Male Reproductive System Flashcards
Prostatitis causes
acute bacterial (least common by gram negative) chronic bacterial (usually recurrent UTIs) chronic pelvic pain syndrome (most common, inflamm or non inflamm sometimes autoimmune) asymptomatic inflammatory (inflammation w/out GU symptoms)
prostatitis s/s
fever chills arthralgia low back pain perineal fullness dysuria urinary frequency/urge nocturia painful ejaculation foul-smelling urine hematuria
prostatitis DX
Digital rectal exam urinalysis urine culture semen analysis CT needle biopsy
prostatits TX
ABX if infection anticholinergics (for incontinence) alpha blockers (for GU syms) stool softeners (decrease pain from BM) analgesics muscle relaxants antipyretics
bph
nonmalignant enlargement of prostate
increased estrogen w/ aging or more estrogen than testosterone
not a precursor to cancer
bph aggravating factors
alpha-adrenergic agonists anticholinergics testosterone anabolic steroids caffeine alcohol
bph s/s
related to obstruction & decreased flow difficult starting flow even when straining hematuria weak urine flow multiple interruptions of urine flow bladder fullness feeling nocturia dribbling once urination complete
bph DX
DRE
prostate specific antigen
bph TX
watchful waiting
avoid excess fluids in evening
no caffeine or alcohol
static pharm (relates to anatomical enlargement)
dynamic pharm (for alpha-adrenergic receptors compression urethra)
finasteride
5-alpha-reductace inhibitors
AA blockers: doxazosin, terazosin, tamsulosin
intermittent catheterization
severe: transurethral resection of prostate
finasteride
antiprostatic
inhibits 5-alpha-reductase (that converts testosterone to dihydrotestosterone which proliferates prostate)
shrinks enlarged prostate (most effective with large prostate)
TX: BPH and hirsutism in women (can take 6-12 months for maximum benefit)
SE: sexual dysfunction, diminished libido, HA, rash, dizziness, increased risk for prostate canccer, hypotension, bradycardia/bronchoconstriction
contra: pregnancy, lactation, children
interx: anticholinergics (decreased finasteride)
testosterone (reduction in both)
saw palmetto (increases finasteride)
prostate cancer
second most common cancer in men peripheral zone most susceptible tumors go unnoticed until pain often mets to lymph/lungs usually curable when localized response well to treatment
prostate cancer s/s
local my be asymptomatic frequent urination weak urine flow frequency (nocturia) blood in semen erectile dysfunction dysuria discomfort while sitting
Prostate Cancer DX and TX
tissue samples from 2+ sites
tx: surgery (radical prostatectomy), radiation (concern for bladder/bowel), cryotherapy (liquid nitrogen to freeze), ablative hormone therapy (testosterone suppression for bone metastasis)
chemo
hypogonadism
lack of testosterone
primary: mumps, trauma, inflammation
secondary: inadequate FSH & LH (cushing’s thyroid)
diminished secondary sex characteristics
testosterone and related hormones
control many male repro functions
women have small amount of androgens
lack of androgens
primary: due to testicular failure
secondary: due to lack of FSH or LH
s/s: sparse hair, increased subQ fat, small testes
androgen pharmacology
TX hypogonadism, increase libido, correct erectile dysfunction, TX certain cancers
TESTOPEL
implantable pellets (1-6) doses last 304 months inflamm or infection can occur
testosterone cypionate & testosterone enanthate
IM
doses last 2-4 weeks
serum levels vary widely
can cause mood/energy swings
testosterone undecanoate
intranasal
easy to use
can be 3 doses/day
can cause naspharyngitis/epistaxis/rhinorrhea
buccal testosterone
continuous supply of testosterone in blood
local irritation to buccal mucosa
transdermal gel testosterone
absorbed into skin (30 min and relased slowly into blood)
can be transfered by skin-to-skin contact
anabolic steroids
testosterone-like compounds
frequently abused by athletes
SE: hyperlipidemmia, low sperm count, impotence, aggresion, psychological dependence, feminzation
testosterone
male sex hormone
stimulates RNA synthesis/protein metabolism
high doses may suppress spermatogensis
SE: virilization (development of male characteristics: body hair, muscles, hirsutism, male-pattern baldness, deep voice, clitoral enlargement)
sodium/water retention
liver damage (rare)
increased or decreased libido
abuse: feminization due to excess metabolized to estrogen
BBW: children/women should avoid application sites
contra: breast or prostate cancer, pregnant or potentially pregnant, pre-existing enlarged prostate, renal/hepatic disease
interx: w/ anticoagulants = risk for severe bleeding
X
cryptorchidism
one or both testes is undescended from abdomen into scrotum
exact cause unknown
common in premature males
cryptorchidism TX
wait
may require surgery if doesn’t descend on its own (orchiopexy)
cryptorchidism complications
testicular cancer (3-5x) fertility problems testicular torsion trauma inguinal hernia
varicocele
enlargement of veins in scrotum may cause fertility issues "bag of worms" DX: physical exam no treatment
