Problems with the male reproductive system

Question 1

What are the rough dimensions of the prostate

Answer 1

342

In adult male, approx 20g

Question 2

What is the function of the prostate

Answer 2

Makes up 30% of seminal fluid- alkaline secretions to neutralise acidity of vagina
Secretes anticoagulant to ensure sperm can swim effecitvely

Question 3

Name the 3 zones of the prostate

Answer 3

Transitional zone
Central zone
Peripheral zone

Question 4

Describe the peripheral zone of the prostate

Answer 4

Makes up 70% of the prostate, runs around the periphery and surrounds urethra at inferior border

Question 5

Describe the central zone of the prostate

Answer 5

Makes up 25% of the prostate, surrounds the ejaculatory ducts and vas deferens. Lots of connective tissue

Question 6

Describe the transition zone of the prostate

Answer 6

Makes up 5% of the prostate. Surrounds more proximal part of urethra as it exits bladder. Transition from central zone to glandular tissue in periphery

Question 7

Which zone of the prostate is most effected by

a) prostate cancer
b) BPH

Answer 7

a) peripheral zone

b) transitional zone

Question 8

How does the prostate appear/ feel in benign prostatic hyperplasia

Answer 8

Appears significantly bigger but retains smooth surface throughout
Nodules are present inside but can’t be felt externally

Question 9

How does the prostate appear/ feel in prostatic cancer

Answer 9

Feels like a nodule as cancer usually arises in prostatic zone

Question 10

What cellular changes that happen in advanced age result in BPH? Why is advanced age thought to be linked to this

Answer 10

Increased cell proliferation and decreased apoptosis

Happens due to lifelong exposure to testicular androgens

Question 11

What happens in the stroma of prostate

Answer 11

Testosterone is converted to estradiol by aromatase
Binds to oestrogen receptor alpha
Causes fibroblasts and SMC to proliferate
Hypertrophy and hyperplasia in connective tissue of transitional zone

Question 12

What causes epithelial cell apotosis in prostate

Answer 12

In the epithelial cells estradiol leaks across

Testosterone converted to DHT and binds to receptor

Question 13

Compression of which structure produces symptoms of benign prostatic hyperplasia

Answer 13

Urethra

Question 14

What % of people with the symptoms of BPH also have it histologically

Answer 14

50

Question 15

How can BPH be diagnosed?

Answer 15

• History
• Digital rectal exam
• Visualisation of prostate, accurate idea of measurments and regions

Question 16

What do blood tests for BPH look for

Answer 16

PSA which is an anticoagulant

If <10ng/ml due to BHP not cancer

Question 17

How do alpha adrenergic blockers treat BHP

Answer 17

Relaxes smooth muscle in bladder neck improving flow rate

Question 18

How does 5 alpha reductase inhibitor work to treat BHP

Answer 18

Blocks the conversion of testosterone to its active form

Question 19

What is transurethral resection

Answer 19

Goes through urethra and cuts out transitional zone

Question 20

What is open prostatectomy

Answer 20

Inner core of prostate is shelled out

Question 21

What is laser ablation

Answer 21

Laser ‘cooks’ off transitional zone

Question 22

What is urolift

Answer 22

Procedure goes through urethra and ties prostate to open it up so urethra is widened

Question 23

Describe the structure of the superficial inguinal ring

Answer 23

Area where the vas deferens is coming up through the testes and going through abdomen

Question 24

Describe the deep inguinal ring

Answer 24

Where vas deferens comes in, external iliac vessels are found on the inside

Question 25

What vessels come off the external iliac vessels

Answer 25

Inferior epigastric artery and vein

Question 26

How do you differentiate between direct and indirect hernias

Answer 26

Medial to inferior epigastric artery= direct

Lateral= indirect

Question 27

When do direct hernias occur

Answer 27

Acquired due to age

Question 28

When do indirect hernias occur

Answer 28

Associated with failure of the inguinal canal to close properly after passage of the testes in utero
Defect that intestine can follow through

Question 29

Which side do indirect hernias usually occur on and why

Answer 29

Right

Right testes is larger and descends later

Question 30

2 definitions of erectile dysfunction

Answer 30

• Inability/ inconsistenty in having an erection

- Inability to maintain an erection

Question 31

What are some causes of erectile dysfuntion

Answer 31

Diabetes
Vascular disease
Radical surgery
Spinal cord injury
Endocrine disorders
MS

Question 32

What vessel drains the penis

Answer 32

Dorsal deep vein

Question 33

Describe movement of blood in the penis when it is flaccid

Answer 33

Cavenosal artery bring blood in but it drains quickly

Question 34

Describe blood movement in the penis when its erect

Answer 34

Inflow increases expanding the sinusoids compressing the outflow

Question 35

Describe parasympathetic control of erection

Answer 35

• Parasympathetic neurone release NO
• NO diffuses across to smooth muscle and into smooth muscle cell
• Binds to soluble guanylyl cylase producing cyclic GMP which causes smooth muscle relaxation
• Vasodilation of sinusoids= erection

Question 36

Describe sympathetic control of erection

Answer 36

Release noradrenalin
Binds to alpha 1
Contraction of sinusoids

Question 37

How does viagra work?

Answer 37

Prevents breakdown of cGMP

Causes relaxation for longer and increased erection

Question 38

Does viagra work for people with spinal cord issues

Answer 38

No because it requires sexual arousal to work

Question 39

What is Peyronies disease

Answer 39

Bent penis

Caused by scar tissue in the corpus cavernosus leading to it bending

Question 40

What is variocele

Answer 40

Varicose veins on scrotum, always on the left testes because testicular vein on left side doesn’t drain properly