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AA. Patho 2 > Male Reproductive Disorders > Flashcards

Male Reproductive Disorders Flashcards

1
Q

what parts of the MRS and FRS constitute primary gonads?

A

gonads - gland that produces gametes and secretes sex hormones
primary gonads of male - testes
Female - ovaries

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2
Q

what is structure and function of cremasteric reflex? what is the significance of this reflex for reproduction?

A
  • this muscle found in the scrotum consists of a series of small bands of skeletal muscle that descend, as an extension of the internal oblique muscle, and surround the testes.
  • contraction of this muscle moves the testes closer to the body, where they can absorb heat.

*cantraction of the muscles of the scrotum are for the purpose to regulate the temperature of testes.

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3
Q

what nerve is responsible for cremasteric reflex?

A

uses sensory and motor fibers of genitofemoral nerve from L1 and L2 spinal nerves

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4
Q

what is function of scrotum?

A
  • this is the supporting structure for the testes, consists of loose skin and an underlying subcutaneous layer that hangs from the root of the penis.
  • externally, it is separated into lateral portions by a median ridge called the “Raphe”
  • internally, the “Scrotal Septum” divides the scrotum into two sacs, each containing a single teste.
  • two muscles of this supporting structure are:
    1. )Dartos Muscle
    2. ) Cremaster Muscle
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5
Q

Accessory Sex Glands

A
  • these glands produce substances that protect gametes and facilitate their movement.
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6
Q

Supporting Structures

A
  • these structures such as the penis in males and the vagina in females, assist the delivery of gametes and, Uterus assists in the growth of the embryo and fetus during pregnancy.
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7
Q

Male Reproductive System

A
  • this reproductive system includes:
  • Testes
  • System of Ducts (including epididymis, ductus deferens, ejaculatory ducts, and urethra)
  • Accessory Sex Glands (seminal vesicles, prostate, bulbourethral glands)
  • Several supporting structures inlcuding Scrotum & Penis
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8
Q

Scrotum: DARTOS MUSCLE

A
  • this muscle found in the scrotum is composed of bundles of smooth muscle fibers,
  • contraction of this muscle causes the scrotum to become tight, which reduces heat loss.

*cantraction of the muscles of the scrotum are for the purpose to regulate the temperature of testes.

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9
Q

Testes

A
  • this part of the MRS produce sperm and the male sex hormone ‘Testosterone’
  • within these are ‘Seminiferous Tubules’ where sperm are produced. Seminiferous Tubulesis where sperm are produced!
  • cells within Seminiferous Tubules that are mainly responsible for the production of Sperm are:
    1. ) Spermatogenic Cells
    2. )Sertoli Cells
    3. ) Leydig (interstitial) Cells
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10
Q

SERTOLI CELLS

A
  • these cells of the testes, are embedded among spermatogenic cells in the seminiferous tubules.
  • these cells are responsible for protection of sperm whose functions include:
  • via tight junctions, these cells form the “Blood-Testis Barrier”.
  • Blood-Testis Barrier - this prevents an immune response against spermatogenic cells
  • these cells also nourish spermatocytes, spermatid, & spermatozoa
  • control movements of spermatogenic cells and release of spermatozoa
  • mediate the effects of testosterone and FSH on spermatogenisis
  • secrete fluid for sperm transport
  • secretes inhibin, which regulates sperm production
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11
Q

LEYDIG (interstitial) CELLS

A
  • these cells of the testes secrete testosterone, which is the most important androgen in the MRS.
  • Androgen - is a hormone that promotes the development of masculine characteristics.
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12
Q

Ducts of the Testis

A
  • pressure generated by the fluid secreted by Sertoli cells pushes sperm and fluid along the lumen of seminiferous tubules and then into a series of very short ducts called ‘straight tubules’.
  • the straight tubules lead to a network of ducts in the testis called ‘Rete Testis’
  • from the rete testis, sperm move into coiled ‘Efferent Ducts’ in the epididymis that empty into the ‘Ductus Epididymis’
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13
Q

M-R-S; Reproductive Ducts: EPIDIDYMIS

A
  • is a comma shaped organ along the posterior border of each testis.
  • consists mostly of tightly coiled ductus epididymis
  • functionally, this is the site of ‘Sperm Maturation’ which is the process by which sperm acquire motility and ability to fertalize an egg/ovum.
  • also stores sperm and helps propel them during sexual arousal by peristalic contraction into the Ductus (vas) Deferens.
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14
Q

M-R-S; Reproductive Ducts: DUCTUS (vas) DEFERENS

A

this duct ascends from the tail of the epididymis.

