Reproductive system disorders

Question 1

What is benign prostatic hyperplasia?

Answer 1

Prostate gland enlargement. The prostate grows and compresses on the urethra (which passes through the prostate) causing urinary symptoms.

Question 2

What causes Benign Prostatic Hyperplasia?

Answer 2

It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.

Question 3

What are the risk factors for Benign Prostatic Hyperplasia?

Answer 3

Aging- Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.

Family history - Having a blood relative, such as a father or a brother, with prostate problems means you’re more likely to have problems.

Diabetes and heart disease - Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.
Lifestyle - Obesity increases the risk of BPH, while exercise can lower your risk.

Question 4

What are the symptoms of Benign Prostatic Hyperplasia?

Answer 4

Frequent or urgent need to urinate
Increased frequency of urination at night (nocturia)
Difficulty starting urination
Weak urine stream or a stream that stops and starts
Dribbling at the end of urination
Inability to completely empty the bladder

Less common signs and symptoms include:
Urinary tract infection
Inability to urinate
Blood in the urine

Question 5

What are the possible complications of Benign Prostatic Hyperplasia?

Answer 5

Acute urinary retention - May require catheterisation or surgery

UTIs -Inability to fully empty the bladder can increase the risk of infection, recurrent UTIs with BPH may require surgery to have part of the prostate removed

Bladder stones - These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.

Bladder damage - A bladder that hasn’t emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder.

Kidney damage - Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

Most men with an enlarged prostate don’t develop these complications. However, acute urinary retention and kidney damage can be serious health threats.

Question 6

Why might patients with Benign Prostatic Hyperplasia be encouraged to limit caffeine and alcohol?

Answer 6

They can increase urine production, irritate the bladder and worsen symptoms.

Question 7

Why might patients with Benign Prostatic Hyperplasia be encouraged to limit decongestants or antihistamines?

Answer 7

These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.

Question 8

What are the main treatments for Benign Prostatic Hyperplasia?

Answer 8

Medication
- Alpha blockers e.g. Tamsulosin
- H-alpha reductase inhibitors e.g. Finasteride

Surgery
Catheterisation
Symptom control
-Lifestyle changes
-Techniques for urination

Question 9

How do alpha blockers treat BPH?

Answer 9

These medications relax the muscle of the prostate and bladder neck, which allows urine to flow more easily

Question 10

What are 5-ARIs and how do they treat benign prostatic hyperplasia?

Answer 10

5-Alpha Reductase Inhibitors

Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase. Thus, 5-alpha reductase inhibitors (5-ARIs) effectively reduce the serum and intraprostatic concentration of DHT, causing an involution of prostate tissue.

Question 11

What is chlamydia?

Answer 11

Chlamydia trachomatis bacterial infection

Question 12

What are the symptoms and complications of chlamydia?

Answer 12

Often has few and/or mild symptoms:

-Painful urination
-Vaginal discharge
-Discharge from the penis
-Painful sexual intercourse in women
-Vaginal bleeding between periods and after sex
-Testicular pain
-Conjuntivitis/pneumonia in neonates

Complications include:
In women
-Pelvic Inflammatory Disease
-Risk of transmission to baby if pregnant
In men:
-Can affect fertility.
-Epididymitis
-Reactive arthritis (SARA - sexually acquired reactive
arthritis) joints/eyes or urethra become inflamed, usually within the first few weeks after having chlamydia (can affect women but more common in men)

Question 13

What is gonorrhea?

Answer 13

A bacterial infection that can infect the cervix, urethra, rectum, throat and eyes.

Question 14

What are the symptoms of gonorrhea?

Answer 14

Dysuria and discharge (thick, greenish/yellow/cream). Intermenstrual bleeding.
Pelvic inflammatory disease and infertility in women
Prostatitis and epididymitis in men.
Both sexes may develop reactive arthritis.
Neonates may have conjunctivitis.

Women are often asymptomatic

Question 15

What are the complications of gonorrhea?

Answer 15

Verticle transmission from mother to baby, neonate may develop permanent blindness if untreated.

Miscarriage and premature labour in women.

Infertility in men and women.

Question 16

What is syphilis?

