ED tx - inhibits phosphodiesterase - blocks Ca++ influx

oral agents (PDE5 inhibitors) - inc intracellular cGMP - inc intracavernosal smc relaxation

Male Sex Function and Dysfunction, Prostate/Penis/Testes Flashcards by Alegra Mendez

neurogenic ED causes

central (parkinson’s, alzheimers, CVA, tumor, trauma)

spinal cord (trauma, disc, spina bifida, syringomyelia, tumor, MS)

peripheral (pelvic trauma - post surgical, EtOH, vitamin deficiency, DM)

How well did you know this?

Not at all

Perfectly

Drugs leading to ED

b-blockers
spironolactone
ketoconazole
cimetidine
antipsychotic meds

How well did you know this?

Not at all

Perfectly

ED tx

PDE5 inhibitors
intraurethral PGE1
vacuum
intracavernosal injection (CCBs, alpha-blockers, vasodilators)

How well did you know this?

Not at all

Perfectly

Injectables for ED tx

3Ps

papavarine
phenoxybenzamine/phentolamine
prostaglandin E1

How well did you know this?

Not at all

Perfectly

papavarine

ED tx

inhibits phosphodiesterase
blocks Ca++ influx

How well did you know this?

Not at all

Perfectly

phenooxybenzamine/phentolamine

ED tx

alpha-blockade
vasodilataion

How well did you know this?

Not at all

Perfectly

PGE1

ED tx

vasodilation

How well did you know this?

Not at all

Perfectly

Most ED is of which etiology

vasculogenic

How well did you know this?

Not at all

Perfectly

ED tx begins with

oral agents (PDE5 inhibitors)

inc intracellular cGMP
inc intracavernosal smc relaxation

How well did you know this?

Not at all

Perfectly

tx of low flow priapism

URGENT TX!!!!!!!

corporal aspiration
intracavernosal phenylephrine (sympathetic –> constriction)
surgery

How well did you know this?

Not at all

Perfectly

BPH histo

inc epithelial and stromal cells in the periurethral area

How well did you know this?

Not at all

Perfectly

BPH etiology

androgens/estrogens –> impaired apoptosis –> inc cellular accumulation

How well did you know this?

Not at all

Perfectly

Type 2 5-alpha reductase primary location

stromal cells

play central role in androgen-dependent growth

How well did you know this?

Not at all

Perfectly

90% of prostatic androgen is

DHT

How well did you know this?

Not at all

Perfectly

bladder response to BPH obstruction

detrusor instability or dec compliance –> freq/urgency

2. dec contractility –> dec flow rate, hesitancy, inc PVR –> detrusor failuresa

How well did you know this?

Not at all

Perfectly

BPH complications

bladder decomposition/
urinary incontinence
upper tract deterioration/renal insufficiency
hematuria

How well did you know this?

Not at all

Perfectly

clear indication for surgery for BPH

acute urinary retention

–> Transurethral resection of the prostate (TURP)

How well did you know this?

Not at all

Perfectly

primary determinant of tx response or disease progression of BPH

Intl prostate sx score (IPSS)

How well did you know this?

Not at all

Perfectly

medical therapy for BLH

alpha1-antagonists
5alpha-reductase inhibitors
aromatase inhibitors
plant extracts

How well did you know this?

Not at all

Perfectly

BPH, bladder outlet obstruction assoc w/ _____ in prostate smc

alpha-adrenergic receptors

How well did you know this?

Not at all

Perfectly

5alpha-reductase inhibitors for BPH

suppress DHT synthesis, dec prostate size

How well did you know this?

Not at all

Perfectly

prostate cancer natural history

mostly death from other causes

How well did you know this?

Not at all

Perfectly

PSA screening effects on dx of prostate cancer

declining age at diagnosis, diagnosis at earlier stages, decreased tumor volumes, and increased treatment rates

unclear effect on mortality

How well did you know this?

Not at all

Perfectly

PSA

secreted in high concentrations into seminal guid and is involved in liquefaction of the seminal coagulum but it is found in low concentration in serum.

How well did you know this?

Not at all

Perfectly

Transrectal ultrasound guided prostate biopsy indication

if a patient has a digital rectal exam that is suspicious for cancer and/or an elevated and rising PSA level.

gold standard for long term control of clinically localized prostate cancer in young healthy men

