male repro path Flashcards
external oblique essentially “continues” into the scrotum as what?
cremaster muscle
acts as a guide or “line” for drawing testis into the scrotum.
The gubernaculum
Twisting of the _______ causing compression of its blood supply
spermatic cord
Most common cause for ball torsion
“bellclapper’s deformity”–
What would the symptoms of a torsion be
Cremasteric reflex is typically absent
Pain is significant and acute (my nuts!!!!)
Testis is swollen, tender, and high in the scrotum, with an abnormal transverse lie
2 possible paths for ball inflammation infection
from the blood stream
retrograde (vas deferens to epididymis to testis)
Usually caused by infection
Often in combination with epididymal inflammation
Testicular Inflammation(Orchitis) (Orchitis-Epididymitis) (you done messed up)
Bacterial Testicular Inflammation and non-sexually transmitted testicular inflammation agents:
Staph, Strep, E. Coli (increased risk with surgical manipulation or frequent catheterization)
Testicular Inflammation Sexually transmitted agents:
Gonorrhea (GC), Chlamydia (Cz), Syphilis
Testicular Inflammation Viral agents:
usually mumps, sometimes coxsackie or parvovirus
Orchitis Symptoms
rapid onset of pain in one or both testicles that usually begins locally but over several days may spread to the groin.
testicles may appear tender, swollen, red or purple.
Patient may have a “heavy feeling” in the swollen testicle.
Blood may appear in ejaculate; urethral discharge may occur (but not always!) (such a pretty color)
pain/burning with urination, or pain with increased abdominal pressure (e.g. with bowel movement), groin pain, pain with intercourse.
Systemic symptoms: high fever,nausea,vomiting, malaise
Treatment of testicular inflammation :
Antibiotics– p.o. x 10 days specific to the infecting agent
Sometimes IV abx needed
STD counseling (wrap that shit up idiot)
Fertility counseling (no babies bro, fucking please no babies)
how does Orchitis- Epididymitis effect fertility
If both testes are affected, fertility can be affected
Damage to Leydig cells– testosterone
Damage to seminiferous tubules
Especially concerning with mumps orchitis
Should ask about hx of orchitis during any infertility visit, or with finding of hypogonadism or low testesterone.
Testicular Tumors can arise from two cell types
germ cells (Seminoma or embryonal)
non germ cells (Sertoli or Leydig cells)
Most common ball cancer=
seminoma
Half of all cases diagnosed between 20 and 34 years of age
Testicular Cancer
cure rate testi cancer
High* – 90% survival at 5 years
80% of people with testicular cancer have an extra copy of a portion of what chromosome
chromosome 12
Most cancer cells are triploid or tetraploid– so the genetic defect seems to affect what? (what a dumb question! do better Caleb!)
proofreading of chromosomes at the pre-mitotic checkpoint.
If the cancer arises from germ cells, testicular cancers can secrete what?
embryonic proteins, like β-HCG, AFP, or LDH.
dylan loves ball protein
Dilation of veins in the pampinoform plexus
Varicocele
Varicocele Most common cause
is poor blood return from pampinoform plexus to testicular vein to central circulation.
Which side gets more varicoceles
left
One way to treat a varicocele
Embolize the veins (what the hell does that mean!)
A fluid collection within the scrotum.
Can occur in adults or infants.
Can be communicating or non-communicating
Hydrocele
Occurs when there is a patent funicular process (processus vaginalis from embryology) allowing fluid to descend from the peritoneal cavity into the scrotal sac.
(stomach fluid goes into YOUR ballsack)
Communicating Hydrocele
All hydroceles are caused by fluid accumulation where? (be more specific than the nut sack)
tunica vaginalis (the peritoneum-like remnant of the processus vaginalis).
t/f Patent funicular process may increase risk of indirect hernia in men.
t
what intra-abdominal disease processes could cause this person to have scrotal swelling?
Intraperitoneal bleeding
Ascites
Abdominal cancer
Hydrocele that occurs even when the processus vaginalis has closed, and is now a tunica vaginalis.
non communicating hydrocele
Two ways non communicating hydrocele happen
Fluid accumulates in the tunica vaginalis before birth, and just doesn’t get reabsorbed.
A process inside the scrotum (infection, cancer, or fluid production by the tunica itself) causes fluid to build up there.
If you can see through the sack hydrocele or cancer.
hydrocele (or magic!!!!!!!)
