Testis, Prostate, and Urinary Bladder Flashcards
When do the testicles usually descend from the pelvic region?
During the last 2 months of gestation
Is cryptorchidism usually bilateral or unilateral?
Unilateral (only 10% bilateral)
When is a child diagnosed with cryptorchidism?
Age 1 year
What is the most common location for testicular halt in cryptorchidism?
High scrotal (60%)
Cryptorchidism is a risk for what kind of cancer?
Testicular cancer (3-5X)
What is the name of the surgery done to treat cryptorchidism?
Orchiopexy
Why does sterility occur in cryptorchidism?
Testicular atrophy occurs by age 5-6 years and can affect both the descended and/or undescended testicle
What is the cause of cryptorchidism?
Most commonly idiopathic
What other things besides cryptorchidism can cause testicular atrophy?
Ischemia, trauma, irradiation, chemotherapy, increased estrogens
What group of people is at an increased risk for testicular atrophy due to increased estrogen levels?
Alcoholics (also those with Klinefelter’s syndrome)
What is the term for inflammation of the testis?
Orchitis
What is the appearance of ejaculatory fluid in orchitis?
Bloody
Is epididymitis most commonly unilateral or bilateral?
Unilateral
Inflammation of the testis or epididymis commonly begins as what condition?
STIs
What kinds of specific infections can lead to inflammation of the male genitalia?
Mumps virus (20%), tuberculosis
What is the concern of orchitis development in adults with a mumps infection?
Tissue necrosis leading to sterility
How does testicular torsion cause engorgement and acute pain?
Spermatic cord twisting blocks venous drainage
Testicular torsion must be untwisted within what time span to prevent infarction?
6 hours
What is the most common age range for testicular torsion?
12-18 years
What kind of deformity is usually the reason for testicular torsion development?
“Bell-clapper deformity” (increased mobility of the spermatic cord)
Is neonatal testicular torsion associated with “bell-clapper deformity”?
No anatomical defect present
What fraction of testicular torsion cases spontaneously resolve?
1/3
What is the term for the enlargement of the pampiniform venous plexus in the scrotum?
Varicocele
What is the most common age for testicular neoplasia?
15-34 years
What is the most common cancer of males aged 15-34 years old?
Testicular cancer
What is the prevalence of testicular cancer?
6 per 100,000
What are risk factors for testicular neoplasia?
Cryptorchidism, familial history, Caucasians, cancer in the contralateral testicle, gonadal dysgenesis or androgen insensitivity
What is the term for the benign form of a testicular tumor?
Sex cord-stromal tumors
What is the term for malignant testicular tumors?
Germ cell tumors
Sex cord-stromal tumors arise from what cells?
Sertoli (nurse) and Leydig (testosterone) cells
From what do germ cell tumors of the testicular arise from?
Intratublar germ cell neoplasia (in situ)
What is cryptorchidism?
Failure of the testicle to descend
What type of testicular tumor makes up 95% of postpubertal testicular tumors?
Germ cell tumors (GCTs)
What are the two types of germ cell tumors (testicles)?
Seminomas and nonseminomatous GCTs
What is the age range for seminomas?
40-50 (slightly older)
What unique elevated blood marker is seen in those with a seminoma?
hCG (10%)
What are the names of some nonseminomatous germ cell tumors?
Embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, mixed tumor
What type of nonseminomatous germ cell tumor is seen at a young age of about 3 years?
Yolk sac tumor
Which types of nonseminomatous germ cell tumors do not present with an elevated blood marker?
Embryonal carcinoma and teratoma
In which type of nonseminomatous germ cell tumor do we see an elevated blood marker level of AFP?
Yolk sac tumor (90%)
100% of patients with what form of nonseminomatous germ cell tumor will have elevated hCG blood levels?
Choriocarcinoma
What is the age range for a teratoma?
All ages
Seminomas make up what percent of germ cell tumors?
50%
Describe the lesion associated with seminomas.
Soft, well-demarcated, gray-white
What cellular appearance of a seminoma is indicative of a favorable prognosis?
More organized, large round cells with distinct borders
Which tumor is usually larger: yolk sac tumor or choriocarcinoma?
Yolk sac tumor (choriocarcinoma is usually a small mass)
What type of tumor is made of all 3 germ cell layers?
Teratoma
Which are more aggressive: seminomas or nonseminomatous germ cell tumors?
Nonseminomatous germ cell tumors
Radiation therapy is more effective for what type of cancer: seminomas or nonseminomatous germ cell tumors?
Seminomas (hence the more favorable prognosis)
Which tend to be less likely to be palpable: seminomas or nonseminomatous germ cell tumors?
