Week 4 Flashcards by Matt Doers

Malformations of penis

Hypospadias (most common)- opening on ventral surface due to faulty closure of urethral folds
Epispadias (rarer)- opening on dorsal surface due to defect in genital tubercle
Phimosis- orifice of prepuce is too small to retract over head bc scarring from prior infxn

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Inflammatory lesions of penis

Balanitis: glans infxn
Balanopothitis: glans and prepuce
More common in uncircumsized, accumulation of smegma
Candida, pyogenic bacteria, anaerobes

must be distinguished from ammoniacal dermatitis: normal redness seen in diapers

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Peyronie’s disease

type of fibromatosis
painful contractures of the penis
may cause infirtility

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squamous cell carcinoma in situ (CIS) of the penis

Bowen disease: leukoplakia involving shaft and scrotum, over 35yo, HPV16,18 assoc, sometimes precursor to invasive scc
Erythroplasia of Queyrat: erythroplakia of mucosal surface of glans and prepuce, HPV16 assoc, precursor to invasive scc
Bowenoid papulosis: pigmented reddish brown papules on external genetals, HPV16 assoc, NO risk of invasive scc

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Invasive squamous cell carcinoma of penis

most common cancer of penis
40-70yo
usually glans or prepuce
HPV16,18 assoc usually
smoking, no circumcision, CIS are risks
metastasizes to inguinal and iliac nodes

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Varicocele

blockage of spermatic veins
usually left sided bc left renal vein, bag of worms appearance
very common cause of infertility

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Hydrocele

accumulation of fluid around testes due to secretion into tunica vaginalis (peritoneum remnant)
common (bike riders)
dx: ultrasound
Tx: remove TV

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Cryptorchidism

failure of testes to descend into scrotum (usually found in inguinal canal)
increased risk of infertility and germ cell tumors
Tx: orchidopexy (move testes down) doesnt decrease germ cell tumor risk

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Orchitis

painful inflammation/swelling and frequent infection of testis
mumps (infertility rare, usually unilateral, usually adults)
congenital or acquired syphilis, HIV, acute epididymitis

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Epididymitis

less than 35yo: Neisseria gonorrhoeae, chlamydia trachomatis
over 35yo: E coli, pseudomonas aeruginosa
also TB
Sx: scrotal pain, swelling, tenderness, urethral discharge(is sex transmitted)
Prehn’s sign: elevation of scrotum decreases pain

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Torsion of testis

spermatic cord is twisted
predisposing: trauma, cryptorchid, atrophy
sudden onset of testicular pain
elevation of scrotum does NOT decrease pain
Tx: immediate surgery to prevent hemorrhagic infarction

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Intratubular germ cell neoplasia, unclassified type (IGCNU)

seen in cryptorchidism
share many features with seminoma, may be precursor
has karyotypic abn, structural changes, PLAP+

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testicular germ cell tumors

seminoma (most common, 40syo)
mixed
non-seminomatous (20-30syo): embryonal, yolk sac, choriocarcinoma, teratoma

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Seminoma

40syo
AFP is normal, bHCG can be elevated, PLAP+
solid nests with fibrous septa, lymphoid infiltrate
Tx: surgery, radiation, carboplatin

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Non-seminomatous germ cell tumors

chemo, but not radio sensitive
Embryonal ca: AFP is normal, hCG can be elevated, fleshy gray with prominant necrosis, gland-like
Yolk-sac: most common in infants, elevated AFP, white/tan masses with myxoid and cystic change, schiller-duval bodies
Teratoma: young kids, mixed in adults, can be mature or immature(worse)
Choriocarcinoma: bHCG is elevated, metastasizes to brain/lungs, multinucleated syncytioblasts

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Sex-cord stromal tumors

Leydig cell: mostly adults, usually unilateral, usually benign but can be malignant, clear cytoplasm
Sertoli cell: can be malignant, estrogen production by tumor can cause gynecomastia and impotence, closely packed cords

Lymphoma and plasmacytoma in testis

lymphoma is most common tumor over 60yo

usually diffuse large B-cell type

Adenomatoid tumor (epididymis)

always benign

mesothelial origin, circumscribed nodule, spiderweb cytoplasm

Vasitis Nodosa (spermatic cord)

usually after vasectomy, at blind end of vas deferens

resembles invasive adenocarcinoma, but sperm, inflammation, and NO atypia are present

