Problems of the Male Reproductive System Flashcards
What are the zones of the prostate?
Peripheral, central and transition zone
Where is the peripheral zone of the prostate?
Makes up 70% of the prostate and surrounds the urethra
Where is the central zone of the prostate?
Makes up 25% of the prostate and surrounds the ejaculatory ducts
Where is the transition zone of the prostate?
Makes up 5% of the prostate and surrounds the proximal urethra
In which zone is there hyperplasia in BPH?
Transitional zone - this is why there is often impedance of urinary flow
In which zone is there hyperplasia in prostate cancer?
Peripheral zone - and there aren’t usually any symptoms
What’s the role of testosterone in BPH?
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.
What’s the role of oestrogen in BPH?
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.
What are the signs and symptoms of BPH?
SHITE - slow stream, hesitancy, intermittent flow, terminal dribbling, emptying is incomplete
FUN - frequency, urgency and nocturia
How is BPH diagnosed?
History, DRE, USS and blood test for PSA
How is BPH treated?
a1 adrenergic blockers, 5a reductase inhibitors and surgery
How do alpha-1 adrenergic blockers work to treat BPH?
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
How do 5a-reductase inhibitors work to treat BPH?
Prevent the conversion of testosterone into DHT and prevent the drive of proliferation
Name two examples of 5a-reductase inhibitors used in the treatment of BPH
Dutasteride and finasteride
How may BPH be treated surgically?
Transurethral reserction, open prostatectomy, laser ablation, transurethral microwave and high energy ultrasound therapy
How may you distinguish between prostate cancer and BPH from PSA levels ?
For prostate cancer the PSA tends to be elevated MUCH higher
Describe an indirect inguinal hernia
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
Describe a direct inguinal hernia
Tends to occur in old age and occurs due to piercing through Hasselbach’s triangle in the anterior abdominal wall
What is Hasselbach’s triangle?
Rectus abdominis medially, inguinal ligament inferiorly, epigastric blood vessels laterally
What is erectile dysfunction?
A complete inability to have an erection (or only the ability to have short-term erections)
Explain the mechanism behind producing an erection
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
How is erectile dysfunction treated?
PDE-5 inhibitors; this enzyme usually converts cGMP to 5’ GMP, and therefore preventing this increases availability of cGNP –> stimulation of smooth muscle relaxation
What is Peyronie’s disease?
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
How is Peyronie’s disease treated?
Para-aminobenzoate, topic verapamil or surgery
What is vacicocoele?
Distended veins in the pampniform plexus of the scrotum
Which testicle tends to be affected by varicocele?
Always the left testicle