Nonseminomatous germ cell tumors
Where is the likely location of metastasis of nonseminomatous GCTs?
Liver and lungs (both lymphatic and hematogenous)
Are the tumors of testicular cancer usually painful or painless?
Painless
What is the treatment for assumed malignancy of a testicular tumor?
Radical orchiectomy
What kind of pain can be felt in the groin and abdomen with a testicular tumor?
Dull ache (referred pain)
What tissues make up the prostate gland?
Glandular, fibrous, and smooth muscle
What structure does the transitional zone of the prostate surround?
Urethra
What zone of the prostate is more susceptible to carcinomas?
Peripheral zone
Which zone of the prostate is more susceptible to hyperplasia (BPH)?
Transitional zone
Which more common: bacterial prostatitis or chronic nonbacterial prostatitis?
Chronic nonbacterial (90-95%)
Those with recurrent UTIs are more at risk for what kind of prostatitis?
Chronic bacterial
What are some symptoms of chronic bacterial prostatitis?
Low back pain, pelvic pain, dysuria, bacteremia
What are other names for chronic nonbacterial prostatitis?
Chronic pelvic pain syndrome or prostatodynia
When asymptomatic, what incidental finding can be seen with those with prostatitis?
Leukocytes in prostatic secretions
Does benign prostatic hyperplasia involve hypertrophy?
NO NO NO
The hyperplasia involved with benign prostatic hyperplasia is dependent upon what substance?
Dihydrotestosterone (androgen)
What is the usual age of onset for BPH?
Over the age of 40 (90% of male over 70 will develop it)
What is the characteristic symptom of BPH?
Difficulty starting and maintaining stream of urine
What is the treatment for BPH?
TURP (transurethral resection of the prostate), smooth muscle relaxants
What are the side effects of TURP used to treat BPH?
Urinary incontinence, erectile dysfunction
What is the number one most common cancer in men?
Carcinoma of the prostate
Is prostate cancer the number one cancer causing death in males?
No, lung cancer
Is prostate cancer more commonly aggressive or indolent?
Indolent (“lazy”, non-aggressive)
About 100% of prostate cancer involves what kind of tumor?
Adenocarcinoma
70-80% of prostate carcinomas are found in what zone of the prostate?
Peripheral zone
What is the most common age range for prostate cancer?
65-75 years (but risk starts over 50)
What race is more at risk for developing prostate cancer?
African descent
What elevated protein enzyme is seen with prostate cancer?
Prostate specific antigen (PSA)
What are risk factors for prostate cancer?
Mutation, increased androgens, African descent, over the age of 50
Is the PSA level specific to cancer?
No; elevated in all prostate conditions, therefore a biopsy is needed
Does prostate cancer require dedicated management?
No because of its indolent nature
What are some adverse effects seen following treatment for prostate cancer?
Erectile dysfunction, incontinence
What is the most common location of osteoblastic metastasis of prostate cancer?
Axial skeleton
What kinds of things can artificially elevate PSA levels and bring in a false positive test for prostate cancer?
BPH, prostatitis, recent ejaculation
What is the number one most common cause of elevated PSA levels?
BPH (already such a common condition, especially compared to cancer)
Ivory vertebra is seen among what conditions?
Prostate cancer, Paget’s disease, and lymphoma
What is the treatment for prostate cancer?
Prostatectomy, radiation therapy, anti-androgen therapy (orchiectomy)
What condition is present with an excessive accumulation of urine in the kidney due to the obstruction of where they kidney meets the ureter?
Hydronephrosis
What population is usually affected by hydronephrosis?
Male infants and young children
What kind of pain is associated with a kidney stone?
Severe, intermittent flank pain
What is the clinical term for a kidney stone?
Renal calculus
How long does it take a renal calculus to pass?
Within 4 weeks
What is the treatment for kidney stones?
Lithotripsy
What is the gender bias for the development of renal canaliculi?
Males
What is the term for urinary bladder inflammation?
Cystitis
What would be a common cause of diverticula in the urinary bladder in males?
BPH
What is the most common size of urinary bladder diverticula and are they usually symptomatic or asymptomatic?
Small and asymptomatic
What is the most common type of urinary bladder cancer?
Urothelial carcinoma (90%)
What kind of infection is associated with a squamous cell carcinoma of the urinary bladder making up 3-7% of all cases?
Schistosoma infection (Egypt)
What are the risk factors for the development of urinary bladder cancer?
1 male 2 urban environments 3 age 50-80 4 chronic bladder irritation 5 smoking 6 occupational carcinogens
Is urinary bladder cancer hereditary?
NO (TP53 mutation)
What is the hallmark feature of bladder cancer?
Painless hematuria