If you’re examining a child with a full testi, what could it be
a loop of bowel in the scrotum from an inguinal hernia!!
what increases with BPH
sorry not penis size that never changes
increased number of cells, not just larger cells.
Gland (secretory) and muscle cells are both increased in number.
The capsule seems to contain the prostate laterally, transmitting pressure of the increased growth which way
medially
what nerves cause urinary symptoms in BPH
Prostate enlargement can compress the plexus branches to the bladder, or cause retrograde dysfunction of those nerves.
pelvic plexus (hypogastric plexus)– a matrix of sympathetic and parasympathetic nerves that supply the pelvic organs, including bladder and prostate.
How does testosterone affect the prostate
Testosterone is at a high concentration in the blood vessels traveling near the prostate.
Both testosterone and its metabolite, DHT, can increase cell division in the prostate
As men age, their serum testosterone goes down– but their DHT levels in the region of the prostate stay higher, causing a a paracrine effect.
So as men age, DHT is the main hormonal actor in BPH.
(fuck you DHT, leave my prostate alone)
activates proto-oncogenes in the prostate.
DHT (i hate DHT!)
t/f prostate cancer is A glandular cancer
true
t/f BPH is a risk factor for prostate cancer
f it is not!
risk factors for prostate cancer.
History of multiple sexual partners, history of HSV or HPV, and positive serology for HPV 16 and 18
Many prostate cancers are known to increase production of what
transcription factors that eliminate apoptosis (increasing odds of cellular immortality).
Prostate cancer is also associated with androgens that do what
that increase cell turnover (increasing mitotic events).
what does prostate cancer look like
Increased metastases
Less organization
Obliterated secretory spaces
Inability to completely retract foreskin that covers the head of the penis.
Phimosis
what is Physiologic Phimosis
Children are born with tight foreskin at birth, and separation occurs naturally over time.
what age does physiologic phimosis resolve
Typically resolved by age 7
At birth, the glans is exposable in less than 4% of boys
At three years of age, 10% of boys still don’t have a retractable foreskin.
Foreskin is partially retracted but “stuck” at that position
Paraphimosis
treatment for paraphimosis
Good hygeine (also prevention)
Gentle manipulation of the foreskin from the glans
Never traumatize a child with overzealous manipulation
If needed emergently: circumcision
these describe what
In situ Invasive Ulcerative HPV Regional lymph nodes. Metatasizes widely.
Squamous Carcinoma of the penis
what hpv viruses cause Squamous Carcinoma of the penis
HPV 16 and 18
Pathologic Phimosis
Glans either cannot be exposed at all or can only be exposed partially
Adhesions and scar tissue prevent full exposure
Usually caused by recurrent balanitis (infection below the foreskin) or improper hygeine
dick look like an elbow macaroni
Peyronie’s Disease
Principal manifestation of Peyronie’s disease
the formation of a plaque (a segment of flat scar tissue) within the connective tissue of the penis.
can cause your dick to shrink
peyronie’s disease (ahhhh leave my dick alone!!!!)
Peyronie’s Disease causative agents
Probably secondary to mild penile trauma Most experts believe that Peyronie’s disease is likely the consequence of a minor penile trauma
Increases risk for peyronie’s disease
with diabetes, tobacco use, or a history of pelvic trauma
Painful Erection lasting >4 hours
Uncommon, usually not due to sexual stimulation
Has to do with increased flow into penis vs. decreased flow out
Priapism
Normal function of erectile tissue
Filling of cavernous sinuses
Relaxation of penile smooth muscle
mechanisms are important in erection.
Nitric Oxide and paracrine signaling
2 types of priapism
High-flow (non-ischemic)
Result of overabundance of arterial flow
Low Flow (ischemic) Result of decreased venous drainage, usually due to vaso-occlusion
Metabolic demands within penile tissue
Average temperature 4 degrees lower than the body
Probably why erection can be tolerated for up to 4 hours
In low-flow priapism, however, metabolic needs cannot be met
Elevated pCO2, low pO2
Acidic pH
Who is at risk for priapism
People with viscous or occlusive blood disorders
Sickle cell
Leukemia
Polycythemia
Those on certain Rx meds
Viagra, cialis
Zyprexa, wellbutrin, coumadin
Penile/ genital injury
Spinal cord injury, blood clots, spider venoms
Treatments for priapism
Inhibitors of parasympathetic muscle relaxation
Intracavernous injections of vasoconstrictors
Shunting of venous blood
