Male reproductive system pathologies Flashcards
Function of Bulbourethral gland?
Production of pre - ejaculate.
0 Neutralists urine that may be in urethra.
0 located in membranous Urethra
What is the ejaculatory duct made up of ?
Pathway of semen?
duct from seminal vesicles + vans deferens from prostate
Pathway of semen
Ejaculatory duct ——> prostatic urethra ——> Membranous U——> Penile / spongy U —– > glans penis (semen leaves through this )
- Semen - mixture of sperm and accessory fluid.
Where does the majority of blood go to in penis during an erection ?
Why?
90 % to corpus cavernosa
10% to corpus spongiosum
(majority goes to cavernosa so that only little goes to spongiosum - this contain male urethra. too much blood will cause too much pressure build up and occlude urethra.
Function of cremaster and dartos muscle.
0 located in scrotum , smooth muscle
0 contact to elevate the testes - bring closer to belly during cold weather to retain heat.
What is the spermatic cord ?
Cord containing testicular vein, arteries and nerves.
0 formed at opening of inguinal canal ——> enters scrotum via supercritical inguinal canal
What is the rete testis ?
Astamosing network of the seminiferous tubules in the testes - help with the transfer of sperm.
(seminiferous tubules join to form this network)
What are the possible cause of lump in testes ?
0 Hydrocele 0 indirect / scrotal hernia 0 Varicocele 0 Epididymitis 0 Epdidymal cyst 0 Tumour
What is a hydrocele ?
Painless swelling of scrotum
Common in newborns
collection of fluid between parietal and visceral layers of tunica vaginalis.
Can be : - non -communicating (isolated) - communicating (connects to abdominal cavity through potential hernia space - patent processus vaginalis )
hydrocele ofen get better on their own
surgical intervention 0 may be required for communicating hydroceles to close channel
What is epididymitis ?
inflammation of the epididymis
Characterised by :
unilateral scrotal pain
unilateral scrotal swelling
Causes
Bacterial epidymitis
0 <35 - most commonly sexually transmitted diseases (Neisseria gonorrhoeae or Chlamydia trachomatis) - can start as urethritis (infection of urethra).
0 > 35 - most commonly occur in urological abnormalities , indwelling catheters or recent urological procedures.
Other causes - rare except for in immunocompromised patients (HIV - infected patients )
Tuberculous epididymitis and syphilitic gummas
(bacteria infections )
Viral causes - Cytomegalovirus
Mycotic causes - (fungal causes )
What is an epididymal cyst ?
- Fluid filled sac - benign
0 Grows at top end of testicle (where spermatic cord is attached )
0 can be small or large - can grow to size of testes.
0 can be one or several on both testicles.
0 is felt separate from testicle (unlike testicular cancers)
SYMPTOMS
- pain free , lump at top of testicles , separate from testes.
- small cyst do not need treatment. Larger ones may need surgery or needle aspiration (not common)
- More common in men above 40
- spermatocele - can feel the same but is a cyst filled with sperm.
What is a varicocele ?
collection of varicose veins of the small vein near one or both testicles.
varicose
veins in
scrotum -
abnormal
dilation/
enlargement
of scrotal
venous
pampiniform
plexus -
drains from
each testicle.
0 Can happen above beside one or both testicles.
- Caused by weakening of valves so venous blood flow backwards
RARE CAUSES
0 Deep vein thrombosis
0 renal arteriovenous malformations
0 thrombosis of the pampiniform plexus.
- Can be felt as a bag of worms in scrotum.
- if man is over 40 and suddenly get varicocele - could be cancer (tumor in kidney adds back pressure - on smaller veins in scrotum.
What is testicular cancer ?
Cancerous
rare -not common but have to be on the look out.
- effect men between 15 and 49 most commonly.
SYMPTOMS
Felt as :
- painless swelling lump -usually 1
- Dull ache / sharp pain in testicles/ scrotum
- Heaviness in scrotum
- Testis loses normal shape - larger, irregular and bumpy.
Most lumps or swellings in the scrotum are not in the testicle and are not a sign of cancer, but they should never be ignored
- men whose testes did not descend into the scrotum (cryptorchidism) by age 3 have a greater chance of developing testicular cancer.
0 Correcting cryptochidism can decrease risk of this cancer - but still higher than normal. - Metastic cancer - spread to other parts of the body causing other symptoms.
What is an scrotal hernia ?
Can also be called indirect hernia
Appears as a swelling / lump in groin or as enlarged scrotum.
Hernia - structure passes through a space or defect into an
abnormal location.
inguinal hernia - most common
0 protrusion of abdominal contents through acquired or congenital area of weakness /defect in abdominal wall just above inguinal ligament.
Symptoms
- visible bulge
- discomfort
- can be asymptomatic
findins - cannot rise above it affects spermatic cord.
Causes :
0 increased intra - abdominal
0 weakness in abdominal muscles
These can be caused by - chronic cough - constipation -obesity - heavy lifting advanced age.
Direct vs indirect hernia ?
Direct - abdominal contents passes through defect (abnormal opening) in posterior inguinal canal wall ——-> into inguinal canal (medial to deep ring )—–> out of superficial inguinal ring.
INDIRECT
Abdominal contents passes through deep ring —> inguinal canal —–> out via superficial
ring.
Clinical test to differentiate :
Indirect - press on deep ring (mid line of inguinal ligament) - you can control the indirect hernia which has been reduced
Direct - same thing is done, but hernia still protrudes indicates it is merging through posterior inguinal wall defect.
Meaning of these terms relating to hernias.
- reducible
- incarcerated
- obstructed
- strangulated
Reducible - hernia contents can be manipulated back into original position (returned to it original compartment through defect that it emerged through. ) - can provide symptom relief
Incarcerated / irreducible - Cannot be pushed back into original position / compartment,- due to compression of hernia by defect.
Obstructed - relates mainly to hernias containing bowel - hernia containing bowel compressed so bowel obstruction occurs
bowel lumen not patent (open - unobstructed )
Strangulated - lack of blood flow to hernia contents due to compression around the hernia - causes ischemia and pain.
