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HD 2 > Problems of the Male Reproductive System > Flashcards

Problems of the Male Reproductive System Flashcards

1
Q

What is the size of a normal prostate (length, width, depth)?

A

3cm long, 4 cm wide and 2 cm in AP depth

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2
Q

What are the three glandular regions of the prostate?

A

Peripheral zone, central zone and transition zone

Secretes a fluid making up semen

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3
Q

How much of the prostate does the peripheral zone make up? What does it surround?

A

70%

Urethra

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4
Q

How much of the prostate does the central zone make up? What does it surround?

A

25%

Ejaculatory ducts

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5
Q

How much of the prostate does the transition zone make up? What does it surround?

A

5%

Proximal urethra

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6
Q

What does the prostate secrete? What is this fluid’s function?

A

A fluid making up semen

This makes semen less thick, so the sperm can still be motile

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7
Q

Where does BPH mainly occur in the prostate? What type of cells does it affect?

A

Transition zone

Epithelial and stromal cells

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8
Q

Where does carcinoma mainly occur in the prostate?

A

Peripheral zone

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9
Q

Where does focal atrophy mainly occur in the prostate?

A

Peripheral zone

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10
Q

What does BHP stand for?

A

Benign hyperplasia of the prostate

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11
Q

How much does a normal prostate weigh?

A

20-25g

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12
Q

How can a BHP prostate and cancerous prostate be differentiated on examination?

A

BHP retains smooth surface, just larger

Cancer feels like a nodule or craggy surface

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13
Q

What are the causes of BHP? (5)

A 
Advancing age
Testicular androgens
Oestrogens
Prostatic stromal and epithelial tissue interactions
Neurotransmitters from the gland
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14
Q

How does an advancing age contribute to BHP?

A

Age related enlargement is caused by increased cell proliferation and decreased apoptosis.

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15
Q

How do testosterone and oestrogen cause proliferation/apoptosis?

A

Testosterone is mainly converted by aromatase to estradiol. This causes stromal cell proliferation via ER-alpha. Some of the estradiol passes through the basal epithelium and causing apoptosis (ER-beta) of epithelial cells.

Testosterone is also converted to DHT and combines the AR (androgen receptor) both directly and via DHT. This causes epithelial cell to antagonise apoptosis.

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16
Q

What are the symptoms of BHP? (5)

A 
Weak or interrupted flow of urine
Frequent urination (nocturia)
Trouble urinating
Pain or burning during urination
Blood in urine or seme
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17
Q

What does SHITE stand for in relation to BHP symptoms?

A 
Slow stream
Hesitancy
Intermittent flow
Terminal dribbling
Emptying is incomplete
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18
Q

What does FUN stand for in relation to BHP symptoms?

A

Frequency, Urgency, Nocturia

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19
Q

Out of all men over the age of 40, how many % will develop histological hyperplasia?
How many of these will have lower urinary tract symptoms?
What else may some develop? (2)

A

50%
50%
Significant enlarged prostate and bladder outlet obstruction

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20
Q

How is BHP diagnosed?

A

History
Digital rectal exam
Ultrasound (+/- biopsy)
Blood test (raised PSA, but less 10ng/ml)

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21
Q

What blood test is there for the prostate?

A

Prostate specific antigen

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22
Q

What is PSA also called?

A

Gamma-seminoprotein/kallikrein-3

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23
Q

What is a normal PSA level for a 40-49 year old?

A

0 - 2.5 ng/ml

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24
Q

What are the two main pharmacological treatments for BHP?

A

α1-adrenergic blockers

5-α-reductase inhibitors

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25
Q

How do α1-adrenergic blockers work?

A

Relaxes smooth muscle in bladder neck and prostate improving urine flow rate

26
Q

How many isoforms of 5-α-reductase are there?

A

2 isoforms - type I and type II (type II predominant prostatic reductase)

27
Q

Name two 5-α-reductase inhibitors.

A

Dutasteride

Finasteride

28
Q

What surgical procedures can be done for BHP? (5)

A 
Transurethral resection of the prostate
Open prostatectomy
Laser ablation
Transurethral microwave
High energy ultrasound therapy
29
Q

When is transurethral resection of the prostate considered? (4)

A

Failed voiding trials
Recurrent gross hematuria
Urinary tract infection
Renal insufficiency secondary to obstruction

30
Q

When is open prostatectomy considered?