radical prostatectomy

prostatitis sx

``` dysuria dribbling/hesitancy pain in abd, groin, lower back pain in perineum painful ejaculation ```

prostatitis tx

alpha blockers pain relievers prostatic massage lifestyle changes/home remedies

most common solid tumor in young adults

testicular cancer *gern cell

testicular cancer, spread via

lymphatics, predictable fashion retroperitoneal lymph node is most comm

testicular cancer non-normal mets

lung, liver, brain, bone, kidney, adrenal, GI, spleen

testicular carcinoma more comm pure seminoma or non-seminoma?

non-seminoma 60-70%

bell clapper deformity

testicular torsion

premalignant penile lesions

bowenoid papulosis | carcinoma in situ

bowenoid papulosis

20-30 y/o circumcised HPV detected rare risk of SCC devel

penile carcinoma in situ

50-60 y/o uncircumcised HPV detected 10%

premalignant penile lesions tx

topical 5-fluorouracil laser ablation partial penectomy

balanitis xerotica obliterans

inflammatory via chronic infection flat, white patches on the glans and prepuse

95% of penile cancers

squamous cell carcinoma

squamous cell carcinoma risk fx

uncircumsized premalignant lesions light therapy to tx psoriasis tobacco

gold standard for invasive penile CA

partial or total penectomy 2cm neg margin

phimosis

foreskin is tight and narrow, painful to retract nml in infancy, if persists beyond 5 y/o --> med/surg low potency steroids circumcision

priapism

persistent infection >4 hr | ischemic or nonischemic

priapism ischemic tx

corporal aspiration and irrigation penile corporal shunts

Peyronie's disease

inelastic scar in tunica albuginea of the corpora unknown cause penile pain, shortening, deformity

Peyronie's tx

meds - vitE, colchicine intracorporal injection - verapamil surgery - shorten corpora contralateral to plaque --> straighten penis

cryptorchidism

undescended testes complications: sterility, malignancy

descent of testes is dependent on

mullein inhibiting substance and androgen

ovarian tumors mostly epithelial or germ cell?

epithelial

testis tumors mostly epithelial or germ cell?

germ cell

ovarian component of testicular seminoma

dysgerminoma

peak age for most testicular tumors

25-35 years

testicular tumor common >65 y/o

spermatocytic seminoma

testicular tumor common <4 y/o

yolk sac

testicular tumor common 4-13 y/o

teratoma

intratubular germ cell neoplasia

50% devel cancer in 5 years

Intratubular Germ Cell Neoplasia (ITGCN)

Enlarged neoplastic germ cells w/ clear cytoplasm, centrally located BIG nuclei and nucleoli Thicknened basement membrane Absence of spermatogenesis Almost no Sertoli cells

extragonadal seminoma is a

germinoma

seminoma

``` B-hCG synctotrophoblasts sheets of cells with clear cytoplasm centrally located nucleus "FRIED EGG" lymphocytes ```

fried egg

seminoma

embryonal carcinoma histo

``` poor diffrentiation some gland formation mitosis hyper chromic nuclei hemorrhage, necrosis --> MALIGNANT FEATURES ``` CD30+

CD30+

embryonal carcinoma

testicular germ cell tumor with BOTH syncytiotrophoplast AND cytotrophoblast

choriocarcinoma

yolk sac tumor histo

hyaline globules eos cytopasm Schiller-Duvall body

Schiller-Duvall body

capillary surrounded by cancer cells seen in yolk sac tumors

Mixed Germ Cell Tumor

- comprises at least 2 types of germ cell tumors with or without ITGCN - 32-60% of all testicular tumors - in testis, extra-testicular sites in males - caucasians - postpubertal men, mean 30 y/o - present w/ testicular mass

alpha feto protein

yolk sac tumor

golden brown mass

Leydig cell tumor

leydig tumors may produce

androgensestrogens | corticosteroids

sertoli tumors may produce

no hormones | rarely produce androgen or estrogen

back to back irregular glands with nuclei containing prominent nucleoli

adenocarcinoma/embryonal CA

large monomorphic lymphoid cells with scant cytoplasm, large nuclei and prominent nucleoli

testicular NHL

most common subtype of NHL involving testes

diffuse lg B-cell lymphoma

diffuse suppurative inflammation with gram negative rods on gram stain

suppurative orchitis

full thickness epithelial dysplasia with intact BM

seen on squamous/transitional epithelium

islands of cartilage, squamous epithelial pearls and glands lined by tall columnar epithelium

teratoma

nests of large polyhedral cells with watery cytoplasm and large nuclei with prominent nucleoli, surr by lymphoid storm

seminoma

rounded cells w/ abundant granular eos cytoplasm containing crystalloid of Reinke

Leydig cell tumor

synctiotrophoblast and cytotrophoblast arranged in sheets w/ extensive hemorrhage and necrosis

choriocarcinoma

In which male age group are teratomas regarded as malignant?

all post-pubescent males

spermatohytic seminoma

older men very low malignanant potential no ITGCN precursor

PSA accepted threshold

<4ng/mL

PSA is specific for prostate cancer T/F

F elevated also in BPH, prostatitis, etc

BPH

- stroma and gland involvement | - affects inner portion of prostate around urethral/transitional zone

poorly differentiated glands packed back to back and lined by a single layer of epithelium

BPH

most comm cancer in men

prostatic adenocarcinoma

prostate adenocarcinoma location

peripheral zone of prostate posterior lobe

TMPRSS2/ERG fusion

prostate adenocarcinoma

prostatic adenocarcinoma histo

prominent nucleoli | single layer of cells, no basal layer

grading of prostate adenocarcinoma

sum of tumor grade patterns based on well vs poor differ cells high grade 7-10 predicts prognosis

prostate adenocarcinoma common spreads to

bones | **lumbar spine

50% of patients with ___ will develop cancer in 5 yr

ITGN

which testicular tumor is highly radiosensitive?

seminoma

prostate carcinoma is the ____ leading COD in men

second