  • passes through inguinal canal and ultimately down the posterior border of the urinary bladder.
  • functionally this duct stores sperm and moves sperm during sexual arousal from the epididymis toward the urethra by peristaltic contractions
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15
Q

M-R-S; Reproductive Ducts: EJACULATORY DUCTS

A
  • these ducts are formed by the union of the Ductus deferens and the duct from the seminal vesicle.
  • terminate in the prostatic urethra
  • these ducts eject sperm and seminal vesicle secretions just before the release of semen from the urethra to the exterior.
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16
Q

M-R-S; ACCESSORY SEX GLANDS

A
  • in the male reproductive system, these glands secrete most of the liquid portion of semen.
  • glands included are:
  • Seminal Vesicles
  • Prostate
  • Boulbourethral Glands
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17
Q

M-R-S; Accessory Sex Glands: SEMINAL VESICLES

A

these accessory sex glands secrete alkaline, which is a fluid that helps neutralize acid in the female reproductive tract, also provides fructose for ATP production by sperm.

  • contributes to sperm motility.
  • helps semen coagulate after ejaculation.
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18
Q

M-R-S; Accessory Sex Glands: PROSTATE

A

this accessory sex gland secretes a milky, slightly acidic fluid that helps semen coagulate after ejaculation, subsequently it breaks down the clot.

  • also the largest accessory gland of the male.
  • size of a walnut, surrounding the urethra, and lies inferior to urinary bladder.
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19
Q

sperm flow

A

SEVEN UP

S: Seminiferous Tubules 
E: Epididymis 
V: Vas Deferens 
E: Ejaculatory Duct 
N: Nothing --

U: Urethra
P: Penis

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20
Q

tunica vaginalis

A

serous covering of testis; pouch

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21
Q

hydrocele testis

A

accumulation of clear fluid in tunica vaginalis

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22
Q

where do spermatogenic cells mature?

A

initial stage occur within the testes and progress to the epididymis, where the developing gametes mature and are stored until ejaculation

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23
Q

endocrine control of testes:

fx of FSH

A

Follicle Stimulation Hormones - stimulates primary spermatocytes to undergo first division of meiosis, to form secondary spermatocytes

FSH enhances production of androgen-binding protein by Sertoli cells of testes by binding to FSH receptors on their basolateral membranes, and is critical for initiation of spermatogenesis

FSH is a gonadotropic glycoprotein hormone, secreted in anterior pituitary, that stimulates growth of ovarian follicles in Female and induces spermatogenesis in male

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24
Q

endocrine control of testes:

fx of LH

A

Luteinizing Hormon triggers production of testosterone from Leydig cells of testis; testosterone causes the development of secondary sex characteristics in male

LH is produced by part of pituitary gland, that stimulate ovulation and development of corpus luteum in Female and production of androgens by male

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25
Q

endocrine control of testes:

fx of DHT

A

Testosterone enters the tubules and binds, both as testosterone and after conversion to DHT, to androgen receptors
in the Sertoli cells. This is required for spermatogenesis. (Note that Sertoli cells make DHT. DHT is a more power-
ful androgen than testosterone and does not escape from the tubules in appreciable quantities.)

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26
Q

what are 3 parts of make urethra?

A
  1. prostatic urethra
  2. membranous urethra
  3. spongy urethra
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27
Q

what is major function of Cowper’s gland?