Prostatitis

acute: causes: intraprostate reflux of urine, pathogens (e coli, P aeruginosa, K pneumonia)
chronic: usually abacterial, recurrent acute prostatitis
Sx: fever, lower back, suprapubic pain, painful gland on rectal exam, dysuria, elevated PSA,, elevated WBCs or bacteria in end of urine specimen
granulomatous: due to prior instrumentation, other trauma, or TB, fungal

Chronic Pelvic pain syndrome (CPPS)

a type of chronic nonbacterial prostatitis
prostatitis without UTI or positive cultures
chlamydia, ureaplasma urealyticum, trichomonal vaginalis

Benign prostatis hyperplasia (BPH)

transition zone proliferation of glands and stroma
androgen-dependent process
sx: signs of urinary obstruction, hematuria, PSA mildly elevated
Tx: alpha-blockers to relax smooth muscle, 5a-reductase inhibitors to reduce growth of gland, surgery

High grade prostatic intraepithelial neoplasia (HGPIN)

precursor to invasive cancer, does not on its own increase PSA
large nucleoli

Prostate cancer

almost always in peripheral zone, thus accessable to rectal palpation
graded on gleason scale based on atypia
atypical small acinar proliferation (ASAP): a finding on biopsy indicative of cancer, needs to be followed up
Spread: seminal vesicles, external iliac lymph nodes, low back bones (via batson venous plexus)
5a-reductase inhibitor: dutasteride

Linear model of sexual response

``` desire arousal/excitement plateau orgasm resolution/ refractory period in men ```

Sexual pain disorders

Vaginismus: recurrent or persistent involuntary contraction of perineal muscles when insertion is attempted Dysparenunia: genital pain assoc with intercourse

Treatments for sexual dysfunction

SSRIs: delay orgasm Opioid antagonists and vasodilators: erectile disorders PDE5 inhibitors: erectile dysfunction Behavior therapy

Sexual dysfunction

biological, psych, or interpersonal probs primary: lifelong (rare) secondary: acquired must cause significant distress, and not better explained by another mental disorder Causes: diabetes, adhesions, SSRIs, alcohol, hormonal probs, stress, depressions, etc DO NOT assume anything

Gender identity disorder

significant discomfort caused by disagreement with assigned gender strong persistent cross-gender identification must not be for reasons of advantages of other sex must be persistent discomfort, significant distress must not have another intersex physical condition Tx: treat mood/anxiety, hormonal tx, sexual reassignment surgery

Postpartum mood disorders

blues: normal, peaks at 3-5d, resolves in 2w Depression: onset 2-12w, match sx of major depressive episode, lasts more than 2w, risks: hx, short inter-preg interval, health probs, younger mother

Male vs female devo stuff

Male: SRY gene on Y chrom, has TDF (testicular det factor) (week 6-7) germ cells form spermatogonia Sertoli cells express Sox9 and AMH Leydig cells secrete testosterone (week 8) Female: lack of SRY, so WNT4 expression instead

Mesonephric duct stuff

Males: presence of testosterone- growth and diff of mesonephric ducts supported, makes semenial vessels,, AMH stimulates regression of paramesonephric ducts Females: absence of testosterone- mesonephric ducts atrophy,, absence of AMH- paramesonephric ducts form uterus, oviducts, upper vagina

46XX disorders of sex development (DSD)

excessive fetal androgen= CAH (21-OH def)- most common also excessive maternal androgens, drugs, other congenital anomalies, ovotesticular dsd, XX males via SRY on X-chromosome

46XY DSD

``` mostly idiopathic defect in testicular differentiation, sertoli cell fux, leydig cell fxn defect in androgen taget tissues gonadal dysgenesis CAH ```

Ovotesticular DSD

both ovarian and testicular tissue with normal responsiveness to hormones spectrum from feminine to masculine mostly 46XX, can be xy or mosaic Tx: gonad biopsy as infant, surgical reconstruction and matching

Complete androgen insensitivity (CAIS) | also: Complete testosterone biosynthetic defect

XY testes develop, androgens are produced but body cannot respond wolffian ducts regress, MIS is produced, mullerian ducts do not develop ext genitals are female feminizing puberty without menses Tx: gonadectomy due to ca risk, HRT identify as females

Partial androgen insensitivity (PAIS)

very difficult to assign gender, 46XY normal-high testosterone, normal MIS surgical reconstruction often delayed until puberty very variable, male or female identifications

Congenital adrenal hyperplasia

21-OH deficiency usually XX, ovaries develop no testicular androgens, but excessive adrenal androgens wolffian regress, mullerian develops, no MIS ambiguous ext genitalia feminizing puberty if tx with cortisol