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Human Development 2 > Problems of the Male Reproductive system > Flashcards

Problems of the Male Reproductive system Flashcards

1
Q

How big is at the normal prostate gland

A
  • 3cm long
  • 4cm wide
  • 2cm in AP depth
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2
Q

What is the function of the prostate gland

A

makes about 1/3 of alkaline seminal fluid that contains an
anticoagulant (PSA) to that sperm can swim and survive in the female vaginas
acidic environment.

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3
Q

what does seminal fluid contain that keeps it fluid d

A

it contains an anticoagulant (PSA) that keeps it liquid and the sperm liquid

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4
Q

what are the 3 zones that make up the prostate

A
  • peripheral zone
  • central zone
  • transitional zone
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5
Q

describe the peripheral zone

A
  • 70%

* Surrounds urethra

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6
Q

describe the central zone

A
  • 25%
  • Surrounds ejaculatory ducts
  • Just underneath the peripheral zone
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7
Q

describe the transitional zone

A
  • 5%

* Surrounds proximal urethra

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8
Q

what zone is prostate cancer found in

A

peripheral zone

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9
Q

what zone is Benign prostate hyperplasia BPH found in

A

transitional zone

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10
Q

describe the histology of the prostate gland

A
  • made up of glandular tissue and smooth muscle
  • there is a lot of smooth muscle around the urethra
  • glandular ducts are also present as the seminal fluid from the prostate has to be added to the ejaculatory ducts in the central zone
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11
Q

what cells do you get hyperplasia and hypertrophy of in the transitional zone leading to BPH

A
  • Get both hyperplasia (proliferation)and hypertrophy (enlargement) of the epithelial cells and stromal cells (made up of collagen, fibroblasts and smooth muscle cells) in the transitional zone
  • mores smooth muscle and more fibroblasts in the transitional zone therefore there are larger fibromsucular septa between the proliferating glands
  • Epithelium = have an outer columnar layer and a more inner cuboidal layer
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12
Q

what is the difference between hyperplasia and hypertrophy

A

Hyperplasia is proliferation of tissue

hypertrophy is enlargement of tissue

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13
Q

what can block the outflow of seminal fluid

A

Corpora amylacea

- accumulation of calcified material in ducts which is protein based and insoluble common in BPH rare in adenocarcinoma

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14
Q

what is the difference between benign prostate enlargement and prostate cancer

A
  • in benign prostate hyperplasia this is in the transitional zone therefore you cannot feel in enlargement as it is mainly inwards, therefore the prostate feels smooth
  • Prostate cancer tends to be in the peripheral zone therefore you can feel the nodules enlarge when you do a DRE
  • can often feel it be irregular hard and enlargement is on one side
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15
Q

what do you use a DRE for

A
  • can feel the prostate and see if it is bumpy or smooth, can be used as an intial investigation for more tests for cancers
  • use an index finger
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16
Q

what is a normal ration in a DRE

A

normal ratio when you feel the rectum you can put one index finger over the prostate gland,

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17
Q

what can cause benign prostatic expansion

A

dvancing age
• Age related enlargement caused by increased cell proliferation and decreased apoptosis

– Testicular androgens = testosterone

– Other contributing factors
• Oestrogens
• Prostatic stromal and epithelial tissue interactions
• Neurotransmitters from the gland

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18
Q

due to advancing age what happens in terms of proliferation and apoptosis

A

there is less apoptosis and more proliferation means that there is more cells overall

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19
Q

What happens when the transitional zone enlarges

A
  • it presses on the narrowed urethra

- this eventually can block the outflow of the bladder

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20
Q

Explain the mechanism of action behind proliferation versus apoptosis of the cells in the prostate gland

A
  • in the stomal cell testosterone is converted to estradiol via aromatase this causes cell proliferation when estradiol binds to ER alpha
  • some of the oestradiol leaks across into the basal and luminal epithelium through the basement membrane and this causes apoptosis when the estradiol binds to ERbeta
  • But Testosterone is converted to DHT via 5 alpha reductase in the basal epithelium, then testosterone can either bind directly to AR or bind to AR by DHT
  • the binding to AR prevents epithelial cell apoptosis
  • but in old age too much DHT and testosterone is produced therefore there is too much proliferation and not enough oestraiol causing apoptosis
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21
Q