hydrocele
common in newborns fluid-filled sack around testicle can be from trauma/inflammation in older males DX: physical exam TX: none
spermatocele
inflammation of epididymis may be acute or chronic infectious process, difficult to identify infections agent s/s: visible cyst on epididymis DX: physical exam TX: none
epididymitis
inflammtion of epididymis may be acute or chronic infectious process hard to determine s/s: pain/swelling over several days DX: STD screening, urinalysis, ultrasound TX: ABX (paitient & partner) rest & ice
orchitis
inflammation of one or both testes
can be virus (STD) or bacteria (sexually active w/ BPH)
DX: STD screening, urinalysis, ultrasound
TX: ABX, rest & ice
orchitis s/s
sudden symptoms swelling in testicles pain tenderness fever nausea vomiting
testitcular torsion
spermatic cord twists w/in testicle = cuts off blood supply to testis (MEDICAL EMERGENCY)
intravaginal; tunica vaginalisis genetically too high = rotation
extravaginal: tunica vaginalis not firmly secured (most often in newborn)
testicular torsion s/s
severe unilateral scrotal pain followed by swelling
1/3 N/V
in newborns: firm/hard/scrotal mass fixed to scrotal skin
testicular torsion DX
TWIST scoring (testis swelling, hard testis, absent cremasteric reflex, n/v, high-riding testes TX: surgical repair w/in 6H to salvage testicle
testicular cancer
exact cause unknown
RF: mumps, low birth weight, trauma to testes, family HX, age, congenital abnormality, caucasian
DX: physical exam, u/s, CT, biopsy
testicular cancer s/s
dull ache in groin
painless lump (maybe swelling, enlargement or hardening of testes)
gynecomastia
TX: radical orchiectomy, chemo, radiation
hypospadias
abnormal position of urethral meatus
congenital abnormality
meatus develops on ventral (under) portion of penis
TX: surgical repair
epispadias
rare, abnormal positon of urethral meatus
congenital abnormality
meatus develops on dorsal (upper) portion of penis
TX: surgical repair
phimosis
disorder of foreskin (can’t retract over glans)
no TX
balanitis
inflammation of glans
balanoposthitis
inflammation of both blans & prepuce
balanitis& balanoposthitis causes
poor hygiene
phimosis w/out circumcision
paraphimosis
disorder of foreskin
occurs in uncircumcised or partially circumcised males
retracted foreskin trapped behind coronal sulcus
s/s: swollen & painful glans
medical emergency
puncture, aspiration, vertical incision, emergent circumcision
priapism
prolonged erection for hours
painful blood cannot leave penis
uncommon
common in males w/ sickle cell
priapism causes
blood disorders medications erectile dysfunction meds spider/scorpion bites spinal cord injury gout penile cancer
priapism DX and TX
physical exam, CBC, u/s, Toxicology
TX: medical emergency, drain blood from penis
medication injections to constrict blood flow
peyronie disease
fibrous plaque affects tunica albuginea causing bend or curve
unknown cause
bend causes painful rections
peyronie disease TX
may resolve on own
oral/injected meds
u/s to break up plaque
surgery last resort
erectile dysfunction
inability to maintain/sustain erection for at least 3 months
disruption of normal neurovascular
most common male disorder
erectile dysfunction TX
lifestyle changes (diet exercise healthy body weight, abstinence from alcohol and tobacco) pharm: sildenafil, tadalafil, vardenafil
ED: harm
successfully TXd by phosphodiesterase-5 inhibitors
sildenafil: only enhances erection
vardenafil: faster onset, longer than sildenafil
tadalafil: acts w/in 30 min and lasts 24-36 hours
sildenafil
phosphodiesterase-5 inhibitor
relaxes smooth muscle in corpus cavernosum, allows increased blood floor
increased blood flow results in firmer & longer lasting erection onset relatively rapid <1 hour & effects up to 4 hours
also used for pulmonary arterial hypertension
SE: serious hypotension, HA, dizziness, flushing, rash, nasal congestion, diarrhea, dyspepsia, UTI, chest pain, indigestion, blurred vision, changes in color perception, priapism
WARNING: >6 hour pripaism = permanent damage
contra: nitrates, severe CV disease, recent MI, CVA, heart failure, dysrhythmias, anatomical deformities of penis
interx: nitrates (hypotension) protease inhibitors (sildenafil toxicity) grapefruit juice (increases plasma concentration), erythromycin & ketoconazole (increased levels)
male infertility
30-40% infertility due to male infertility
difficult to treat pharm (expensive, many injections, not usually endocrine related)
other means of conception explored
TX male infertility for hypogonadism
human chorionic gonadotropin (increases testosterone & sperm production)
menotropin (mixture of FSH & LH)
testosterone therapy
antiestrogens
tamoxifen
clomiphene
male infertility abnormal sperm
head defects
neck and pidpeiece defects
tail defects
penile cancer
most common: squamous cell carcinoma cause: HPV infection occurs on glans/shaft most common in uncircumcised males may mets ot inguinal nodes but not further usually
