rarely result in permanent infertility
38
Prostatitis
Inflammation of prostate gland Acute or chronic Bacterial or nonbacterial Typically occurs as result of direct ascent of bacteria from the urethra through prostatic ducts
39
Acute Bacterial Prostatitis
occurs most frequently in males 20-40 years of age considered subset of UTI. Most commonly E. coli Presents with fever, chills, myalgia, polyuria, dysuria, dull perineal pain urethral discharge, swollen, tender prostate
40
Chronic Prostatitis:
Usually recurrent UTIs with same pathogen in prostate fluid and urine Usually E.coli, Proteus or Klebisella Symptoms: polyuria, dysuria, perineal discomfort and low back pain
41
Benign Prostatic Hyperplasia
Non-malignant enlargement of the prostate Cause not totally understood Dihydrotestosterone plays a role by causing prostate to enlarge One of the most common diseases of aging men Can lead to partial/total urinary retention, due to compression of urethra
42
Signs and symptoms of Benign Prostatic Hyperplasia
Hesitancy/frequency of urination (especially at night) Double voiding Straining to start Dribbling Small volume
43
Carcinoma of Penis is most common in ________ age group and are much common in ___________-
45-60 age group, uncircumcised males
44
T/F is carcinoma of penis is highly curable
True
45
What are the risk factors of Carcinoma of Penis?
Idiopathic but risk factors include: age, poor hygiene, smoking, HPV, UV, immunodeficiency.
46
How does carcinoma of penis begin and where does it extend to?
Begins with small lesion that begins beneath the prepuce or in the coronal region then extends to shaft and glans
47
Prostatic Cancer... 26-30
Disease of aging increasing rapidly over 50 years of age
48
_____________ is the disease of aging, increasing rapidly over 50 years of age
prostatic cancer
49
What are the risk factors for prostatic cancer?
family history AA males High fat intake `
50
Which cancer is the most common non skin CA in the US and 2nd to lung CA as a cause of cancer related death in US men?
Prostatic CA
51
____________ account for approx 98% of prostatic CA
Adenocarcinomas
52
What is the course for a patient with prostate cancer?
unpredictable, can be slow and growing and patient may die from other causes or can grow quickly and metastasize rapidly with early death.
53
Prostate CA is usually asymptomatic so if it is symptomatic, this usually means that it has ___________ advanced or _____________ disease. What are the symptoms?
locally, metastatic. -dysuria -polyuria -painful intercourse -hematuria -pelvic/lumbar/ upper thigh pain
54
What screening is used for prostate CA?
DRE and PSA, most commonly used after age 50 (african american male or famililar history will begin at age 40). DRE may reveal nodular/fixed prostate
55
Gleason Scale
prostate CA grading system 1- small, uniform glands 2- more spaced glands 3- infiltration of cells from glands at margins 4- irregular masses of cells with few glands 5- lack of glands, sheets of cells (goes from well differentiated to poorly differentiated)
56
What is the most common cause of CA in males 15-35 years old?
testicular CA
57
What are the major risks of testicular CA?
Cryptorchidism (even if corrected surgically with the higher the testicle the greater the risk) Hx of mumps orchitis after puberty Torsion of testicle
58
What is the first sign of testicular CA?
painless scrotal mass
59
Most testicular cancers are ___________ cell tumors
germ
60
Seminomas testicular CA are most common in the _______ decade of life
4th
61
Nonseminomas testicular CA
Usually contain more then one cell type and are less differentiated
62
Embryonal testicular CA
most commonly in the 20-30 year age group
63
Choriocarcinoma testicular CA
very rare and highly malignant
64
Yolk sac testicular CA
most common in infants and young children
65
Teratoma testicular CA
2%-3% of all germ cell tumors and can occur at any age
66
What is the MOST COMMON acute scrotal disorder in pediatric and young adult population
Testicular Torsion
67
What is the most common viral infection?
orchitis
68
What is the most common disease of aging men?
BPH

Patho (16 decks)

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