What are the sings of BPE

A
  • SHITE = Slow stream, Hesitancy, Intermittent flow, Terminal dribbling, Emptying is incomplete.
  • FUN = Frequency, Urgency, Nocturia

others

  • pain or burning during urination
  • blood in urine or semen due to infections as the urine is stagnated in the bladder and does not have an exit
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22
Q

How common is BPE

A
  • All men over the age of 40 will have an enlarged prostate
  • Not all well develop symptoms
  • 50% will develop histological hyperplasia
  • 50% of these with have lower urinary tract symptoms (LUTS)
  • Some will develop significant enlarged prostate (EP)
  • Some will develop bladder outlet obstruction (BOO)
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23
Q

how do you diagnose BPE

A
  • History
  • Digital rectal exam
  • Ultrasound – biopsy
  • Blood test PSA (gamma-seminoprotein or kalikrein-3 can also be used)
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24
Q

What does an ultrasound in the diagnosis of BPE allow you to find

A
  • allows an estimate of the width/height/length of prostate.

- Can also take a biopsy to check for cancer

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25
Q

how can you use a blood test to diagnose BPE/prostate cancer

A
  • look for prostate specific antigen (PSA)
  • This can be raised with prostate cancer

Averages

  • 40-49 years, 0-2.5 ng/ml
  • 50 -59 yrs 0 – 3 ng/ml
  • 60 - 69 yrs 0 – 4 ng/ml
  • > 70 yrs 0 – 5 ng/ml
  • Less than 10ng/ml is usually due to BHP
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26
Q

What two medical treatments can you use for BPE

A

Alpha 1 adrenergic blockers

5 alpha redcutase inhibitors

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27
Q

Give an example of an alpha 1 adrenergic blocker

A

(Tamulosin).

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28
Q

give an example of a 5 alpha reductase inhibitor

A

dutasteride and finasteride.

29
Q

How do alpha 1 adrenergic blockers such as tumulosin work

A

• This is an antagonist to the alpha 1 receptor, this causes the smooth muscle to relax and allow the outflow of the urine from the bladder, improves urine outflow

30
Q

How do 5 alpha reductase inhibitors such as finasteride and dutasteride work

A
  • can reduce the amount of growth in the prostate
  • these inhibit 5 alpha reductase which is responsible for the conversion of testosterone into DHT
  • DHT drives the proliferation of the epithelial cells so without this apoptosis commences as there is now a less high ratio between DHT and oestradiol allowing apoptosis to be driven
31
Q

Name the types of BPE surgery that you can have

A
  • TURP
  • open prostatectomy
  • Urolift
  • laser ablation
  • transuthral microwave
  • high energy ultrasound
32
Q

how does TURP work

A
  • go through the urethra and cut out the transitional zone

-

33
Q

What does TURP stand for

A

transurethral resection of the prostate

34
Q

Who is TRUP for

A

people with symptoms

  • voiding
  • recurrent urinary tract infection
  • recurrent haematuria
35
Q

Who is an open prostatectomy for

A

For very large prostates (>75g).

36
Q

what happens in uroLift

A
  • stationary tags put into the prostate

- and these pull the urethra open again

37
Q

what happens in laser Ablation/Transurethral Microwave/High Energy US Therapy

A
  • cook the transitional zones and remove the cells around it increasing the area for the urethra
38
Q

when is PSA higher in BPE or in prostate cancer

A

in prostate cancer PSA is higher

39
Q

describe indirect hernias

A
  • goes through the superificla and deep inguinal rings
  • more serious as they can get strangulated
  • congenital
  • lateral to the inferior epigastric vessels
40
Q

describe direct hernias

A
  • go through hasselbachs triangle
  • direct behind the sueprifical ring
  • medial to the inferior epigastric vessels
  • common in elderly men with weak abdominal muscles
41
Q

what travels underneath the inguinal ligament

A
  • Femoral artery
  • Femoral vein
  • Femoral canal
42
Q

what are the two types of hernia

A

direct hernia

indirect hernia

43
Q

how any people have hernias

A
  • Approx 25% of males will have inguinal hernias in their lifetime
    o 2% of females – don’t have a vas deferens therefore the inguinal canal is a bit more closed and fibrotic in us, more common to have a femoral hernia where it goes underneath the inguinal ligament
44
Q

what is a femoral hernia

A
  • a hernia that goes under the inguinal ligament
45
Q

What are the three borders of hasselbachs triangle

A

made out of the inferior epigastric vessels, rectus abdominis, and inguinal ligament

46
Q

What is the three finger test for hernias

A

index finger on DIR, middle finger on SIR and ring finger on saphenous opening. Ask cough:
 Indirect: deep inguinal ring
 Direct: superficial inguinal ring.
 Femoral: at the saphenous.

