Problems of the Male Reproductive system

Question 1

Prostate dimensions

Answer 1

3cm Long
4cm Wide
2cm AP depth

Question 2

Prostate lobes

Answer 2

Isthmus- anterior
Inferoposterior
Middle lobe

Question 3

Prostate glandular regions

Answer 3

Peripheral Zone
Central Zone
Transition Zone

Question 4

Peripheral zone

Answer 4

70%

Surrounds urethra

Question 5

Central zone

Answer 5

25%

Surrounds ejaculatory ducts

Question 6

Transition zone

Answer 6

5%

Surrounds proximal urethra

Question 7

Prostate function

Answer 7

Secretes a fluid making up semen

Question 8

Main hyperplasia of prostate

Answer 8

Epithelial + stromal cells small glands of TRANSITION ZONE

Question 9

Main area of prostate cancer

Answer 9

Peripheral Zone

Question 10

BPE Causes

Answer 10

Advancing age
–> age related enlargement caused by increased cell proliferation + decreased apoptosis
Testicular androgens
Oestrogen
Prostatic stromal + epithelial tissue interactions
Neurotransmitters from gland

Question 11

Stromal cells + testosterone

Answer 11

Testosterone –> estradiol

–> leads to stromal cell proliferation

Question 12

Epithelial cells + testosterone

Answer 12

Testosterone –> DHT

DHT binds AR –> antagonises epithelial cell apoptosis

Question 13

Estradiol leads to

Answer 13

Apoptosis of epithelial cells

Proliferation of stromal cells

Question 14

BPE Symptoms

Answer 14

SHITE
Slow stream
Hesitancy
Intermittent flow
Terminal dribbling
Emptying is incomplete
FUN
Frequency
Urgency
Nocturia

Question 15

BPE Diagnosis

Answer 15

History
DRE
Ultrasound- biopsy
Blood test- PSA

Question 16

PSA levels

Answer 16

40-49= 0-2.5ng/ml
50-59= 0-3ng/ml
60-69= 0-4ng/ml
>70= 0-5ng/ml
Less than 10ng/ml usually due to BHP

Question 17

BPE treatment

Answer 17

Alpha 1 adrenergic blockers

5 alpha reductase inhibitors

Question 18

Alpha 1 adrenergic blockers

Answer 18

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

Question 19

5 alpha reductase inhibitors

Answer 19

Type I + II
Stops conversion of Testosterone –> DHT
Finasteride

Question 20

BPE surgery

Answer 20

Transurethral resection of the prostate
Open prostatectomy
UroLift
Laser ablation
Transurethral microwave
High energy ultrasound therapy

Question 21

Prostate cancer

Answer 21

Similar symptoms to BPH

PSA (if raised) much higher than in BPH

Question 22

Direct inguinal hernia

Answer 22

Less common
Old age
Not in deep inguinal ring
Doesn’t extend beyond superficial inguinal ring
Neck is medial to inferior epigastric artery

Question 23

Indirect inguinal hernia

Answer 23

More common
Young
Enters deep inguinal hernia
Reaches scrotum
Neck is lateral to inferior epigastric artery

Question 24

Three finger test

Answer 24

Index finger on deep inguinal ring
Middle finger on superficial inguinal ring
Ring finger on saphenous opening
Patient asked to cough
–> felt on deep inguinal, then indirect
–> felt on superficial inguinal, then direct
–> felt at saphenous opening, then femoral

Question 25

Direct inguinal hernia anatomy

Answer 25

Hasselbach's triangle | Rectus abdominis, inferior epigastric, inguinal ligament

Question 26

Indirect inguinal hernia facts

Answer 26

Associated with failure of inguinal canal to close properly after passage of testis in utero

Question 27

Erection MOA

Answer 27

Lots more blood flow into lacunar space (surrounded by cavernosal smooth muscle) Lots more inflow due to vasodilation, more smooth muscle --> compresses + stretches veins and reduces outflow Blood remains maintaining erection

Question 28

What is pressure within penis to close off venous return

Answer 28

200mmHg

Question 29

Parasympathetic effect on penis

Answer 29

``` AP travels down neurone Ca comes in Releases NO NO goes into smooth muscle in arteries, causing activation of soluble guanylyl cyclase Causes cGMP production cGMP relaxes smooth muscle --> ERECTION ```

Question 30

Sympathetic effect on penis

Answer 30

Symp. neurone releases NA Works on Alpha 1 adrenoreceptor Contracts smooth muscle --> Ejaculation

Question 31

Phosphodiesterase type 5

Answer 31

breaks down cGMP | Stops erection

Question 32

Sildenafil

Answer 32

PDE-5 inhibitor Increases intracellular cGMP conc. Stops breakdown of cGMP--> keeps smooth muscle relaxed --> erection stays No more than 1 a day

Question 33

PDE 5 inhibitors

Answer 33

Vardenafil (Levitra) | Tadalafil (Cialis)

Question 34

Peyronie's disease

Answer 34

Scar tissue forms in shaft of penis - -> bending or deformities - -> painful erections + difficulties with sex

Question 35

Peyronie's disease treatment

Answer 35

Surgical | Non-surgical= stretching, topical verapamil, para-aminobenzoate

Question 36

Para-aminobenzoate

Answer 36

B group of vitamins | Used to treat disorders associated with excess formation of fibrous tissue

Question 37

Varicocele

Answer 37

Varicose veins of scrotum (pampiniform venous plexus) Always left testis 2 degree rise in temp 35-40% infertile men have it