UW and FA Flashcards
Leyding cells (endocrine cells) - function
secrete testosterone in the presence of LH
Leyding cells (endocrine cells) vs temperature
testosterone production unaffected by temperature
vasectomy?
remove of ductures deferens (vas deferens) –> birth control
prostate location
types of obstruction in BPH
between pubic symphisis + + anal canal
- static obstriction (androgen-mediated)
- dynamic obstriction (α adrenoreceptor mediated)
Benign prostatic hyperplasia - treatment (and mechanism)
- a1 antagonists (terazosin, tamsulosin) –> relaxation of SMC
- 5α-reductase inhibitors (eg. finasteride
- tadalafil (PDE-5 inhibitor)
Prostatitis - divided to/due to
- acute: bacterial (eg. E.coli)
2. chronic (bacterial or abacterial)
Prostatitis - symptoms / PE
- dysuria
- frequency
- urgency
- low back pain
- warm, tender, enlarged prostate
PSA - in Prostatic adenocarcinoma
increased total with decreased fraction of free
PSA - normal range
- increases in age by BPH
- under 2.5 ng/ml in 40-49
- under 7.5 ng/ml in 70-79
Penile pathology - 4 diseases
- Peyronie disease
- iscemic priapism
- SCC
- penile fracture
Peyronie disease - definition/mechanism
abnormal curvature of penis due to fibrous plaque within tunica albuginea (goes up)
Peyronie disease - symptoms / treatment
- pain
- anxiety
- erectile dysfunction
- surgical repair once curvature stabilizes
Ischemic priapism - definition / etiology
painful sustained erection lasting more than 4 hours
etiology: 1 sickle cell anemia (trapped RBCs in vascular channels)
2. drugs (sildenafil, trazodone, prazosin,methylfainidate, cocaine)
3. cauda equina syndrome
ischemic priapism - management
treat immediately with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia
SCC of penis - epidimiology
more common in Asian Africa, South America
SCC of penis - precursor in situ lesions/and their definition
- Bowen disease –> leukoplakia in penile shaft
- erythroplasia Queyrat –> in situ carcinoma of glans, presents as erythroplakia
- Bowenoid papulosis –> carcinoma in situ of unclear malignant protention, presenting as redish papules
SCC of penis - risk factors
- HPV
2. lack of circumcision
Cryptorchidism - sperm vs testosterone - mechanism
- impaired spermatogenesis: sperm develops best at less than 37. sertoli are Q sensitive
- normal Testosterone levels (Leyding unaffected to Q)
Cryptorchidism - complication / RF
high risk of germ cell tumors
RF: 1. prematurity
2. Hypospandias
Cryptorchidism - endocrine profile
low inhibin B, High FSH and LH
testosterone low in bilateral, normal in unilateral
MCC of scrotal enlargement in adult males
Varicocele
Varicocele - complication
infertility because of high temperature
Varicocele - diagnosis
- standing clinical exam (distention on inspection and bag of worms
- US with Doppler (retrograde flow, dilation of pampiniform, tortuous anechoic tubules)3. does not transilluminate
Varicocele - treatment
gonadal vein ligation (boys _ young men with test atrophy)
2. scrotal support + NSAID (older who do not desire additional childrenfffff
Testicular tumors are divided to (proportions and behavioural)
- germ cell (95%) –> Mostly malignant, children mature teratoma benign
- non-germ cell (5%) –> mostly benign, but lymphoma is aggressive
Testicular non-germ cell tumors - types and aggressiveness
Mostly benign
1. Leydig cells
2 Sertoli cells
3. Testicular lymphoma (aggressive)
Leydig celll tumor - presentation mechanism)
produce androgens or estrogens –> gynecomastia in men. precosious puberty in boys
MC testicular cancer in older men
Testicular lymphoma
Testicular lymphoma - characteristics
- Not 1ry –> arises from metastatic lymphoma to testes
- Aggressive
Testicular germ cell tumors - risk factors
- Cryptorchidism
2. Klinefelter syndrome
Testicular germ cell tumors - characteristics
- can resent as a mixed germ cell tumor
- does not transilluminate
Testicular germ cell tumors - types (mc?)