47
Q

How do you treat direct hernias

A
  • Reducible = truss which pushes the itnesitnes back into the abdomen and this is usually a reducible hernia
  • Or surgery
48
Q

How do you treat indirect hernias

A
  • surgery
49
Q

what side are you more likely to have an indirect hernia in

A
  • right testes
  • this is because the right is a bit slow and delayed and thus arrives later in the scrotum therefore the processes vaginalis doesn’t have time to close up and doesn’t heal
50
Q

How many people does erectile dysfunction effect

A

1 in 10 men

- increase with age

51
Q

what is erectile dysfunction

A
  • Complete inability to have an erection
  • Inconsistent ability to achieve an erection
  • Ability to have short term erections
52
Q

what causes erectile dysfunction

A
  • reduction in blood flow in the cavernosal arteries

- there is a problem with the nervous supply to the penis that causes erectile dysfunction

53
Q

what is the penis made out of

A

 2 X corpus cavernosa: for vascular engorgement. -cavernosal arteries run down the centre of here and are the thing that can go wrong in an erection
 1 X corpus spongiosum: urethra passes down: stops it from being compressed.

54
Q

What happens in an erection

A

Normally: blood comes into the corpus cavernosa and leaves at the same rate.

Erection: increased blood flows stays in the sinusoids as arteries and smooth muscle relax.
 This expands them and this
makes the penis rigid.
 Causes the outflow to be
compressed therefore the blood cannot leave

55
Q

What does dilation of the arteries cause

A

increase in blood flow

56
Q

describe the nerve supply that is important in erections

A
  • parasympathetic neurone (non adrerongic and non cholinergic) - causes the erection
  • sympathetic causes the ejaculation
  • point and shoot
57
Q

describe the mechanism fo action of the smooth muscle relaxation during an erection

A
  • Parasympathetic neurone which is non adrenergic and non cholinergic allows calcium to enter the synapse and causes the release of nitric oxide
  • the nitric oxide then diffuses across the smooth muscle
  • NO binds to soluble gauntly cylases and produces cGMP this causes the smooth muscle to relax and decreases calcium inflow
  • then signals from the sympathetic neurone does the opposite
58
Q

How do you lose an erection

A

PDE5 causes the breakdown of cGMP to 5’GMP

59
Q

How does viagra work

A

It inhibits PDE5 therefore slowing the breakdown of cGMP

60
Q

Name some phosphodiesterase type 5 inhibitors (PDE5)

A 
Phosphodiesterase type 5 inhibitor.
o Sildenafil (Viagra)
o Vardenafil (Levitra)
o Taladafil (Cialis)
61
Q

when does PDE5 only work

A
  • takes about 20-60 minutes and lasts for 6 hours, it only works if you are still in the mood as you need the parasymatpehtic nervous system to fire to allow nitric oxide release
62
Q

what surgery can you get for loss of erection

A
  • Penile prosthesis
    • it replaces the corpus cavernous, two fluid filled tubules which are expandable, fluid filled reservoir and a pump
  • The pump goes into he scrotum
  • If you pump it will move the fluids into the tube and give you an erect penis
63
Q

What is peyronies disease

A
  • Bent penis – effects 5% of men
64
Q

What causes peryonies disease

A
  • Scar tissue forms in shaft of penis
    o Causes bending or deformity of the penis
    o Painful erections and difficulties with sexual intercourse
    o When it expands the scar tissue is not as stretcy and stops the scar tissue from becoming erect normally
65
Q

How do you treat peryronies disease

A

o Non-surgical
 Stretching – break down sar tissue
 Para-aminobenzoate – b vitamin that you can take and rub on, increases oxygen to the penis and improves the scar tissue
 Topical verapamil

o surgical

66
Q

What is a varicocele

A

• Varicose veins of the scrotum (pampiniform venous plexus)

67
Q

what sides does a varicocele happen on

A

– Very common 10-15% and always in the left testis (80-90%) on the left side it drains into the renal vein whereas on the right side drains straight into the vena cava

68
Q

what can a varicocele do that is harmful

A

– Usually harmless but can be a cause infertility
• 35-40% of infertile men have variocle (15% of men with variocele are infertile)
• this might be cause it causes a 2 degree rise in temperature

Human Development 2 (34 decks)

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