Reproductive: Diseases of Penis and Prostate Flashcards
define hydrospadias
urethra opens onto ventral surface of penis
What is hydrospadias associated with?
poorly developed penis curving ventrally
What is a ventral curving penis?
chordee
define epispadias
urethra opens onto dorsal surface
what is epispadias associated with?
exstrophy of bladder
What is a common problem with hypospadias and epispadias?
infertility
define phimosis
prepuce orifice that is too small to be retracted normally
What is the problem associated mostly with phimosis?
generally leads to poor hygiene causing bacterial infections
What is a paraphimosis?
foreskin retracted over the glans leading to urethral constriction
What is the treatment for phimosis and paraphimosis?
circumcision
What are the 2 types of penile carcinoma?
Bowen disease; Squamous cell carcinoma
What is the epidemiology of squamous cell carcinoma of the penis?
usually age 40-70;
1% of cancer in men
What is the etiology of squamous cell carcinoma of the penis?
uncircumcised penises increase incidence;
slow growing, non-painful;
patients often delay seeking medical attention
What is closely associated with squamous cell carcinoma of penis?
HPV 16 and 18
What does squamous cell carcinoma of penis look like grossly?
plaque progressing to ulcerated papule or fungating growth
Where does squamous cell carcinoma of penis typically metastasize?
local lymph nodes
What is Bowen disease typically associated with?
carcinoma in situ associated w/ visceral malignancy
When and where does Bowen disease typically present?
Men > 35y/o;
involves shaft of penis and scrotum
What does Bowen disease look like grossly?
thick ulcerated plaque
How does Bowen disease look microscopically?
squamous cell carcinoma in situ
Define Peyronie disease
curved penis due to fibrosis of tunica albuginea
Where and how does the most common cancer in men metastasize?
prostate cancer metastasizes via lymph or hematogenously to bone
Who is at highest risk for developing prostatic cancer?
after age 50 with AA> whites > asians
What will a patient with prostatic cancer typically present with?
urinary problems and/or palpable mass on rectal exam
What are clinical Sx associated with prostatic metastases?
pelvis and lower vertebrae pain associated with osteoblastic metastases
How do labs and Dx tests help with prostatic cancer diagnosis?
elevated PSA and enlarged prostate =>highly suggestive of carcinoma
Why is the 10yr survival rate for prostatic cancer only?
most patients present in advanced disease
What are the prostatic carcinomas Tx?
surgery;
radiation;
hormonal modalities (orchiectomy/androgen block)
Define benign prostatic hyperplasia (BPH)
large nodules in periurethral region (median lobe) of prostate may lead to narrowing of urethral canal
Who and how will patients present with BPH?
men after age 45 with varying degrees of urinary obstruction and difficulty urinating
Acute prostatitis results from what?
bacterial infection of prostate typically from E. coli
How does bacteria cause acute prostatitis?
direct extension from posterior urethra or bladder via the lymph or hematogenously
What is the common cause of chronic prostatitis?
recurrent UTI in men
How may either form of chronic prostatitis present?
bacterial or non-bacterial may be asymptomatic or may present w/ lower back pain and urinary Sx
What is an antiandrogen used specifically for prostate cancer? what is its MOA?
Flutamide => androgen receptor antagonist
MOA of spironolactone?
androgen receptor antagonist but also K+ sparing diuretic
When is spironolatone used?
Hirsuitism;
primary hyperaldosteronism, edema, HTN
What drug is used in its depot form for prostate cancer? and MOA?
Leuprolide => GnRH analog
What drug is used for BPH and male pattern baldness? and MOA?
Finasteride => 5a-reductase inhibitor (prevents conversion of T to DHT
When is ketoconazole used?
androgen receptor positive prostate cancer
What is the MOA for ketoconazole?
inhibits steroid synthesis (also antifungal agent)