- Seminoma (MC)
- Yolk sac (endodermal sinus) tumor
- Chroriocarcinoma
- Teratoma
- Embryonal carcinoma
seminoma - clinical characteristic / prognosis / marker
- painless, homogenous testicular enlargment
- excellent –> 1. Radiosensitive 2. late matastasis
- high placental ALP
- mildly elevated HCG
tests - Yolk sac (endodermal sinus) - behavioral / appearance / marker
aggressive malignancy
- yellow mucinous
- Schiller Duval bodies resemble primitive glomeruli
- high AFP is highly characetristic
MC testicular in boys under 3
yolk sac
male teratoma - behaviour
unlkie in females. mature teratoma in adults males may be maligntn. Benign in children
testicular choriocarcinoma - marker
high HCG
testicular cancer that is painful
Embryonal carcinoma
Embryonal carcinoma - markers
if pure (rare) --> high hCG, normal AFP if mixed with other tumors --> high hCG, increased AFP
Scrotal masses?
benign scrotal lesions presents as testicular maasses thatn cen be transilluminated
Scrotal masses - types
- congenital hydrocele
- Acquired hydrocele
- Spermatocele
congenital hydrocele?
Common cause of scrotal swelling in infants due to incomplete obliteration of processus vaginalis
Acquired hydrocele?
scrotal fluid collection usually 2ry to infection, trauma, tumor (if bloody –> hematocele)
Spermatocele?
cyst due to dilated epididymal duct or rete testis –> paratesticular fluctuant nodule
Extragonadal germ cell tumors - location
MIDLINE location:
- adults –> MC retroperitoneum, ediastinum, pineal, suprasellar regions
- young childrens: sacroccygeal teratomas are MC
Paratesticular fluctant nodule
Spermatocele
- Leyding tumor produces
- Yolk sac produces
- choriocarcinoma produces
- seminoma
- estrogens, testosterone
- AFP
- HCG
- placental ALP, mildly HCG
clinical suspicion of testiuclar tumor - next step
U/S
diagnosis of testicular tumor - next
orchiectomy –> then check under the microscope to assess the further treatment
(usually: radiation if local, chemo if widespread)
testicular cancer - treatment - seminoma vs nonseminoma
seminoma: sensitive to chemo and radio
nonseminoma: sensitive to chemo
prostate cancer presents with
- Obstructive symptoms on voiding (similar to BPH)
- palpable lesion on examination
MOST ARE ASYMPTOMATIC
prostate cancer best initial / most accurate test
biopsy for both
prostate cancer - complications of radiation
- like prostatectomy (erectile dysfunction is much less common)
- diarrhea
prostate cancer - hormonal manipulation
Flutaminde, GNRH agonists, ketoconazole, and orchiectomy help control the size and progesion of metastases once they have occurred. They are not like tamoxifen in breast cancer. THEY DO NOT PREVENT RECURRENCES. They shrink the lesions that are already present
prostate cancer - chemotherapy
only if hormonal theray fails
prostate cancer - lumpectomy
never
prostate cancer - US as a screening and other uses
it is not a screening test –> it is used to localize lesions to biopsy after a high PSA
prostate cancer - PSA
controversial:
- No clear mortality benefit
- Not routinely offered
- Normal PSA does not exclude ca
- above age 75, do not do even if asked
- higher the PSA, the greater the risk (volume of cancer)
elevated PSA - NEXT STEP
- palpable mass –> biopsy
- no palpable mass –> transrectal US:
if mass –> biopsy
if no mass –> multiple blind biopsies
absent of achilles reflex in eledery with difficulty to void
may be normal in elderly
Mytonoci dystrophy - levels of hormones
low test
high LH, FSH, GNRH
Common causes of erectile dysfunction
- vascular (smoking, CAD etc)
- neurologic (DM, MS, spinal injury/surgery)
- Psychogenic
- endocrine
- medications
- hypogonasisms
erectile dysfunction due to neurologic causes - clinical manifestation
loss of bulbocavernosus reflex
medications that causes erectile dysfunction
antihypertensives (esp b-lockers and thiazides), SSRIs, anti-androgen
diagnosis of prostatitis - next step
culture of mid-stream urine sample
acute vs chronic prostatitis regarding treatment
acute: TMP-SXM, fluoroquinolones (-6 wks)
chronic: fluoroquinolones
when to suspect prostate abscess? next step
acute prostatitis continues to fave fever despite antibiotics
–> do an CT
metastatic symptoms of testicular cancer
back pain, cough, dyspnea, neck mass
metastiatic symptoms of testicula cancer - back pain?
