McIntyre- surgical approach to male repro. disorders Flashcards
______ can inhibit sperm motility
lubricants
patient’s progressive motility high or low
very low
varicocele
dilation of pampiniform plexus
varicocele
L or R side more common spot for varicocele
L side
exists to regulate temperature and wash down toxin metabolites from kidney and wash away oxidative stress and ROS
scrotum
top to bottom
top: skin
dartos
external spermatic fascia
cremaster muscle
internal spermatic fascia
tunica vaginalis
hydrocele
collection of fluid in tunica vaginalis
hydrocele
development the testis start in abdomen and migrate to scrotum (gubernaculum brings them down); if canal stays open, intra-abdominal fluid builds up (patent process vaginalis)
infantile hydrocele
why you never want to go below inguinal ligament
femoral a, n, v are there
testes drop through what during their descent
inguinal canal
a form of surgical sterilization by which the vas deferens is divided or damaged to the point it will no longer transport sperm
vasectomy
role of epididymis
sperm maturation and storage
vasectomy (isolate vas deferens)
Complete absence of sperm or presence of nonmotile sperm in semen after procedure means what
successful vasectomy
time of vasectomy to time of reversal; sperm backs up in epididymis
obstructive interval
steps of sperm transport
created in seminiferous tubules
stored in epididymis
move from epididymis to vas deferens
mix with fluids from seminal vesicles and prostate
travel through ejaculatory duct, prostate, and urethra and exit
diploid cells
spermatogonia and primary spermatocyte
haploid cells
secondary spermatocyte, spermatids, and sperm cells
____ to ____ after the 1st meiotic division
spermatogonia to primary spermatocyte
primary spermatocyte to ______ then to spermatid and sperm cells
secondary spermatocyte
____ region of epididymis is where sperm gains ability to fertilize
cauda (tail region)
______to inguinal ring obstruction to vas deferens is reversible
external
come together to form ejaculatory duct
vas deferense, seminal vesicles, and ampulla
useful surgical anatomy to identify what first
vas deferens
no sperm seen on semen analysis
Azoospermia
vas deferens absent in what main disease
CF
The vas is unable to form embryonically due to thickened secretions lack of canalization
Seminal vesicles are also atretic
CF
semen volume mainly from what
fluid from seminal vesicles
primordial bladder
cloaca
_____ descends over time
Vas (Wolffian duct)
“precum”; neutralizes the urethra; lubrication
bulbourethral glands
watery discharge; contributes PSA
prostate
(screening tool for prostate cancer) —-break down coagulum that comes out with ejaculate (so it can stick to cervix)
PSA
Sperm formation is normal but they are unable to traverse the male genital tract.
Obstructive Azoospermia
sperm retrieval in setting of OA
percutaneous approach to the epididymis
men of reproductive age should never be above _____ for FSH
7.5
LH and FSH abnormally high but testosterone normal; what does this mean
pituitary is abnormal
brain is not seeing ______ signal back from testicles for negative feedback loop to work
inhibin
example of primary hypogonadism/testicular failure where FSH and LH are elevated
Klinefelter’s (XXY)
progressive scarring of testicles
disproportionate stature
infertility
hypogonadism
Klinefelter’s
treatment options for non-obstructive azoospermia
IVF
sperm retrieval rates for NOA patient
60%
pregnancy rates for NOA patient
45%
scrotal ultrasound shows what
a mass
labs to order for testicular mass
hCG
LDH
AFP
orchiectomy
remove testicle
scrotum drains to what nodes
inguinal
if you violate the scrotum while removing a testicle what can happen
expose lymphatics to cancer
what else is seen here
hydronephrosis on L side
elevated hCG most likely associated with what type of testicular cancer
Nonseminomatous germ cell tumor
most common germ cell tumor
seminoma
marker for Yolk Sac Tumor
AFP
marker for choriocarcinoma
beta hCG
treatment for seminoma w/ mets to retroperitoneum
chemo/radiation
treatment for non-seminomatous germ cell tumor with mets to retroperitoneum
surgery/chemo
R sided modified template
L sided modified template
why would you need to spare the nerves that innervate male reproductive tract
erection and ejaculation happen from sympathetics and parasympathetics
Erection
Preganglionic neurons innervate the corpora cavernosa
IML at the S2-S4 level.
Exit through pelvic nerves
Pass through the hypogastric plexus
parasympathetic
_____ artery comes off internal iliac artery
internal pudendal that supplies the penis
______ artery becomes cavernous arteries
internal pudendal
what pinches outflow of blood through veins that keeps blood into cavernous and maintains erection
Buck’s fascia
what causes NO release in the erection pathway
parasympathetic stimulation
NO stimulates ______ that upregulates cGMP
smooth muscle guanylyl cyclase
_____ causes penile arteriolar vasodilation and relaxation of penile corporeal smooth muscle
cGMP
terminates cGMP function
PDE5
erectile dysfunction can be treated by inhibiting what
PDE5
_____ inhibitors increase blood flow and muscle relaxation of penis
PDE5 inhibitors
main 2 causes of ED
vascular and diabetes
____ is a risk factor for cardiovascular disease in the future
ED
first used for primary pulmonary HTN treatment and then ED
Viagra (Sildenafil)
negative pressure pumped in to help erection
vacuum erection device
topical prostaglandin E1 (intraurethral suppositories to do what)
erection
inject prostaglandin E1 to vasodilate arteries is _____ mediated
cAMP
_____ activates protein kinase G and causes decreased intracellular Ca2+ and decreased smooth muscle tone and vasodilation of penile arteries
cGMP
____ activates protein kinase A and causes decrease in intracellular Ca2+ and decreased smooth muscle tone and vasodilation of penile arteries
cAMP
another way to achieve erection if all other options dont work
penile implant (pump in scrotum)
how long can penile implant last
7-10 years