A

located inferior to prostate gland and lateral to urethra

exocrine glands with approx 2.5 cm ducts that passes through the perineal membrane and into proximal portion of spongy urethra. when sexually aroused, the glands produce mucous like fluid called pre-ejaculate. the pre-ejaculate fluid is viscous, clear, and salty liquid that neutralizes any residual acidity in urethra. the now neutralized urethra is a more hospitable environment for sperm to travel in.

protects sperm during ejaculation

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28
Q

semen characteristics

A
  • 65% fluid is produced by seminal vesicles
  • 30 to 35% by prostate
  • 5% from testicles and epididymes
contains: 
citric acid
free amino acids
fructose
enzymes 
phosphorylcholine
prostaglandin
potassium, zinc
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29
Q

what is erectile tissue composed of

A

During erection, the corpora cavernosa will become engorged with arterial blood, a process called tumescence.

The corpus spongiosum is a single tubular structure located just below the corpora cavernosa. This may also become slightly engorged with blood, but less so than the corpora cavernosa.

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30
Q

what autonomic nervous system controls erection?

A

parasympathetic

-parasympathetic nerves from the S2, S3 and S4 levels of your spinal cord.
-Psychogenic erection, involves conscious or mental levels of the brain, and is under the control of your sympathetic nerves from the T10-L2 levels of your spinal cord.
-Parasympathetic nerves from the S2-S4 levels of your spinal cord also contribute.
To maintain an erection you must have both reflex and psychogenic erection functioning together.

31
Q

what autonomic nervous system controls ejection?

A

sympathetic nerves

  • sympathetic nerves from the T11-L2 levels of your spinal cord.
  • Spinal nerves from the S2-S4 levels of your spinal cord control ejaculation and transmit sensation from your genitals to your brain.
32
Q

what is a neurotransmitter responsible for erection?

A

oxytocin

33
Q

what is Benign Prostatic Hyperplasia / BPH?

this is also known as Benign Prostatic Hyperthropy (which is a misnomer)

A

BPH is increase in size of prostate in middle-age and elderly men.

34
Q

Benign Prostatic Hyperplasia is characterized by?

A

hyperplasia of prostate stromal and epithelia cells, resulting in formation of large, fairly discrete nodules in PERIURETHRAL region of prostate

  • when enlarged, nodules compress urethral canal to cause partial, or sometimes virtually complete obstruction of urethra, which interferes with normal flow of urine.
  • leads to symptoms of urinary hesitancy, frequent urination, dysuria (painful urination), increased risk of urinary tract infections, and urinary retention
35
Q

the prostate specific antigen (PSA) levels in benign prostatic hyperplasia patients are elevated or not? what does it mean?

A

PSA levels may be elevated because increased organ volume and inflammation due to urinary tract infections, BPH is NOT considered to be pre-malignant lesion

normal values are 0.1 - 4.0 ng/ml of blood
if more than 4 than suggest cancer, if more than 6 than 90% chance of it being cancer - but you need biopsy to confirm

PSA tells you if there is tissue growth and if there is increase in volume, but it will NOT tell you if the growth is benign or cancerous); it is a preliminary test to see if you need to do trans-rectal biopsy which can be very invasive

36
Q

when does adenomatous prostatic growth believed to begin approximately?

A

at age 30

estimated 50% of men have histologic evidence of BPH by age 50 and 75% by age 80 years

37
Q

what is major cause of Benign Prostatic Hyperplasia?

A

autocrine stimulation of the prostate glands by active form of testosterone (DHT), produced by the prostate itself, is a major cause of prostatic hyperplasia.
- BPH is associated with diet, based on saturated fat, as it is major precursor for testosteroe synthesis

38
Q

Is Benign Prostatic Hyperplasia considered a precursor for prostate cancer?

A

NO it is not

39
Q

what are clinical presentation of Benign Prostatic Hyperplasia?

A

Storage and Voiding

Storage: urinary infrequency, urgency, urgency incontinence, and voiding at night (nocturia)

Voiding: weak urinary stream, hesitancy, intermittency, straining to void, dribbling,

[pain and dysuria burning sensation in urethra are usually NOT present]

40
Q

how are S&S of Benign Prostatic Hyperplasia, storage and voiding, evaluated?

A

using the International Prostate Symptom Score (IPSS) questionnaire, designed to assess severity of BPH

41
Q

what are complications of Benign Prostatic Hyperplasia?