due to retroperitoneal lymphadenopathy
best initial treatment of BPH
a1-blocker
finasteride takes months to work
treatment of BPH - antimuscarinics?
to treat overeactive bladder
BPH with atypical presentation (under 50 years old) or no response to medications - next step
urodynamic studies
transrectal U/S for prostate cancer as screening
NO –> low sensitivity
do or not PSA for screening
discuss it with the patient
chronic prostatitis / chronic pelvic pain syndrome - symptoms
- pain in pelvis, perineum, genitalia
- irritateive voiding symptoms (urgencym hesitancy)
hematospermia, pain with ejaculation
MORE THAN 3 MONTHS
chronic prostatitis/cronic pelvic pain syndrome - diagnosis
- no or mild prostate teenderness
- sterile urine culture
NORMAL PSA
chronic prostatitis / chronic pelvic pain syndrome - management
- a-blocker
- antibiotics (cipro) esp if history of UTI
- 5a-reductase inh
chronic prostatitis/chrnonic pelvic pain syndrome - = chronic BACTERIAL prostatitis ???
no it is different
epididymitis presentation
irriattative voiding symptoms
scrotal pain, swelling, tenderness, purulent urethral discharge
sildanefil - SE?
- cardiovascular: Hypotenstion (esp with nitrates, a-blockers)
- ocular: blue vision, nonarteritic anterior iscemic optic neuropathy
- genitourinary: priapism
- other: flushing, headache, HEARING LOSS
a new SE of sildanefil
hearing loss
sildanefil is contraindicated with
nitrates
a blockers
CAD patients under metoprolol has erectile dysfunction - nect step
sildanefil (dont stop the b-blocker)
indications for cytoscopy
- gross hematuria with no evidence of glomerular disease or infection
- microscopic hematuria wiht no evidence of glomerular disease or infection but increased risk for malignancy
- recurrent UTIs
- obstructive symptoms with suspicion for stricture, stone
- irritative symptoms without urinary infection
- abnormal bladder imaging or urine cytoogy
BPH vs cancer regarding RF
BPH: older than 50
cancer: older than 40, African american, family history
penile fracture - test?
retrograte urethrogram
urinary Stress incontinence - treatment
- pelvic floor muscle strengthening (Kegel) exercise
- weight loss
- pessaries ( a plastic device inserted into the vagina)
urinary Urgency incontinence - treatment
- pelvic floor muscle strengthening (Kegel) exercise
- bladder training (timed voiding, distraction and relaxation techniques)
- antimuscarinics
Overflow incontinence - treatment
catherterization relieve obstruction (α-blockers for BPH)
Bladder cancer RFs
- smoking (until up to 20 years after cessation)
- occupational exposures
- chronic cystitis
- iatrogenic causes (cyclophosphamide)
- pelvic radiation exposure
cryptorhidism - treatment
irchiopexy before age 1 to avoid complications
- if not descent until 6 months is unlikely to descent
special characteristics of psychogenic erectile dysfunction
- sudden
onset - situational (eg. problem with partner, normal durin masturbation)
- normal nonsexual nocturnal erections
hydrocele - surgery
only after 1 year
varicocelle - translumination?
no
finasteride - SE
low libido, erectile dysfunction
- effectiveness after 6-12 months
age to start offer PSA
40
acute vs chronic prostatitis regarding fever
not in chronic
acute prostatitis with urinary rention –> ….
suprapubic catheterization of the bladder