A

For very large prostates (>75g)

Concomitant bladder stones

31
Q

How is prostate cancer differentiated from BHP on blood test?

A

PSA (if raised) tends to be much higher in cancer

32
Q

Which is type of inguinal hernia is more common (direct or indirect)?

A

Indirect (85%)

33
Q

When do indirect inguinal hernias generally occur (i.e. age)?

A

In the young

34
Q

How do indirect and direct inguinal hernias differ in terms of the deep inguinal ring?

A

Indirect enters the deep inguinal ring, direct doesn’t

35
Q

Where do indirect inguinal hernias reach compared to direct?

A

Scrotum/labium majus

Direct doesn’t extend beyond the superficial inguinal ring

36
Q

Where is the neck of a direct inguinal hernia in relation to inferior epigastric artery? What about indirect hernias?

A

Medial

Lateral

37
Q

How many % of males will have inguinal hernias in their lifetime?
How many % of females?

A

25%

2%

38
Q

What makes up Hesselbach’s triangle? What is relevant about it?

A

Rectus abdominis, inguinal ligament, inferior epigastric artery
Direct hernias leave the abdomen through here

39
Q

How are direct inguinal hernias treated?

A

If they are reducible, then with a truss

Surgery

40
Q

How many % of young children are affected by indirect inguinal hernias?

A

1-3%

41
Q

What are indirect inguinal hernias associated with?

A

Failure of inguinal canal to close properly after passage of testis in utero.

42
Q

What is the treatment for indirect inguinal hernias?

A

Surgery

43
Q

How many (out of 10) men does erectile dysfunction affect?

A

1 in 10

44
Q

What three different levels of erectile dysfunction are they?

A

Complete inability to have an erection
Inconsistent ability to achieve an erection
Ability to have short-term erections

45
Q

What causes 40% of erectile dysfunction?

A

Diabetes mellitus

46
Q

What causes 30% of erectile dysfunction?

A

Vascular disease

47
Q

What causes 13% of erectile dysfunction?

A

Radical surgery

48
Q

What causes 8% of erectile dysfunction?

A

Spinal cord injury

49
Q

What causes 6% of erectile dysfunction?

A

Endocrine disorders

50
Q

What causes 3% of erectile dysfunction?

A

Multiple sclerosis

51
Q

How is erectile dysfunction treated (what type of drug)?

A

PDE-5 inhibitors (they increase the intracellular concentration of cGMP)

52
Q

Give three examples of PDE-5 inhibitors.

A

Sildenafil (viagra)
Vardenafil (levitra)
Tadalafil (cialis)

53
Q

What is the benefit of Cialis over Viagra?

A

Viagra absorption may be affected by recent/heavy meals. Also Cialis has a much longer length of action.

54
Q

How is smooth muscle relaxed in order to get an erection?

A

Action potential reaches the parasympathetic neuron, causing calcium ion release. Nitric oxide is released from the neuron and diffuses into the smooth muscle cell, to attach to guanylyl cyclase and cause increase of cGMP. This leads to reduction in calcium influx and so relaxation of the smooth muscle.

55
Q

How does the smooth muscle contract?

A

Action potential reaches the sympathetic neuron, causing the release noradrenaline. This binds to alpha-1 receptors on the smooth muscle to cause contraction.

56
Q

What does the enzyme PDE do?

A

Break cGMP down to 5 GMP

57
Q

What is Peyronie’s disease?

A

When scar tissue forms in shaft of penis, causing bending or deformity of the penis.

58
Q

What does Peyronie’s disease cause?

A

Painful erections

Difficulties with sexual intercourse

59
Q

How is Peyronie’s disease treated non-surgically?

A

Stretching
Para-aminobenzoate
Topical verapamil

60
Q

How does para-aminobenzoate work?

A

It is thought to increase the amount of oxygen taken up, which is required MAO to function (MAO breaks down fibrous tissue).

61
Q

What is a varicocele? Which testis does it always affect?

A

Varicose veins of the scrotum (pampiniform venous plexus)

Left testis

62
Q

What can varicoceles cause?

A

Infertility (35-40% of infertile men)

HD 2 (25 decks)

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