A

BPH can be progressive disease, if left untreated

  • incomplete voiding results in stasis of bacteria in bladder residue and an increase risk of urinary tract infections.
  • urinary ladder stones are formed from crystalization of salts in residual urine

can lead to both:

  • acute urinary retention - inability to void
  • chronic urinary retention - residual urinary volume gradually increases, and the bladder distends; may also lead to renal failure (obstructive uropathy)
42
Q

how do you Dx Benign Prostatic Hyperplasia?

A
  • rectal examination of prostate - nodular masses re usually detected in central/periurethral region of gland
  • ultrasound
  • residual ladder volume of urine
  • blood test for Prostate Specific Antigen
  • definitive dx - needle or surgical biopsy
43
Q

Tx of Benign Prostatic Hyperplasia?

A
  • alpha blockers relax smooth muscle in prostate and bladder neck,
  • 5 alpha-reductase inhibitors - which in turn inhibits production of DHT, of hormone responsible for enlarging prostate
44
Q

what are some minimally invasive therapies for Benign Prostatic Hyperplasia?

A

two most common office-based therapies are
Transurethral microwave thermotherapy (TUMT)
and TransUrethral Needle Ablation (TUNA)

goal is to cause necrosis in prostate, so dead tissues can be reabsorbed by the body

45
Q

which surgery can be performed on Benign Prostatic Hyperplasia?

A

Transurethral resection of prostate (TURP) - removing part of prostate through urethra

46
Q

how does prostate cancer grow?

A

from periphery and comes closer and closer to urethra

47
Q

what is epidemiology of Prostate Cancer?

A

second most common cancer in male
usually occurs after age 50
most common in African Americans, rare in Asians

48
Q

etiology of Prostate Cancer?

A
  • endocrine and environmental influences
  • elevated levels of active testosterone and estrogen, fat diet, smoking, obesity, genetics, possible viral influences, chronic prostatitis (to a lesser degree)
49
Q

characteristics of Chronic Prostatitis?

A
  • there may be a bacterial agent accompanying inflammation, and cystitis or urethritis
  • however, more commonly, chronic prostatitis is abacterial and there is no history of urinary tract infection
  • serum prostate specific antigen may be slightly elevated
50
Q

what is pathogenesis of Prostate cancer?

A

prostate cancer is classified as adenocarcinoma, or glandular cancer, that begins when normal prostate gland cells mutate into cancer cells

  • initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN)
  • overtime, these cancer cells begin to multiply and spread to surrounding prostate tissue (the stroma) forming a tumor
  • eventually, the tumor may grow large enough to invade nearby organs such as seminal vesicles or rectum, or tumor cells may develop the ability to travel in bloodstream and lympathic system
51
Q

Prostate Cancer most commonly metastasizes to?

A

bones, including vertebral column, lymph nodes, rectum, and urinary bladder

52
Q

why does early prostate cancer asymptomatic?

A

due to peripheral growth with no or minimal urine obstruction

53
Q

how is Prostate Cancer often dx?

A

an elevated Prostate Specific Antigen noticed during routine checkup (screening)

54
Q

why might prostate cancer associated with urinary dysfunction?
why might it affect sexual fx?

A
  • prostate cancer associated with urinary dysfunction bc prostate gland surround prostatic urethra
  • vas deferens deposits seminal fluid into prostatic urethra, and secretions from prostate gland itself are included in semen content, thus prostate cancer may also cause problems with sexual fx and perfroamnce, such as difficulty achieving erection or painful ejaculation
55
Q

what are some of S&S?

what is most COMMON sypmtom?

A

-there can be symptoms similar to Benign Prostatic Hyperplasia, such as increased urination at night, difficulty starting and maintaining a steady stream of urine, hematuria, painful urination

  • most common symptom is bone pain (fixed, worse at night, resistant to pain killer drug use), often in vertebrae (bone of spine), pelvis or ribs,
  • spreads of cancer into other bones such as femur is usually to the proximal part of bone
  • prostate cancer in spine can also compress spinal cord, causing leg weakness ad urinary and fecal incontinence
56
Q

what are RED FLAG for Prostate Cancer and requires immediate referal?

A
  • fixed lower back pain at night!!!
  • urinary voiding difficulty
  • unevenly enlarged and “boggy” prostate
  • hematuria
  • hematospermia
  • elevated PSA
57
Q

what are RED FLAG for Prostate Cancer and requires immediate referal?

