Problems of the Male Reproductive System

Question 1

What are the zones of the prostate?

Answer 1

Peripheral, central and transition zone

Question 2

Where is the peripheral zone of the prostate?

Answer 2

Makes up 70% of the prostate and surrounds the urethra

Question 3

Where is the central zone of the prostate?

Answer 3

Makes up 25% of the prostate and surrounds the ejaculatory ducts

Question 4

Where is the transition zone of the prostate?

Answer 4

Makes up 5% of the prostate and surrounds the proximal urethra

Question 5

In which zone is there hyperplasia in BPH?

Answer 5

Transitional zone - this is why there is often impedance of urinary flow

Question 6

In which zone is there hyperplasia in prostate cancer?

Answer 6

Peripheral zone - and there aren’t usually any symptoms

Question 7

What’s the role of testosterone in BPH?

Answer 7

Testosterone is mainly covered into estradiol in stromal cells, causing them to proliferate. DHT also binds to the androgen receptor in the luminal epithelium of the prostate and prevents apoptosis. Therefore, there is increased proliferation and reduced apoptosis.

Question 8

What’s the role of oestrogen in BPH?

Answer 8

Oestrogen stimulates oestrogen receptor B (ERB) in the epithelial cells of the prostate and stimulates their apoptosis. The absence of this process gives rise to BPH.

Question 9

What are the signs and symptoms of BPH?

Answer 9

SHITE - slow stream, hesitancy, intermittent flow, terminal dribbling, emptying is incomplete

FUN - frequency, urgency and nocturia

Question 10

How is BPH diagnosed?

Answer 10

History, DRE, USS and blood test for PSA

Question 11

How is BPH treated?

Answer 11

a1 adrenergic blockers, 5a reductase inhibitors and surgery

Question 12

How do alpha-1 adrenergic blockers work to treat BPH?

Answer 12

a1 adrenergic receptors are present in the smooth muscle of the neck of the bladder, which usually receives sympathetic innervation to the internal urethral sphincter to contract. Antagonising this receptor –> relaxation of the smooth muscle in bladder neck and prostate –> less impeded urinary flow

Question 13

How do 5a-reductase inhibitors work to treat BPH?

Answer 13

Prevent the conversion of testosterone into DHT and prevent the drive of proliferation

Question 14

Name two examples of 5a-reductase inhibitors used in the treatment of BPH

Answer 14

Dutasteride and finasteride

Question 15

How may BPH be treated surgically?

Answer 15

Transurethral reserction, open prostatectomy, laser ablation, transurethral microwave and high energy ultrasound therapy

Question 16

How may you distinguish between prostate cancer and BPH from PSA levels ?

Answer 16

For prostate cancer the PSA tends to be elevated MUCH higher

Question 17

Describe an indirect inguinal hernia

Answer 17

These are the most common form of inguinal hernia and are associated with the failure of the inguinal canal to close properly. The herniation goes through the deep inguinal ring and reaches the scrotum

Question 18

Describe a direct inguinal hernia

Answer 18

Tends to occur in old age and occurs due to piercing through Hasselbach’s triangle in the anterior abdominal wall

Question 19

What is Hasselbach’s triangle?

Answer 19

Rectus abdominis medially, inguinal ligament inferiorly, epigastric blood vessels laterally

Question 20

What is erectile dysfunction?

Answer 20

A complete inability to have an erection (or only the ability to have short-term erections)

Question 21

Explain the mechanism behind producing an erection

Answer 21

Stimulation to the nerves in penis and vascular endothelium –> release of NO –> activates guanylate cyclase in the cytoplasm of smooth muscle cells in the penis –> increased conversion of GTP to cGMP –> causes relaxation of smooth muscle in corpus cavernous –> dilatation of the cavernosal and helicon arteries with engorgement of lacunar spaces –> compression of subtunical venous plexus against the tunica albuginea –> decreases cavernosal venous outflow –> increased intercavernosal pressure –> penile rigidity

Question 22

How is erectile dysfunction treated?

Answer 22

PDE-5 inhibitors; this enzyme usually converts cGMP to 5’ GMP, and therefore preventing this increases availability of cGNP –> stimulation of smooth muscle relaxation

Question 23

What is Peyronie’s disease?

Answer 23

This is where scar tissue forms in the shaft of the penis which causes bending or deformity of the penis and as a result erections are painful and an individual will have difficulties with sexual intercourse

Question 24

How is Peyronie’s disease treated?

Answer 24

Para-aminobenzoate, topic verapamil or surgery

Question 25

What is vacicocoele?

Answer 25

Distended veins in the pampniform plexus of the scrotum

Question 26

Which testicle tends to be affected by varicocele?

Answer 26

Always the left testicle