Answer 16

Bacterial infection

Characterised by three stages:
Primary: Chancre and immune response
Secondary: Rash. General infection signs
Latent stage: Usually asymptomatic. Rash may reoccur. Serological evidence remains.
Some have a tertiary stage – damage to organs from ‘Gummas’. (Less common now due to treatment)

Can cause miscarriage in pregnancy or malformations to the baby

Question 17

What causes genital warts?

Answer 17

HPV virus

Question 18

What is endometriosis?

Answer 18

The growth of endometrial tissue in sites other than the uterine cavity causing inflammation, pain and the formation of adhesions.

Question 19

How many women in the UK have endometriosis?

Answer 19

1.5-2 million

Question 20

What are the symptoms of endometriosis?

Answer 20

Severe pain
Excessive PV bleeding
Bladder and bowel complaints
General unwell symptoms
Pain during sexual intercourse

Can cause infertility

Question 21

What is the treatment for endometriosis?

Answer 21

Analgesia
Hormone treatment to slow growth of tissue
Fertility treatment
Surgery

Question 22

What is Pelvic Inflammatory Disease (PID)?

Answer 22

Bacterial infection affecting the mucosa of the upper female reproductive system including the uterus, fallopian tubes and ovaries. Can cause scar tissue and abscesses to develop in the reproductive tract, which can cause permanent damage.

Question 23

Where do infections causing PID come from? How do they cause PID?

Answer 23

Usually the vagina and cervix.

The mucus that protect the cervix from bacteria can become thinner during normal menstural cahnges or in the case of bacteria vaginosis the normal flaura of the vagina are altered to an extent that anaerobic bacteria proliferate and degrade the mucus.

Question 24

What are the symptoms of Pelvic Inflammatory Disease (PID)?

Answer 24

The signs and symptoms of pelvic inflammatory disease might be mild and difficult to recognize. Some women don’t have any signs or symptoms. When signs and symptoms of pelvic inflammatory disease (PID) are present, they most often include:

Pain — ranging from mild to severe — in the lower abdomen and pelvis

Unusual or heavy vaginal discharge that may have an unpleasant odor

Unusual bleeding from the vagina, especially during or after sex, or between periods

Pain during sex

Fever, sometimes with chills

Painful, frequent or difficult urination

Question 25

What are the two main complications of fallopian tubes?

Answer 25

Tubo-ovarian absecess
- Life-threatening if ruptured

Hydrosalpinx (watery fluid build-up)

Question 26

What is testicular tortion?

Answer 26

When the testicle rotates which twists the spermatic cord (vessel which supplies blood to the scrotum).
This compresses the vessels and ischemia develops. This causes pain and swelling of the scrotum.

Question 27

What are the symptoms of testicular tortion?

Answer 27

Sudden, severe pain in the scrotum
Swelling of the scrotum
Abdominal pain
Nausea and vomiting
A testicle that’s positioned higher than normal or at an unusual angle
Frequent urination
Fever

Question 28

How soon does testicular tortion need surgery?

Answer 28

The sooner the testicle is untwisted, the greater the chance it can be saved. After six hours from the start of pain, the chances of needing testicle removal are greatly increased. If treatment is delayed more than 12 hours from the start of pain, there is at least a 75 percent chance of needing testicle removal.

Question 29

What are the two types of abortion and for what gestation are they possible?

Answer 29

Medical (pill)
Surgical

Both only done before 24 weeks unless special circumstances such as the safety of the mother or the child being born with a severe disability

Question 30

What does a chemical abortion entail?

Answer 30

2 pills taken 1-2 days apart

The first pill is mifepristone (a drug that blocks a hormone called progesterone that is needed for a pregnancy to continue) which helps the body prepare for the second pill.

The second pill is misoprostol (synthetic prostaglandin off-label uterotonic) which encourages shedding and contraction of the uterus to expel the foetus.

Question 31

How long does a chemical abortion take to happen?

Answer 31

Within 4-6 hours after the 2nd pill the uterus will begin to break down and the pregnancy will be expelled

Question 32

Is a chemical abortion done at home or in hospital?

Answer 32

If under 10 weeks the pill can be taken at home, if over 10 weeks the pill should be taken at a clinic in hospital.

Question 33

What are the possible complications of abortions?

Answer 33

Infection/sepsis (unusual discharge, temperature spikes etc.)
Incomplete removal (more surgeries or doses of uterotonic may be needed)
Pain
Excessive bleeding
Diarrhoea & Vomiting (chemical abortions)
Damage or injury to cervix