A
  • fixed lower back pain at night!!!
  • urinary voiding difficulty
  • unevenly enlarged and “boggy” prostate
  • hematuria
  • hematospermia
  • elevated PSA
58
Q

penile cancer?

A

is the male equivalent to female cervical cancer

  • squamous cell carcinoma of penis
  • mostly due to STDs such as Human Papiloma Virus (HPV) there are 3 highly carcinogenic HPV responsible for 98% of penile cancer
59
Q

what is hydrocele?

A

clear fluid accumulates in a sac of tunica vaginalis lined by serosa with variety of inflammatory and neoplastic conditions.
-this must be distinguished from true testicular mass, and transilumination may help (mass will not transiluminate)

60
Q

testicular torsion

A

rare, but when it happen requires immediate medical attentio

  • occurs when twisting of spermatic cord cuts off the venous drainage leading to hemorrhagic infarction
  • greater mobility from incomplete descent or lack of sacrotal ligament predisposes to this condition
  • orchiopexy - procedure of shortening of spermatic cord is done bilaterally, after surgically untwisting cord
61
Q

what is most common types of testicular neoplasm? most common in what age group?

[neoplasm - new and abnormal growth of tissue, esp, characteristic of cancer]

A

germ cell neoplasms / disgerminoma (cancer of testis from spermatogenic / immature cells)

common in age group bt 15 to 34

62
Q

what are the several histologic component of testicular cancer?

and what is the most likely?

A

seminoma
embryonal carcinoma
teratoma
choriocarcinoma

most likely is Seminoma [germ cell tumor of testis. originates in germinal epithelium of seminiferous tubules]

63
Q

testicular cancer, esp seminoma, causes what S&S?

A
  • tends to produce hormones of pregnancy in male organism
  • CG and alpha feta-protein
  • feminization of males - males become more plump in midsection, breast might grow, even lactating (galactoria)
  • depression, impotence, low libido
  • painless mass
64
Q

what is cryptorchidism?

A

absence of one or both testes from scrotum, meaning undescended testis
-usually represents failure of testis to move, or “descend” during fetal development from an abnormal position, through inguinal canal, into ipsilateral scrotum

65
Q

cryptorchidism is strong pre-requisite to…?

what are some outcomes of cryptorchidism?

A

testicular cancer
testis originate from mesoderm of posterior abdominal wall and need to descend into lingual canal

  1. sperm lacks quantity and quality
  2. even after surgical descending, risk of cancer is still very high
66
Q

what is orchitis?

A

inflammation of testes (unilateral or, most commonly, bilateral)

67
Q

what is the most common causative facto of Orchitis?

what are some other causative factors?

A

most common infectious cause: MUMPS virus

STDs, gonorrhea, chlamydia, syphilis, or TB

68
Q

Orchitis in POST-Pubertal males may lead to what?

why?

A

lead to partial or complete sterility
bc before puberty, males do not produce spermatogenic cells

after puberty, quality and quantity of spermatogenic cell is compromised leading to sterility

69
Q

what is priapism?

A

potentially harmful and painful condition in which penile erection is prolonged, when penis does not return to its flaccid state, despite the absence of both physical and psychological stimulation for hours.

70
Q

what other disease is priapism discussed with, why?

A

priapism can most commonly be due to ischemic heart disease, ischemia due to thrombosis - so it is discussed with sickle cell anemia, Thalassemia, diabetes mellitus type 1
*children as early as 5 yrs old with sustain erection

71
Q

what are major complications of priapism?

A

severe ischemia with thrombosis and gangrene, warranting penis amputation, and impotence

72
Q

what are tx option for priapism?

A

aspiration of blood from corpus cavernosum, management and monitoring of blood circulation, and shunts, if necessary

73
Q

what is varicocele?

A

a dilation of pampiniform venous plexus and internal spermatic vein

  • well recognized cause of decreased testicular function and occurs in approx 15-20% of all males and in 40% of infertile males
  • inferes with testicular thermoregulation
  • may cause further atrophy and impairment of sperm maturation

AA. Patho 2 (8 decks)

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