Problems of the Male Reproductive System Flashcards
What is the function of the prostate?
Makes up alkaline seminal fluid which contains anticoagulant (PSA) so sperm can swim and survive in female vagina acidic environment
What are the anatomical relations of the prostate?
Base - neck of bladder Apex - fascia on superior aspect of urethral sphincter Posterior - ampulla of rectum Anterior - muscular surface Inferolateral - levator ani
What are the 3 regions of the prostate?
Peripheral Zone
Central Zone
Transition Zone
What are the properties of the peripheral zone?
- around periphery of gland
- surrounds urethra at lower end
- large glandular tissue (contains seminal fluid)
- site of prostate cancer
What are the properties of the central zone?
Surrounds ejaculatory ducts
What are the properties of the transition zone?
Surrounds proximal part of urethra as exits bladder
- transition from CT in central zone to glandular tissue in peripheral
- benign prostate enlargement
What is benign prostatic hyperplasia?
Hyperplasia of epithelial and stromal cells
- thickening of CT around glandular tissue and fibroblast proliferation
- nodule form but not felt (deep within prostate)
What is BPH associated with?
- advanced age = increased cell proliferation/decreased apoptosis
- testicular androgens (lifelong exposure to testosterone and oestrogen = proliferation)
- neurotransmitters from gland
- prostatic stromal and epithelial interactions
What are the signs and symptoms of BPH?
- weak/interrupted urine flow
- nocturia
- trouble urinating
- pain/burning during urination
- blood in urine/semen
SHITE = slow stream, hesitancy, intermittent flow, terminal dribbling, emptying incomplete
FUN = frequency, urgency, nocturia
What may some men over 40 develop when they have BPH?
- enlarged prostate
- Bladder outlet obstruction
How do you diagnose BPH?
History
DRE
Ultrasound (biopsy) = estimate of weight/height/length of prostate
- blood test PSA
What drugs are used to treat BPH?
- alpha-1-adrenergic blockers (relax SM in bladder and prostate)
- 5-alpha reductase inhibitors (block conversion of testosterone to active form dihydrotestosterone which binds to androgen receptor causing cell proliferation)
What is an example of a alpha-1 adrenergic blocker?
Tamulosin
What are some examples of 5 alpha reductase inhibitors?
Dutasteride and finasteride
What surgical options are there for BPH?
- transurethral resection of prostate
- open prostatectomy (large prostates)
- laser ablation/transurethral microwave/high energy US therapy (kills transitional zone)
- urolift (urethra opening)
When would transurethral resection of the prostate occur?
- UTI
- recurrent gross haematuria
- failed voiding trials
- renal insufficiency secondary to obstruction
What is transurethral resection of the prostate
- cuts out transitional zone leaving PZ
How does prostate cancer present?
- BHP symptoms
- if PSA raised higher than in BPH
What are the features of a direct inguinal hernia?
- less common than indirect
- old age
- does not enter deep inguinal ring
- does not extend beyond superficial inguinal ring
- neck medial to IEA
- ring test negative
What are the features of an indirect inguinal hernia?
- more common
- young
- enters deep inguinal ring
- reaches scrotum (labius majus)
- neck lateral to IEA
- ring test positive
How is a 3 finger test done?
- index finger on DIR
- middle finger on SIR
- ring finger on saphenous opening
- ask patient to cough
- indirect = DIR
- direct = SIR
- femoral = saphenous
How do you treat direct inguinal hernia?
Reducible through truss or surgery
How do you treat indirect hernia?
Always requires surgery
What is the mechanism of BPH?
- stromal cells proliferation converting testosterone into estradiol
- epithelial cells convert testosterone to DHT preventing apoptosis
- estradiol leaks across causing apoptosis of epithelial cells but in old age not enough to stop gland overgrowth
How does erectile dysfunction present?
- complete inability to have erection
- inconsistent ability to achieve erection
- ability to have ST erections
What are the causes of erectile dysfunction?
Poor/insufficient blood supply Vascular disease MS Diabetes Mellitus Spinal cord injury Endocrine disorders
What anatomical structures make up the penis?
- corpus cavernosa x 2 (vascular engorgement)
- corpus spongiosum (urethra passes down stopping it from being compressed)
How does blood allow erection?
Increased blood flow stays in sinusoids of corpus cavernosa as arteries relax
- expands them making penis rigid
- outflow becomes compressed
What is the mechanism of SM in erection?
- non-adrenergic non cholinergic PS neuron releases NO which diffuses to SM
- NO binds to soluble guanylyl cyclase producing cGMP
- causes SM relaxation decreasing calcium inflow
- signals from sympathetic neuron does the opposite
- artery dilation = increases blood flow
What are the phospdiesterase type 5 inhibitors?
Sildenafil (Viagra)
Vardenafil (Levitra)
Taladafil (Cialis)
What is Peyronie’s disease?
- bent penis
- scar tissue forms on shaft of penis = bending/deformity of penis = painful erections
What is the treatment for Peyronie’s disease?
Non surgical (stretching)
Pharmacological (para-amino benzoate)
Surgical
What is variocele?
Varicose veins of scrotum (pampiniform venous plexus)
- always in left testis
- usually harmless but can cause infertility
