Week 4 Flashcards
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
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
Peyronie’s disease
type of fibromatosis
painful contractures of the penis
may cause infirtility
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
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
Varicocele
blockage of spermatic veins
usually left sided bc left renal vein, bag of worms appearance
very common cause of infertility
Hydrocele
accumulation of fluid around testes due to secretion into tunica vaginalis (peritoneum remnant)
common (bike riders)
dx: ultrasound
Tx: remove TV
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
Orchitis
painful inflammation/swelling and frequent infection of testis
mumps (infertility rare, usually unilateral, usually adults)
congenital or acquired syphilis, HIV, acute epididymitis
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
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
Intratubular germ cell neoplasia, unclassified type (IGCNU)
seen in cryptorchidism
share many features with seminoma, may be precursor
has karyotypic abn, structural changes, PLAP+
testicular germ cell tumors
seminoma (most common, 40syo)
mixed
non-seminomatous (20-30syo): embryonal, yolk sac, choriocarcinoma, teratoma
Seminoma
40syo
AFP is normal, bHCG can be elevated, PLAP+
solid nests with fibrous septa, lymphoid infiltrate
Tx: surgery, radiation, carboplatin
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
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
