Male Reproductive Flashcards
Erection
PNS - cavernous nerves
release NO –> increased cGMP –> sm.m. relaxation
cGMP broke down by phosphodiesterase 5
- use PDE5 inhibitors to block and maintain erection
- Sildenafil, tadalafil
Pudendal N.
-contract muscles at base of penis to maintain erection
Emission and ejaculation
Emission: sperm into urethra mix w/ fluid from seminal vesicles and prostate gland –> semen
Ejaculation: semen expelled from penis
Mediated by sympathetic n.
Some pudental n. - base of penis muscles
“Point and Shoot”
PNS for erection
SNS for emission and ejaculation
Spermatogenesis
Spermatogonium (one 2N) --> interphase --> primary spermatocyte (one 2N) --> meiosis I --> secondary spermatocyte (two 1N) --> meiosis II --> Spermatid (four 1N) --> spermiogenesis --> mature spermatozoon
Failure of meiosis I –> accumulation of primary spermatocytes
Failure of meiosis II –> accumulation of secondary spermatocytes
Regulation of spermatogenesis
Hypothalamus –> GnRH –> anterior pituitary
AP:
- LH –> Leydig Cells = T
- FSH –> Sertoli cells
a. inhibin
b. ABP (androgen binding protein) –> sperm production
Aromatase
T –> estrogen
produced by sertoli cells, bone, brain, skin, adipose tissue
obese patients become T deficient d/t estrogen conversion in fat tissue
5 alpha reductase inhibitors
finasteride
dutasteride
tx BPH, male pattern baldness
blocks conversion of T to DHT
Flutamide
non steroidal competitive inhibitor at T receptor
used in prostate cancer
Seminoma
Germ cell tumor
Most common - 50%
15-35 yo
malignant
painless homogenous testicular enlargement
Histo: large cells, lobules, watery cytoplasm, “fried egg” appearance
Radiosensitive
Late mets
Good prognosis
homologous to dysgerminoma in females
Embryonal carcinoma
Germ cell tumor
malignant
worse prognosis
PAINFUL palpable mass in scrotum
Histo: glandular, papillary morphology
-can differentiate into other tumors
AFP normal (increased in mixed germ cell) high hCG
Yolk sac (aka endodermal sinus tumor)
Germ cell tumor
most common under 3 yo
yellowish, mutinous
Schiller-Duval body - primitive glomeruli
high AFP
Choriocarcinoma
Germ cell tumor
malignant
HIGH hCG
disordered synctiotrophoblasts and cytotrophoblasts
hematogenous mets
Teratoma of testis
Germ cell tumor
mature - malignant
multiple tissue types
high hCG
high AFP in 50%
Leydig cell tumor
benign, non-germ cell tumor
Most common - adults
Reinke crystals - lipofusion pigment in odd shapes
androgen producing - may produce estrogens –> virilizing or feminizing sx
Endo sx: decreased libido, ED, infertility
Kids: precocious puberty in boys
Golden brown tumor
Sertoli cell tumor
90% benign, non-germ cell tumor
secrete estrogen –> gynecomastia
assoc w/ Peutz-Jegher’s and Carney syndromes
Testicular lymphoma
met to testes
most common tumor in older men
Hydrocele
increased fluid d/t incomplete fusion of processes vaginalis
common in newborns
Spermatocele
dilated epidermal duct
Varicocele
bag of worms
dilated v. in pampiniform plexus
infertility
Epididymitis
Painful testicle
inflammation of epididymis
dx: support of testes –> some relief
Tx: GC/Chlamydia - ceftriaxone IM then doxycycline x10 d
tx older 35 yo or hx of anal intercourse = Ecoli, enterobacteriaceae - fluoroquinolone x 10-14 d
Testicular torsion
high riding testis oriented longitudinally
absent cremasteric reflex on side of torsion
twisting of spermatic cord –> ischemia
dx: support of testis = no relief, US
tx: surgical detorsion w/ b/l orchiopexy w/in 6 hours
Cryptorchidism
increased risk in premature
failure of testis to descend into scrotum
usually u/l
descent complete in first year of life
increased risk of testicular concern - germ cell tumor, increased in contralateral testicle too
higher body temp = low spermatogenesis
tx: early orchiopexy - anchor to scrotum
or orchiectomy
R/O CAH - may have ovaries
Mechanisms of ED
failure to initiate - psychogenic, endocrinologic or neurogenic
failure to fill - atherosclerosis - DM, drug related - 80% in older men
Failure to store adequate blood volume w/in lacunar network - DM
Phosphodiesterase Inhibitors
block PDE5 - don’t break down cGMP –> decreased Ca2+ = sm.m. relaxation
Sildenafil
Vardenafil
Tadalafil - BPH
Uses: ED, raynaud dz, primary pulmonary HTN
Side effects:
HA, flushing, dyspepsia
Impaired blue/green color vision
Risk of life threatening hypotension w/ nitrates
Bowen disease
Gray, solitary, crusty plaque on penile shaft, scrotum (or female genitalia)
occasionally progress to invasive squamous cell carcinoma - 5th decade
Erythroplasia of Queyrat
Red, velvety plaque involving the glans
type of bowen disease
Bowenoid papulosis
multiple papular lesions, do not become invasive
younger adults
Squamous cell carcinoma of penis
Asia, Africa, S. America
95% of penile cancers
Ass oc w/ HPV, lack of circumcision
Peyronie disease
Angulation of the penis leading to painful erections
Due to inflammation and fibrous tissue formation of the tunica albuginea
Priapism
Persistent penile erection - painful
Can lead to ischemia and clotting of the blood retained in the penis
Assoc w/ sickle cell disease and spinal cord injuries
Condyloma acuminatum
Benign genital warts
HPV 6, 11
tx: chemical/physical destruction
immunologic tx
surgical excision
Balantitis
Inflammation of glans penis
Causes: candida 40%, local trauma, bacteria, viruses, STDs
More common in uncircumcised and DM
Prostatitis
Inflammation of prostate
Sx: dysuria, frequency, urgency, low back pain
Under 35: G/C
Over 35: E coli, Klebsiella, Sebratia, Enterobacter, Proteus
Tx: Fluoroquinolone (levofloxacin), TMP/SMX x 4 weeks
Benign prostatic hyperplasia (BPH)
Too much DHT
80% over 80 have it
Sx: incomplete voiding, urinary frequency, straining to void, intermittent or weak urine stream, urgency, nocturia at least 2-3 times/night
palpable prostate size (posterior lobe) does not correlate w/ obstruction or sx severity - nodular enlargement of periurethral - lateral and middle lobes
Tx of BPH
nonselective a1-blockers: doxazosin, prazosin, terazosin
- decrease prostate sm.m. tone –> IMMEDIATE improvement in urine flow
- SE: dizziness, POSTURAL HYPOTENSION, fatigue, asthenia
Selective alpha 1A,D blocker - tamulosin
-fewer SE than nonselective, no antihypertensive effects
5alpha-reductase inhibitors: finasteride, dutasteride
-SLOWLY reduce DHT levels = 20% decrease in prostate volume over 3-6 mo
Surgical intervention - can lead to permanent ED
Prostate Adenocarcinoma
95% from glands/ducts of prostate
Slow growing
over 50 yo
sx: urinary frequency, nocturia, weak stream (same as BPH)
Develops in posterior lobe - rectal exam
Screen w/ PSA - confirm with bx
May met to bone: LBP, increased alkaline phosphatase
Histo: obliteration of orderly glands, dense darker, little cytoplasm
Tx: flutamide (inhibit T at receptor level), resection
