Reproduction - PATHO Flashcards
2 functions of the testicles
- Testosterone production
- Leydig cells
- line seminiferous tubules
- production testosterone and androgens - spermatogenesis
- sertoli cells
- line seminiferous tubules
- production sperm
- mature in epididymis and stored in vas deferens
Testicular descent occurs when in utero
Descent from abdomen -> inguinal canal -> scrotum
last 3 months of development
Control of blood flow to Leydig Cells
Autonomic adrenergic neurons
Blood flow to surface of testicles
cools to 4 degrees
temperature for spermatogenesis
Function of the Epididymis
- Structural
- posterior testicle
- 5-7cm
- connection seminiferous tubules to vas deferens - Functional
- matruation sperm
- 12 days to swim across
- testosterone, nutrients
A. motility - maturation
- fertility
Function of the vas deferens
- storage of mature sperm
- muscular peristalsis for ejactulation
Anatomy and function of the prostate
- Seminal fluid
- high pH (alkaline)
- survival and motility of sperm
- secreted from the seminal vesicle
Size of walnut
- surrounds urethra
- common duct for sperm and urine
Brief summary Embryonic Male Development
Chromosome Y expression SRY signalling
TDF - testes determining factor
MIF - mullerian inhihitory factor (inhibition internal female genitalia)
Leydig cells secrete testosterone - testicle development (wolfian duct)
Male Hormones Gonad development
Definition
GnRH
- gonadotropin releasing hormone
- hypothalamus
- stimulates release of anterior pituitary gonadotrophins
LH
- leutinizing hormone
- Leydig cells
- production androgens and testosterone
- primary and secondary sexual characteristics (testicular development)
FSH
- follicle stimulating hormone
- Sertoli cells
- production sperm (spermatogenesis)
Testosterone
- produced by Leydig cells (testicles)
- produced by adrenal glands
- primary and secondary sexual characteristics
- anabolic (muscle, bone buildnig)
- libido
- hair, acne, sebaceous glands, etc.
List Structural Disorders
Penis
Cryptorchidism
- undescended testicle
Ectopic testicle
Phimosis
- unable to retract prepuce
Paraphimosis
- unable to reduce prepuce
Hypospadias
- uretra on the ventral side of the shaft
Peyronie’s disease
- fibrosis of penis results in bend
Cryptorchidism
Definition
Testicles do not descend to scrotum from abdomen
Unilateral > bilateral (high sterility)
Found anywhere along ectopic, abdomen, inguinal canal, suprapubic
palpable and non-palpable
Cryptorchidism
Incidence and Complications
3-4% at birth
1% remain undescended at 1 year
Complications
- infertility
- 50x increase risk of testicular cancer in adulthood (contralateral testicle)
Co-morbidities: anatomy
- vas deferens
- epididymis
- urethra, upper genital tract
- hypospadias
- mixed sex: both cryptorchidism + hypospadias
Cryptorchidism
Etiology
genetics x environment (hormones x structure x maternal age)
- Structural
- adhesions
- fibrosis
- narrowing inguinal canal
- no gubernaculum (cord that pulls them through) - Hormonal (environmental)
- insensitive to gonadotrophic hormones, maternal hormones - Maternal age
- advanced maternal age - Heredity (genetics)
When is physiological cryptorchidism normal
Retractile Testicle
- involuntary retraction of testes into inguinal canal (can be repositioned) in response to ANS activation
- cold, physical excitement
Cryptorchidism
Treatment
- Monitor for first month
- 50% descend in first month - Referral to urology MD
- 6 months
- Rx. Testicular ultrasound
- assess gonads and genitals (comorbidities) - Surgical intervention
- 6-18 months
Orchiopexy
- surgical descent of testicles
- 20% remain infertile
- retain 50x increase risk for testicular cancer
Phimosis
Definition
Inability to retract the prepuce (foreskin)
Two Types phimosis
- Congenital phimosis
- normal
- up to age 3 years should not retract the foreskin to clean - Poor hygiene
- not usually STI (can be)
- poor hygiene
- poor diabetic control (immunocompromised)
- secondary infection
Phimosis
Pathophysiology
Most commonly from poor hygiene
- inflammation
- swelling
- erythema
- edema
- pain
- discharge
–> cannot retract the foreskin
phimosis
Complications
- blanitis
- inflammation glans of penis - posthitis
- inflammation prepuce - paraphimosis
- inability to reduce the forskin
- cuts off circulation to glans of penis
- medical emergency
Phimosis
Treatment
- Treat infection and inflammation
- if infection, treat infection
- corticosteroid cream for inflammation
- control blood sugars if diabetic
- MD referral
- surgical release or circumcision
Phimosis
Incidence and risk factors
- can occur at any time, any age
- poor hygiene
- poor diabetic control
- not usually STIs
Paraphimosis
Definition
Inability to reduce the prepuce over the glans of the penis
Paraphimosis
Pathophysiology
Inflammation prepuce or glans
inability to reduce foreskin over
restriction blood flow to glans
MEDICAL EMERGENCY
Paraphimosis
Treatment
Surgical release or circumcision
Hypospadias
Definition
Urethral opening is on the ventral side of the penis (glans, shaft, base, penoscrotal junction, perineum)